Vaccine controversy 1742315 226007053 2008-07-16T12:25:06Z AdultSwim 885146 Fixed the reference <ref name=Halvorsen/> restoring the missing content using version 224316638 [[Image:The cow pock.jpg|thumb|300px|[[James Gillray]], ''The Cow-Pock—or—the Wonderful Effects of the New Inoculation!'' (1802)]] A '''vaccine controversy''' is a dispute over the morality, ethics, effectiveness, or safety of [[vaccination]]. Medical opinion is that the benefits of preventing suffering and death from [[infectious disease]]s greatly outweigh the risks of [[adverse effect]]s following [[immunization]].<ref name=BH/><ref name=Cochrane/> Since the inception of vaccination in the late 18th century, opponents have argued that vaccines do not work, that they are or may be dangerous, that individuals should rely on personal hygiene instead, or that mandatory vaccinations violate individual rights or religious principles.<ref name=wolfesharp/> ==Effectiveness== [[Image:Rubella-us-1966-93-cdc.gif|thumb|left|Rubella fell sharply when immunization was introduced. CDC]] Mass vaccination campaigns were essential components of strategies that led to the eradication of [[smallpox]], which once killed as many as every seventh child in [[Europe]],<ref name="Fenner">{{cite book |author= Fenner F, Henderson DA, Arita I, Ježek Z, Ladnyi, ID |url=http://whqlibdoc.who.int/smallpox/9241561106.pdf |accessdate=2007-09-04 |format=PDF |title= Smallpox and its Eradication |publisher= World Health Organization |location= Geneva |year=1988 |isbn=92-4-156110-6}}</ref> and the [[eradication of polio|near-eradication of polio]].<ref>{{cite journal |journal= Curr Top Microbiol Immunol |year=2006 |volume=304 |pages=195–220 |title= Mass vaccination campaigns for polio eradication: an essential strategy for success |author= Sutter RW, Maher C |pmid=16989271 |doi= 10.1007/3-540-36583-4_11}}</ref> As a more modest example, incidence of invasive disease with ''[[Haemophilus influenzae]]'', a major cause of [[bacterial meningitis]] and other serious disease in children, has decreased by over 99% in the U.S. since the introduction of a vaccine in 1988.<ref>{{cite journal |author= Centers for Disease Control and Prevention (CDC) |title=Progress toward elimination of ''Haemophilus influenzae'' type b invasive disease among infants and children—United States, 1998–2000 |journal=MMWR Morb Mortal Wkly Rep |volume=51 |issue=11 |pages=234–7 |year=2002 |pmid=11925021 |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5111a4.htm}}</ref> Fully vaccinating all U.S. children born in a given year from birth to adolescence saves an estimated 33,000 lives and prevents an estimated 14 million infections.<ref>{{cite news |author= Park A |url=http://www.time.com/time/health/article/0,8599,1808438-1,00.html |title= How safe are vaccines? |work= [[Time (magazine)|TIME]] |date=2008-05-21}}</ref> Some vaccine critics claim that there have never been any benefits to [[public health]] from vaccination.<ref>Dr. med. Gerhard Buchwald (Ref: The Vaccination Nonsense. ISBN 3-8334-2508-3 page 108. Asserts that vaccination has never provided any benefit.</ref><ref name="eLetters: Vaccination">{{cite web | author=Morrell, Peter| publisher=Canadian Medical Association Journal |title=eLetters: Vaccination: the wider picture? |url=http://epe.lac-bac.gc.ca/100/201/300/cdn_medical_association/cmaj/vol-163/issue-7/10-13.htm |date=[[October 13]], [[2000]] | accessdate=2007-11-23}}</ref> They argue that all the reduction of [[Infectious disease|communicable diseases]] which were rampant in conditions where overcrowding, poor [[sanitation]], almost non-existent [[hygiene]] and a yearly period of very restricted diet existed, are reduced because of changes in conditions excepting vaccination.<ref name="eLetters: Vaccination"/> Other critics argue that immunity given by vaccines is only temporary and requires boosters, whereas those who survive the disease become permanently immune.<ref name=wolfesharp/> As discussed below, the philosophies of some [[#Alternative medicine|alternative medicine]] practitioners are incompatible with the idea that vaccines are effective.<ref name=Ernst/> Children who survive diseases like [[diphtheria]] develop a natural immunity that lasts longer than immunity developed via vaccination. Even though the overall mortality rate is much lower with vaccination, the percentage of adults protected against the disease may also be lower.<ref>{{cite journal |author= Galazka AM, Robertson SE |title= Diphtheria: changing patterns in the developing world and the industrialized world |journal=Eur J Epidemiol |volume=11 |issue=1 |pages=107–17 |year=1995 |pmid=7489768 |doi= 10.1007/BF01719955}}</ref> Vaccination critics argue that for diseases like diphtheria the extra risk to older or weaker adults may outweigh the benefit of lowering the mortality rate among the general population.