When a prominent British medical journal recently retracted a study linking vaccines and autism, it was a shot heard by parents around the world. The 1998 study set off a sharp decline in immunizations in Europe and launched the anti-vaccine movement in the United States. The opposition to immunization now threatens to jeopardize public health.
After a dozen years of criticism, the journal Lancet acknowledges that the study of only 12 children was poorly designed and that researcher Dr. Andrew Wakefield had financial conflicts. Discrediting his findings should never have taken this long. An entire generation is growing up with gaps in basic immunizations. Measles and mumps - two serious illnesses largely prevented by the alleged culprit MMR vaccine - are making a comeback in developed countries.
Nassau County has recently recorded three cases of measles, still a deadly disease in many parts of the world but declared eliminated in the United States in 2000. Nassau babies caught it after traveling to Ireland and Israel.
In Rockland County, a northern suburb, public health officials are battling a mumps outbreak infecting more than 1,521 people since last August. Also, 215 students at an unidentified Woodmere school are being monitored after being exposed to the virus, which can cause hearing loss or male infertility.
Public health officials are anxious to shore up what they call herd immunity - the safety net that protects whole communities because most inhabitants are vaccinated. Herd immunity is generally strong in New York, meaning that in places like Suffolk and Nassau counties, at least 90 percent of children are inoculated against childhood diseases. But even a small decline - it's 85 percent in Rockland County - can allow a forgotten disease to resurface.
Parents enrolling children in day care, summer camp or school know the operators require full immunization records. But increasingly in New York, parents are seeking religious exemptions. Exemptions climbed to 3,615 in 2008, from 1,542 in 1999.
Families worried by the infectious disease outbreaks can return to their pediatrician for make-up shots. But parents' faith in the medical community has been badly shaken. Beyond the now disputed MMR-autism link, parents' fears extend to all inoculations. Pertussis, or whooping cough, is also in resurgence, with 453 cases reported in 2008 in New York. Pertussis can lead to violent coughing and rib fracture, pneumonia and seizures, but immunity is given as part of the DtAP shot.
In many ways, U.S. public health officials must look to themselves if many parents - and dissident physicians - distrust them. In 1999, the Centers for Disease Control and Prevention, concerned about cumulative mercury exposures in young children, asked manufacturers to phase out the use of thimerosal, a preservative that contains an ethyl-mercury. Mercury has been implicated in neurological damage. The CDC never said it was concerned about a mercury-autism link - but it didn't say otherwise, either. The CDC's silence led to suspicion that the agency was covering for "big pharma."
Also, the CDC and the Food and Drug Administration maintain an immunization injury database, the Vaccine Adverse Event Reporting System, but deny full access to independent researchers. The CDC and the FDA should open the database to more scrutiny.
Health officials need to stop asking the public to blindly trust them, and simply persuade us with facts. The current public wariness is dangerous in itself. Witness the confusion and angst over the H1N1 vaccine to combat swine flu. Many refused to take the shot or the mist - but what happens now if the swine flu returns full force?
Another step health officials should take is to publicly justify each new immunization added to the roster of recommendations. In the 1970s, the CDC and the American Academy of Pediatrics advised 23 doses of seven vaccines by age 6; today, that has more than doubled to 48 doses of 14 vaccines. Family physicians and parents should have all the information they need to make decisions, including whether the risk from the illness is greater than the risk from the shot.
This country must also muster the resources to find the cause - or causes - of autism. The number of cases has soared - from about 1 child in 2,000 before 1970, to nearly 1 in 150 today. A study published last week correlating autism and maternal age adds to the knowledge base.
Finally, elected officials ought to avoid junk science when making laws. Suffolk County, and subsequently New York State, outlawed vaccines containing thimerosal, based in part on Wakefield's now-discredited findings. These laws don't help public understanding.
Assemb. Marc Alessi (D-Wading River) has submitted a bill making it easier for parents to obtain philosophical exemptions to immunizations. This bill should be placed on hold. Another Alessi idea, for a task force to scrutinize the required number of childhood inoculations, could have merit.
It's not enough for the medical community to say Wakefield was wrong. Health officials must actively rebuild public confidence - now, before an epidemic of previously eradicated infectious diseases proves how eroded confidence has become.hN