Posted by: bridget | 28 November 2007

More Pharmaceutical Fun

A Maryland judge stated that parents who refuse to have their children vaccinated, in accordance with state law, will be sent to jail.  (Zabs has more.)  Here is the list of vaccines required by Maryland law.  Inter alia, the law requires parents to inoculate their one-year-olds against Hepatitis B, which, according to the CDC, is spread,

…when blood from an infected person enters the body of a person who is not infected. For example, HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce transmission), by sharing drugs, needles, or “works” when “shooting” drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth.

Hepatitis B is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, coughing, sneezing or by casual contact.

Sharing needles, frequent unprotected intercourse… you know, stuff that one-year-olds do every day.  The vaccine is effective for up to 23 years, meaning that the protection will only last until age 24; yet, the highest rates of infection  occur after that time period.

I. Historical Rationale 

Public schools required vaccines so that they could perform their educational function without the interruption of epidemic disease.  While vaccination is not directly related to the educational mission of the state, it is an important part of ensuring that it can be carried out, much in the same way that construction work is not a central part of the educational mission but is necessary unless one chooses to educate students out-of-doors.  As such, schools mandated vaccination for highly communicable (i.e. airborne or casual contact), disabling diseases.  If there were to be an outbreak of polio, the school would have to shut down.  Such an occurrence, absent mass vaccination, is both highly probable and destructive to the educational mission of the state. 

The same cannot be said for chicken pox, Hepatitis B, and HPV (the latter previously blogged here), which are either minimally communicable or nominally harmful. 

II. Other considerations

Aside from radical departure from the historical justification for mass vaccination of children, the new mandates are problematic for several other reasons: cost, potential harm of the vaccines, and intrusion into parental and family rights.

The Washington Post announced today that Tamiflu, which entered the market in 1999, may cause psychiatric disorders (here).  Arguably, there is a link between the MMR vaccine and autism (note, however, that thimerosal has not been used in vaccines since 2001).  Likewise, some people theorise that the rise in peanut allergies is caused by vaccines: when the immune system does not fight off normal infections, it attacks benign objects.  (Ironically enough, researchers are working on a vaccine for those allergies.)  Finally, Traci B mentions a connection between certain vaccines and Alzheimer’s.  It is not irrational for parents to want to limit their child’s exposure to vaccines to those which are absolutely necessary for good health.

Fourteen years ago, the New York Times delineated the cost-benefit analysis of childhood vaccines. More recently, Medscape noted that the cost to vaccinate children doubled between 1999 and 2002; a paper presented at the the 38th Annual Immunisation Conference in 2004 stated that the 25th, 50th, and 75th percentiles of out-of-pocket costs for childhood vaccines are $70, $170, and $275. (This does not include costs absorbed by the insurer.)  Even the NY Times got in on the fun and announced that the cost of all recommended vaccines exceeds $1,600 over the first 18  years of life.  (Even subsidised or national health care systems do not eliminate the cost; they merely shift about the origins of the payment.)

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Responses

  1. What a horrible and dangerous precedent. Think of all the things that could sneak under that umbrella. And of course imagine how the pharmaceuticals could donate big $$ to get the politicians to put there drugs in the queue.

    Ugh!

  2. Neil,

    The pharmaceutical companies are already donating money – I know that Merck lobbied hard for states to make its HPV vaccine mandatory.

    I agree – there is little more horrible than jailing parents for making reasonable decisions that are well within their capacity as parents. I should have addressed that issue more.

  3. What about the religious freedom of Christian Science parents? When I was in public school there were always waivers for such families.

    A point about Hep B, I thought it was transmissible via contact with urine and feces. If so, I can see that it may very well have practical value, even for children. This begs the question, of course, as to what values we place on religious liberty, parental control, and public health.

  4. Sarah,

    I had not looked up the religious freedom angle; there are some bloggers who have covered the parental rights and religion issue (better than I ever could).

    I quoted the CDC for transmission methods; considering that they advocate it for children, I think their view on its transmission is important. (My point, I guess, is that they aren’t being terribly consistent; if Hep B doesn’t spread via urine and feces, why recommend it for kids?)

    This begs the question, of course, as to what values we place on religious liberty, parental control, and public health.

    Very good point. I will, however, add “private health” to that – the idea that what is good for the public is not always good for the individual.

  5. I have often wondered why many, probably most, people who are elected or appointed to public office seem to lose whatever common sense they may have had.

    Thieves and violent criminals often get off easier than these parents who are just tring to do what they believe is the right thing.

    Just a little over a year ago they would have let the parents kill the child.

  6. SST,

    Great points.

    Why don’t you blog? :)

  7. As a husband of a school teacher, I tend to look at some of this a little differently. Yes, the HPV vaciine was a bad push by the Pharm’s and libs. But Hepatitis is not just a sexually transmitted diesease.

    My wife has had to deal with all types of illnesses, including sickle cell anemia.

    One is probably too young to require vaccination.

  8. Excellent article!

  9. Randy,

    Very true, but the question is – how do little kids get Hepatitis in the first place?

    I mean, it seems really cruel to not vaccinate children, but the question is whether or not the state is the proper entity to mandate it, and, if so, what enforcement mechanisms they can/should use.

  10. Thanks, TT.

  11. Couple of years late here, but when my little one was two days away from being born, I ran across an article about how they are vaccinated for Hep B within hours of birth… which set off a mad search across the internet for more information about this.

    The fact that they would give a shot for an adult disease to an infant whose immune system is still in the very early states of development horrified me. Yes, it’s a good idea if the mother is known to be infected, but my wife had tested negative twice within the past year (we did in-vitro, and the tests are standard procedure). That they (the hospitals) give this shot to every baby – usually without even asking the parents – is unconscionable.

    Since then we have been thoroughly studying the over-vaccination of our children, and went out of our way to find a doctor that was sympathetic to our desire not to inoculate our child against every disease under the sun. Hep B (an adult disease), rotavirus (which everyone has had before the age of 5 and is largely harmless), Hib (extremely rare in first world countries), even chicken pox for crying out loud. Even polio – though a devastating disease – hasn’t seen a case in the US in over two decades. Yeah, I get the whole “what’s best for the public at large” angle, but honestly, I’m far more concerned with making the best decision for the my child first and foremost.


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