<ref name=Halvorsen>{{cite book |author= Halvorsen R |title= The Truth about Vaccines |publisher= Gibson Square |date=2007 |isbn=9781903933923}}</ref> ===Population health=== Lack of complete vaccine coverage increases the risk of disease for the entire population, including those who have been vaccinated. One study found that doubling the number of unvaccinated individuals would increase the risk of measles in ''vaccinated'' children anywhere from 5&ndash;30%.<ref>{{cite journal |author=Salmon DA, Haber M, Gangarosa EJ, Phillips L, Smith NJ, Chen RT |title=Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles |journal=JAMA |volume=282 |issue=1 |pages=47–53 |year=1999 |pmid=10404911 |doi=}}</ref> A second study provided evidence that the risk of [[measles]] and [[pertussis]] increased in vaccinated children proportionally to the number of unvaccinated individuals among them, again highlighting the evident efficacy of widespread vaccine coverage for public health.<ref>{{cite journal |author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE |title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization |journal=JAMA |volume=284 |issue=24 |pages=3145–50 |year=2000 |pmid=11135778 |doi=}}</ref> ===Cost-effectiveness=== Vaccines are a cost-effective and preventive way of promoting health, compared to the treatment of acute or chronic disease. In the U.S. during the year 2001, routine childhood immunizations against seven diseases were estimated to save over $40 billion per birth-year cohort in overall social costs including $10 billion in direct [[health costs]], and the societal benefit-cost ratio for these vaccinations was estimated to be 16.5.<ref>{{cite journal |author=Zhou F, Santoli J, Messonnier ML ''et al.'' |title=Economic evaluation of the 7-vaccine routine childhood immunization schedule in the United States, 2001 |journal=Arch Pediatr Adolesc Med |volume=159 |issue=12 |pages=1136–44 |year=2005 |pmid=16330737 |url=http://archpedi.ama-assn.org/cgi/content/full/159/12/1136 |doi=10.1001/archpedi.159.12.1136}}</ref> ===Events following reductions in vaccination=== In several countries, reductions in the use of some vaccines were followed by increases in the diseases' morbidity and mortality.<ref name=Gangarosa_pertussis /><ref name=Allen_herd /> According to the [[Centers for Disease Control and Prevention]], continued high levels of vaccine coverage are necessary to prevent resurgence of diseases which have been nearly eliminated.<ref name='CDC_stop'> {{cite web|url=http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm |title=What would happen if we stopped vaccinations? |accessdate=2008-04-25 |date=2007-06-12 |publisher=[[Centers for Disease Control and Prevention]] }}</ref> ;Stockholm, smallpox (1873–74) An anti-vaccination campaign motivated by religious objections, by concerns about effectiveness, and by concerns about individual rights, led to the vaccination rate in Stockholm dropping to just over 40%, compared to about 90% elsewhere in Sweden. A major smallpox epidemic then started in 1873. It led to a rise in vaccine uptake and an end of the epidemic.<ref>{{cite journal |journal= Soc Hist Med |date=1992 |volume=5 |issue=3 |pages=369–88 |title= The right to die? Anti-vaccination activity and the 1874 smallpox epidemic in Stockholm |author= Nelson MC, Rogers J |pmid=11645870 |doi= 10.1093/shm/5.3.369}}</ref> ;UK, DPT (1970s–80s) A 1974 report ascribed 36 reactions to [[whooping cough]] (pertussis) vaccine, a prominent public-health academic claimed that the vaccine was only marginally effective and questioned whether its benefits outweigh its risks, and extended television and press coverage caused a scare. Vaccine uptake in the UK decreased from 81% to 31% and pertussis epidemics followed, leading to deaths of some children. Mainstream medical opinion continued to support the effectiveness and safety of the vaccine; public confidence was restored after the publication of a national reassessment of vaccine efficacy. Vaccine uptake then increased to levels above 90% and disease incidence declined dramatically.<ref name=Gangarosa_pertussis>{{cite journal |journal=Lancet |year=1998 |volume=351 |issue=9099 |pages=356–61 |title= Impact of anti-vaccine movements on pertussis control: the untold story |author= Gangarosa EJ, Galazka AM, Wolfe CR ''et al.'' |doi=10.1016/S0140-6736(97)04334-1 |pmid=9652634}}</ref> ;Sweden, pertussis (1979–96) In the vaccination moratorium period that occurred when [[Sweden]] suspended vaccination against whooping cough (pertussis) from 1979 to 1996, 60% of the country's children contracted the potentially fatal disease before the age of ten years; close medical monitoring kept the death rate from whooping cough at about one per year.<ref name=Allen_herd>{{cite journal |author= Allen A |title=Bucking the herd |journal= The Atlantic |date=2002 |volume=290 |issue=2 |pages=40–2 |url=http://immunize.org/exemptions/allen.htm |accessdate=2007-11-07}}</ref> Pertussis continues to be a major health problem in developing countries, where mass vaccination is not practiced; the World Health Organization estimates it caused 294,000 deaths in 2002.<ref>{{cite book |chapter=Pertussis |title= Epidemiology and Prevention of Vaccine-Preventable Diseases |editor= Atkinson W, Hamborsky J, McIntyre L, Wolfe S |author= Centers for Disease Control and Prevention |location= Washington, DC |publisher= Public Health Foundation |date=2007 |chapterurl=http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf}}</ref> ;Netherlands, measles (1999–2000) <!-- I'm uncertain whether religious behaviour is in the same category - this is more like a control experiment (as sometimes demanded by anti-vaccinationists) If we define a-v as actively trying to stop others being vaccinated this group probably fall outside it, and therefore should move to the vaccination article AKM --> An outbreak at a religious community and school in [[The Netherlands]] illustrates the effect of measles in an unvaccinated population.<ref>{{cite journal |title= Measles outbreak—Netherlands, April 1999–January 2000 | url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4914a2.htm | journal= MMWR Morb Mortal Wkly Rep |author= Centers for Disease Control and Prevention |date=2000 | volume=49 | issue=14 | pages=299–303 |pmid=10825086}}</ref> The population in the several provinces affected had a high level of immunization with the exception of [[Vaccination and religion|one of the religious denominations]] who traditionally do not accept vaccination. The three measles-related deaths and 68 hospitalizations that occurred among 2961 cases in the Netherlands demonstrate that measles can be severe and may result in death even in industrialized countries. ;Ireland, measles (2000) As a result of the [[MMR vaccine controversy]] vaccination compliance dropped sharply in the United Kingdom after 1996.<ref name=Pepys>{{cite journal |journal=Clin Med |date=2007 |volume=7 |issue=6 |pages=562–78 |title= Science and serendipity |author= Pepys MB |pmid=18193704}}</ref> From late 1999 until the summer of 2000, there was a measles outbreak in [[North Dublin]], Ireland. At the time, the national immunization level had fallen below 80%, and in part of North Dublin the level was around 60%. There were more than 100 hospital admissions from over 300 cases. Three children died and several more were gravely ill, some requiring mechanical ventilation to recover.<ref name="ireland_measles_2000">{{cite news|title=Measles outbreak feared |date=[[30 May]], [[2000]] |publisher= BBC News |url=http://news.bbc.co.uk/1/hi/health/769381.stm |accessdate=2007-11-23}}</ref><ref name="bbc_measles_outbreak">{{cite journal | author = McBrien J, Murphy J, Gill D, Cronin M, O'Donovan C, Cafferkey M | title = Measles outbreak in Dublin, 2000 | journal = Pediatr Infect Dis J | volume = 22 | issue = 7 | pages = 580–4 | year = 2003 | pmid = 12867830 | doi = 10.1097/00006454-200307000-00002}}</ref> ;Nigeria, polio, measles, diphtheria (2001 onward) In the early 2000s, conservative religious leaders in northern [[Nigeria]], suspicious of [[Western medicine]], advised their followers to not have their children vaccinated with oral polio vaccine. The boycott was endorsed by the governor of [[Kano State]], and immunization was suspended for several months. Subsequently, polio reappeared in a dozen formerly polio-free neighbors of Nigeria, and genetic tests showed the virus was the same one that originated in northern Nigeria: Nigeria had become a net exporter of polio virus to its African neighbors. People in the northern states were also reported to be wary of other vaccinations, and Nigeria reported over 20,000 measles cases and nearly 600 deaths from measles from January through March 2005.<ref name=Clements>{{cite journal |journal= Curr Drug Saf |volume=1 |issue=1 |date=2006 |pages=117–9 |title= How vaccine safety can become political – the example of polio in Nigeria |author= Clements CJ, Greenough P, Schull D |url=http://bentham.org/cds/samples/cds1-1/Clements.pdf |format=PDF |doi= 10.2174/157488606775252575}}</ref> In 2006 Nigeria accounted for over half of all new polio cases worldwide.<ref>{{cite web |title= Wild poliovirus 2000–2008 |date=2008-02-05 |url=http://www.polioeradication.org/content/general/casecount.pdf |format=PDF |publisher= Global Polio Eradication Initiative |accessdate=2008-02-11}}</ref> Outbreaks continued thereafter; for example, at least 200 children died in a late-2007 measles outbreak in [[Borno State]].<ref>{{cite news |title= 'Hundreds' dead in measles outbreak |publisher=IRIN |date=2007-12-14 |url=http://irinnews.org/Report.aspx?ReportId=75883 |accessdate=2008-02-10}}</ref> ;Indiana, measles (2005) A 2005 measles outbreak in [[Indiana]] was due to children whose parents had refused to have them vaccinated.<ref name=parker>{{cite journal |author=Parker A, Staggs W, Dayan G ''et al.'' |title= Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States |journal= N Engl J Med |volume=355 |issue=5 |pages=447–55 |year=2006 |pmid=16885548 |doi= 10.1056/NEJMoa060775}}</ref> Most cases of pediatric [[tetanus]] in the U.S. occur in children whose parents objected to their vaccination.<ref>{{cite journal |author= Fair E, Murphy TV, Golaz A, Wharton M |title= Philosophic objection to vaccination as a risk for tetanus among children younger than 15 years |journal=Pediatrics |volume=109 |issue=1 |pages=e2 |year=2002 |pmid=11773570 |url=http://pediatrics.aappublications.org/cgi/content/full/109/1/e2 |doi= 10.1542/peds.109.1.e2}}</ref> ==Safety== Few deny the vast improvements vaccination has made to public health; a more common concern is their safety.<ref name=LancetID>{{cite journal |journal= Lancet Infect Dis |year=2007 |volume=7 |issue=4 |pages=235 |title= Tackling negative perceptions towards vaccination |author= The Lancet Infectious Diseases |doi=10.1016/S1473-3099(07)70057-9 |pmid=17376373}}</ref> All vaccines may cause side effects, and immunization safety is a real concern. Controversies in this area revolve around the question of whether the risks of adverse events following immunization outweigh the benefits of preventing adverse effects of common diseases.<ref name=BH>{{cite journal |journal= Curr Opin Infect Dis |year=2007 |volume=20 |issue=3 |pages=237–46 |title= Adverse events following immunization: perception and evidence |author= Bonhoeffer J, Heininger U |doi=10.1097/QCO.0b013e32811ebfb0 |pmid=17471032}}</ref> ===Auto-immune disorders=== Common childhood conditions such as fevers and middle ear infections pose a much greater challenge to the immune system than vaccines do. Because of changes in vaccine formulation, the fourteen vaccines given to young U.S. children now contain fewer immunologic components than the single smallpox dose given a century ago.<ref name=Offit/> If individual or multiple vaccinations were to "weaken the immune system", as some vaccine critics contend, then one would expect an increase in hospitalizations for other infections following immunization. A large [[Epidemiology|epidemiological]] study, involving all 805,206 children born in [[Denmark]] between 1990 and 2001, found no evidence that multiple-antigen vaccines, nor the increasing number of vaccinations given to children, led to a higher rate of infections.<ref>{{cite journal |author=Hviid A, Wohlfahrt J, Stellfeld M, Melbye M |title=Childhood vaccination and nontargeted infectious disease hospitalization |journal=JAMA |volume=294 |issue=6 |pages=699–705 |year=2005 |pmid=16091572 |doi=10.1001/jama.294.6.699}}</ref> A 2006 study of health data from the Canadian province of [[Ontario]] (where influenza vaccines have been free since 2000), found a correlation between receiving a vaccination and developing [[Guillain-Barré syndrome]] (GBS) in individuals, but no increase of GBS in the general population corresponding to vaccination popularity. The authors concluded, "individuals who receive the influenza vaccine should be advised of the potential risk for GBS".<ref>{{cite journal |author=Juurlink DN, Stukel TA, Kwong J, ''et al'' |title=Guillain-Barré syndrome after influenza vaccination in adults: a population-based study |journal=Arch. Intern. Med. |volume=166 |issue=20 |pages=2217–21 |year=2006 |pmid=17101939 |doi=10.1001/archinte.166.20.2217}}</ref> ===Aluminum=== [[Aluminum]] compounds are used in many vaccines as [[immunologic adjuvant]]s, to stimulate the immune system and increase the response of the vaccine. Although these vaccines can elicit redness, itching, and low-grade fever,<ref>{{cite journal |journal=Vaccine |date=2002 |volume=20 |issue= Suppl 3 |pages=S18–23 |title= Aluminum salts in vaccines—US perspective |author= Baylor NW, Egan W, Richman P |doi=10.1016/S0264-410X(02)00166-4}} Corrigendum (2002). ''Vaccine'' '''20''' (27–8): 3428. {{DOI|10.1016/S0264-410X(02)00307-9}} PMID 12184360.</ref> and aluminum as such is considered neurotoxic for humans, its use in vaccines has not been associated with serious adverse events.<ref name=Francois/> In some cases aluminum-containing vaccines are associated with macrophagic myofasciitis (MMF), localized microscopic [[lesions]] containing aluminum salts that persist up to 8 years. However, recent case-controlled studies have found no specific clinical symptoms in individuals with biopsies showing MMF, and there is no evidence that aluminum-containing vaccines are a serious health risk or justify changes to immunization practice.<ref name=Francois>{{cite journal |journal= Pediatr Infect Dis J |date=2005 |volume=24 |issue=11 |pages=953–61 |title= Vaccine safety controversies and the future of vaccination programs |author= François G, Duclos P, Margolis H ''et al.'' |pmid=16282928}}</ref> ===Thiomersal=== {{main|Thiomersal controversy}} The [[ethylmercury|organic mercury]] content of thiomersal in child vaccines has been alleged to contribute to [[autism]], and thousands of parents in the United States have pursued legal compensation from a federal fund.<ref name=Sugarman>{{cite journal |journal= N Engl J Med |year=2007 |volume=357 |issue=13 |pages=1275–7 |title= Cases in vaccine court—legal battles over vaccines and autism |author= Sugarman SD |pmid=17898095 |url=http://content.nejm.org/cgi/content/full/357/13/1275 |doi= 10.1056/NEJMp078168}}</ref> In July 1999, the [[Centers for Disease Control]] (CDC) and the [[American Academy of Pediatrics]] (AAP) asked vaccine makers to remove thiomersal from vaccines as quickly as possible, and thiomersal has been phased out of most U.S. and European vaccines.<ref name=Offit>{{cite journal |journal= N Engl J Med |year=2007 |volume=357 |issue=13 |pages=1278–9 |title= Thimerosal and vaccines—a cautionary tale |author= [[Paul Offit|Offit PA]] |doi=10.1056/NEJMp078187 |pmid=17898096 |url=http://content.nejm.org/cgi/content/full/357/13/1278}}</ref> However, the 2004 [[Institute of Medicine]] (IOM) panel favoured rejecting any causal relationship between thiomersal-containing vaccines and autism.<ref>{{cite book |author= Immunization Safety Review Committee |title= Immunization Safety Review: Vaccines and Autism |publisher= The National Academies Press |year=2004 |isbn=0-309-09237-X |url=http://www.nap.edu/catalog/10997.html}}</ref> The CDC and the AAP followed the [[precautionary principle]], which assumes that there is no harm in exercising caution even if it later turns out to be unwarranted, but their 1999 action sparked confusion and controversy that has diverted attention and resources away from efforts to determine the causes of autism.<ref name=Offit/> The current [[Thiomersal_controversy#Scientific_consensus_on_controversy|scientific consensus]] is that there is no convincing scientific evidence that thiomersal causes or helps cause autism.<ref>{{cite journal |journal= Can J Neurol Sci |date=2006 |volume=33 |issue=4 |pages=341–6 |title= Immunizations and autism: a review of the literature |author= Doja A, Roberts W |pmid=17168158}}</ref> ===MMR vaccine=== {{main|MMR vaccine controversy}} In the UK, the MMR vaccine was the subject of controversy after publication of a 1998 paper by [[Andrew Wakefield]], ''et al.'', reporting a study of 12 children mostly with [[autism spectrum disorder]]s with onset soon after administration of the vaccine.<ref>{{cite journal |author= [[Andrew Wakefield|Wakefield A]], Murch S, Anthony A ''et al.'' |title= Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children |journal=Lancet |volume=351 |issue=9103 |pages=637–41 |year=1998 |doi=10.1016/S0140-6736(97)11096-0 |pmid=9500320 |url=http://briandeer.com/mmr/lancet-paper.htm |accessdate=2007-09-05}}</ref> During a 1998 press conference, Wakefield suggested that giving children the vaccines in three separate doses would be safer than a single vaccination. This suggestion was not supported by the paper, and several subsequent peer-reviewed studies have failed to show any association between the vaccine and autism.<ref name=NHS>{{cite web |title= MMR: myths and truths |url=http://www.mmrthefacts.nhs.uk/basics/truths.php |accessdate=2007-09-03 |year=2004 |author=National Health Service}}</ref> Wakefield has been heavily criticized on scientific grounds and for triggering a decline in vaccination rates,<ref>{{cite news |url=http://news.bbc.co.uk/2/hi/health/5118166.stm |publisher= BBC News |title= Doctors issue plea over MMR jab |date=2006-06-26 |accessdate=2007-11-23}}</ref> as well as on ethical grounds for the way the research was conducted.<ref name=paid_children>{{cite news |url=http://news.bbc.co.uk/1/hi/health/6289166.stm |title= MMR scare doctor 'paid children' |publisher= BBC News |date=2007-07-16 |accessdate=2007-11-23}}</ref> In 2004 the MMR-and-autism interpretation of the paper was formally retracted by 10 of Wakefield's 12 co-authors.<ref>{{cite journal |author=Murch SH, Anthony A, Casson DH ''et al.'' |title= Retraction of an interpretation |journal=Lancet |volume=363 |issue=9411 |pages=750 |year=2004 |pmid=15016483 |doi=10.1016/S0140-6736(04)15715-2}}</ref> The CDC,<ref>[http://www.cdc.gov/od/science/iso/concerns/mmr_autism.htm Autism and Vaccines Theory], from the U.S. [[Centers for Disease Control]]. Accessed [[June 13]] [[2007]].</ref> the IOM of the [[United States National Academy of Sciences|National Academy of Sciences]],<ref>[http://www.iom.edu/CMS/3793/4705/20155.aspx Immunization Safety Review: Vaccines and Autism]. From the [[Institute of Medicine]] of the [[United States National Academy of Sciences|National Academy of Sciences]]. Report dated [[May 17]] [[2004]]; accessed [[June 13]] [[2007]].</ref> and the UK [[National Health Service]]<ref>[http://www.mmrthefacts.nhs.uk/ MMR Fact Sheet], from the [[United Kingdom]] [[National Health Service]]. Accessed [[June 13]] [[2007]].</ref> have all concluded that there is no evidence of a link between the MMR vaccine and autism. A systematic review by the [[Cochrane Library]] concluded that there is no credible link between the MMR vaccine and autism, that MMR has prevented diseases that still carry a heavy burden of death and complications, that the lack of confidence in MMR has damaged public health, and that design and reporting of safety outcomes in MMR vaccine studies are largely inadequate.<ref name=Cochrane>{{cite journal |doi=10.1002/14651858.CD004407.pub2 |pmid=16235361 |title= Vaccines for measles, mumps and rubella in children |author=Demicheli V, Jefferson T, Rivetti A, Price D |journal= Cochrane Database Syst Rev |year=2005 |volume=19 |issue=4 |laysummary=http://www.cochrane.org/press/MMR_final.pdf |laydate=2005-10-19 |laysource=Cochrane press release (PDF)}}</ref> ===Prenatal infection=== There is evidence that [[schizophrenia]] is associated with prenatal exposure to [[rubella]], [[influenza]], and [[toxoplasmosis]] infection. For example, one study found a seven-fold increased risk of schizophrenia when mothers were exposed to influenza in the first trimester of gestation. This may have public health implications, as strategies for preventing infection include vaccination, antibiotics, and simple hygiene.<ref>{{cite journal |journal=[[Schizophrenia Bulletin|Schizophr Bull]] |date=2006 |volume=32 |issue=2 |pages=200–2 |title= Prenatal infection as a risk factor for schizophrenia |author= Brown AS |doi=10.1093/schbul/sbj052 |pmid=16469941 |url=http://schizophreniabulletin.oxfordjournals.org/cgi/content/full/32/2/200}}</ref> When weighing the benefits of protecting the woman and fetus from influenza against the potential risk of vaccine-induced antibodies that could conceivably contribute to schizophrenia, influenza vaccination for women of reproductive age still makes sense, but it is not known whether vaccination during pregnancy helps or harms.<ref>{{cite journal |journal= Psychiatr News |date=2007 |volume=42 |issue=3 |pages=22 |title= Schizophrenia risk factor found in maternal blood |author= Arehart-Treichel J |url=http://pn.psychiatryonline.org/cgi/content/full/42/3/22}}</ref> The CDC's [[Advisory Committee on Immunization Practices]], the [[American College of Obstetricians and Gynecologists]], and the [[American Academy of Family Physicians]] all recommend routine flu shots for pregnant women, for several reasons:<ref name=ACIP2007/> *their risk for serious influenza-related medical complications during the last two trimesters; *their greater rates for flu-related hospitalizations compared to nonpregnant women; *the possible transfer of maternal anti-influenza antibodies to children, protecting the children from the flu; and *several studies that found no harm to pregnant women or their children from the vaccinations. Despite this recommendation, only 16% of healthy pregnant U.S. women surveyed in 2005 had been vaccinated against the flu.<ref name=ACIP2007>{{cite journal |journal=MMWR Recomm Rep |date=2007 |volume=56 |issue=RR-6 |pages=1–54 |title= Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007 |author= Fiore AE, Shay DK, Haber P ''et al.'' |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm}}</ref> ==Individual liberty== {{see|Vaccination policy}} Compulsory vaccination policies have provoked opposition at various times from people who say that governments should not infringe on the freedom of an individual to choose medications, even if the choice increases the risk of disease to others.<ref name=wolfesharp/><ref>{{cite journal |journal=Am J Public Health |date=2005 |volume=95 |issue=4 |pages=571–6 |title=Manifold restraints: liberty, public health, and the legacy of ''Jacobson v Massachusetts'' |author= Colgrove J, Bayer R |doi=10.2105/AJPH.2004.055145 |pmid=15798111 |url=http://www.ajph.org/cgi/content/full/95/4/571}}</ref> If a vaccination program successfully reduces the disease threat, it may reduce the perceived risk of disease enough so that an individual's optimal strategy is to refuse vaccination at coverage levels below those optimal for the community.<ref>{{cite journal |journal= Am J Epidemiol |date=1986 |volume=124 |issue=6 |pages=1012–20 |title= Individual versus public priorities in the determination of optimal vaccination policies |author= Fine PE, Clarkson JA |pmid=3096132}}</ref> If many exemptions are granted to mandatory vaccination rules, the resulting [[free rider problem]] may cause loss of [[herd immunity]], substantially increasing risks even to vaccinated individuals.<ref name=May-Silverman>{{cite journal |journal= Hum Vaccin |date=2005 |volume=1 |issue=1 |pages=12–5 |title= Free-riding, fairness and the rights of minority groups in exemption from mandatory childhood vaccination |author= May T, Silverman RD |pmid=17038833 |url=http://landesbioscience.com/journals/vaccines/article/mayHV1-1.pdf |format=PDF}}</ref> ==Religion== {{main|Vaccination and religion}} Vaccination has been opposed on religious grounds ever since it was introduced, even when vaccination is not compulsory. Early Christian opponents argued that if God had decreed that someone should die of smallpox, it would be a sin to thwart God's will via vaccination.<ref name=Early-religious> Early religious opposition: *{{cite book |chapter= Theological opposition to inoculation, vaccination, and the use of anæsthetics |title= A History of the Warfare of Science with Theology in Christendom |author= White AD |location= New York |publisher=Appleton |year=1896 |chapterurl=http://abob.libs.uga.edu/bobk/whitem10.html |accessdate=2007-08-17}} *{{cite journal |journal= Stem Cell Rev |date=2005 |volume=1 |issue=4 |pages=345–76 |title= Ethics in the trenches: a multifaceted analysis of the stem cell debate |author= Noble M |doi=10.1385/SCR:1:4:345 |pmid=17142878}} </ref> Religous opposition continues to the present day, on various grounds, raising ethical difficulties when the number of unvaccinated children threatens harm to the entire population.<ref name=May-Silverman/> Many governments allow parents to opt out of their children's otherwise-mandatory vaccinations for religious reasons; some parents falsely claim religious beliefs to get vaccination exemptions.<ref>{{cite news |url=http://www.usatoday.com/news/nation/2007-10-17-19819928_x.htm |date=2007-10-17 |accessdate=2007-11-24 |author= LeBlanc S |title= Parents use religion to avoid vaccines |work= USA Today}}</ref> ==Alternative medicine== Many forms of [[alternative medicine]] are based on philosophies that oppose vaccination and have practitioners who voice their opposition. These include [[anthroposophy]], some elements of the [[chiropractic]] community, non-medically trained [[homoeopathy|homoeopaths]], and [[naturopathy|naturopaths]].<ref name=Ernst>{{cite journal |journal=Vaccine |date=2001 |volume=20 |issue= Suppl 1 |pages=S89–93 |title= Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination |author= Ernst E |doi=10.1016/S0264-410X(01)00290-0 |pmid=11587822}}</ref> Historically, [[chiropractic]] strongly opposed vaccination based on its belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines; [[Daniel D. Palmer]], the founder of chiropractic, wrote, "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison."<ref name=Busse/> Vaccination remains controversial within chiropractic. The [[American Chiropractic Association]] and the International Chiropractic Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease.<ref name=Campbell>{{cite journal |journal=Pediatrics |date=2000 |volume=105 |issue=4 |pages=e43 |title= Chiropractors and vaccination: a historical perspective |author= Campbell JB, Busse JW, Injeyan HS |pmid=10742364 |url=http://pediatrics.aappublications.org/cgi/content/full/105/4/e43 |doi= 10.1542/peds.105.4.e43}}</ref> The Canadian Chiropractic Association supports vaccination; however, surveys in Canada in 2000 and 2002 found that only 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children.<ref name=Busse>{{cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=5 |pages=367–73 |title= Chiropractic antivaccination arguments |author= Busse JW, Morgan L, Campbell JB |doi=10.1016/j.jmpt.2005.04.011 |pmid=15965414}}</ref> Although most chiropractic writings on vaccination focus on its negative aspects,<ref name=Busse/> antivaccination sentiment is espoused by what appears to be a minority of chiropractors.<ref name=Campbell/> Several surveys have shown that some practitioners of [[homeopathy]], particularly lay homeopaths, advise patients against vaccination.<ref>{{cite journal |author=Schmidt K, Ernst E |title=MMR vaccination advice over the Internet |journal=Vaccine |volume=21 |issue=11-12 |pages=1044–7 |year=2003 |pmid=12559777 |doi=}}</ref> For example, a survey of registered homeopaths in Austria found that only 28% considered immunization to be an important preventive measure, and 83% of homeopaths surveyed in [[Sydney, Australia]] did not recommend vaccination.<ref name=Ernst/> Many practitioners of [[naturopathy]] also oppose vaccination.<ref name=Ernst/> ==Financial motives== For many vaccines, the financial risks for producers are great and market returns are usually minimal.<ref name='market_return'>{{cite web |author= Goodman JL |title= Statement before the Committee on Energy and Commerce, U.S. House of Representatives |date=2005-05-04 |publisher= U.S. Food and Drug Administration Office of Legislation |url=http://www.fda.gov/ola/2005/influenza0504.html |accessdate=2008-06-15}}</ref> Despite this, critics allege that the profit motive explains why vaccination is required, and that vaccine makers cover up or suppress information, or generate misinformation, about safety or effectiveness.<ref name=wolfesharp/> Some vaccine critics allegedly have financial motives for criticizing vaccines.<ref name=paid_children /> Legal council and expert witnesses employed in anti-vaccine cases may be motivated by profit.<ref name=Fitzpatrick07>{{cite news |work=spiked |date=2007-07-04 |title= 'The MMR-autism theory? There's nothing in it' |author= Fitzpatrick M |url=http://spiked-online.com/index.php?/site/article/3562/ |accessdate=2008-01-22}}</ref> ==Dispute resolution== {{Main|Vaccine court}} The U.S. Vaccine Injury Compensation Program (VICP) was created to provide a federal no-fault system for compensating vaccine-related injuries or death. It was established after a scare in the 1980s over the [[DPT vaccine]]: even though claims of side effects were later generally discredited, large jury awards had been given to some claimants of DPT vaccine injuries, and most DPT vaccine makers had ceased production. Claims against vaccine manufacturers must be heard first in the vaccine court.<ref name=Sugarman/> By 2008 the fund had paid out 2,114 awards totaling $1.7 billion.<ref>{{cite web |url=http://www.hrsa.gov/vaccinecompensation/statistics_report.htm |accessdate=2008-01-22 |date=2008-01-08 |title= National Vaccine Injury Compensation Program statistics reports |publisher= Health Resources and Services Administration}}</ref> Thousands of autism-related claims are pending before the court, and have not yet been resolved.<ref name=Sugarman/> ==History== [[Image:Edward Jenner2.jpg|thumb|Edward Jenner]] [[Vaccination and religion|Religious arguments against inoculation]] were advanced even before the work of [[Edward Jenner]]; for example, in a 1772 sermon entitled "The Dangerous and Sinful Practice of Inoculation" the English theologian Rev. Edward Massey argued that diseases are sent by God to punish sin and that any attempt to prevent smallpox via inoculation is a "diabolical operation".<ref name=Early-religious/> Some anti-vaccinationists still base their stance against vaccination with reference to their religious beliefs.<ref>{{cite web | title=Vaccination - A Crime Against Humanity | url=http://www.ajwrb.org/science/vaccinat.shtml | publisher=The Associated Jehovah's Witnesses for Reform on Blood | accessdate=2006-11-02}}</ref> After Jenner's work, vaccination became widespread in the [[United Kingdom]] in the early 1800s.<ref>{{cite journal | author = Ellner P | title = Smallpox: gone but not forgotten | journal = Infection | volume = 26 | issue = 5 | pages = 263–9 | year = 1998 | pmid = 9795781}}</ref> [[Variolation]], which had preceded vaccination, was banned in 1840 because of its greater risks. Public policy and successive [[Vaccination/Vaccination acts|Vaccination Acts]] first encouraged vaccination and then made it mandatory for all infants in 1853, with the highest penalty for refusal being a prison sentence. This was a significant change in the relationship between the British state and its citizens, and there was a public backlash. After an 1867 law extended the requirement to age 14 years, its opponents focused concern on infrigement of individual freedom, and eventually a 1898 law allowed for conscientious objection to compulsory vaccination.<ref name=wolfesharp>{{cite journal |author= Wolfe R, Sharp L |title= Anti-vaccinationists past and present |journal=BMJ |volume=325 |issue=7361 |pages=430–2 |year=2002 |pmid=12193361 |doi=10.1136/bmj.325.7361.430 |url=http://bmj.bmjjournals.com/cgi/content/full/325/7361/430}}</ref> In the 19th century, the city of [[Leicester]] in the UK achieved a high level of isolation of smallpox cases and great reduction in spread compared to other areas. The mainstay of Leicester's approach to conquering smallpox was to decline vaccination and put their public funds into sanitary improvements.<ref>{{cite journal |author=Eddy TP |title=The Leicester anti-vaccination movement |journal=Lancet |volume=340 |issue=8830 |pages=1298 |year=1992 |pmid=1359363 |doi=}}</ref><ref>Fourth and other reports of the Royal Commission into smallpox and Leicester 1871 et seq</ref> Bigg's account of the public health procedures in Leicester, presented as evidence to the Royal Commission, refers to [[erysipelas]], an infection of the superficial tissues which was a complication of any surgical procedure.<!--seems to be more about the history of vaccination? CHL --> In the U.S., President [[Thomas Jefferson]] took a close interest in vaccination, alongside Dr. Waterhouse, chief physician at Boston. Jefferson encouraged the development of ways to transport vaccine material through the Southern states, which included measures to avoid damage by heat, a leading cause of ineffective batches. [[Smallpox]] outbreaks were contained by the latter half of the 19th century, a development widely attributed to vaccination of a large portion of the population.<ref>(U.S.) Center for Disease Control</ref> Vaccination rates fell after this decline in smallpox cases, and the disease again became epidemic in the 1870s (see [[smallpox]]). Anti-vaccination activity increased again in the U.S. in the late 19th century. After a visit to New York in 1879 by [[William Tebb]], a prominent British anti-vaccinationist, the Anti-Vaccination Society of America was founded. The New England Anti-Compulsory Vaccination League was formed in 1882, and the Anti-Vaccination League of New York City in 1885. In the early 19th century, the anti-vaccination movement drew members from across a wide range of society; more recently, it has been reduced to a predominantly middle-class phenomenon.<ref>{{cite journal |journal=J R Soc Med |volume=98 |issue=8 |date=2005 |pages=384–5 |title= The anti-vaccination movement in England, 1853–1907 |author= Fitzpatrick M |doi= 10.1258/jrsm.98.8.384}}</ref> Arguments against vaccines in the 21st century are often similar to those of 19th-century anti-vaccinationists.<ref name=wolfesharp/> ==References== {{reflist|2}} ==Further reading== <div class="references-small"> * {{cite journal | author = Bedford H, Elliman D | title = Concerns about immunisation | journal = BMJ | volume = 320 | issue = 7229 | pages = 240–3 | year = 2000 | month=Jan 22 | pmid = 10642238 | url=http://bmj.bmjjournals.com/cgi/content/full/320/7229/240 | doi = 10.1136/bmj.320.7229.240}} * {{cite journal | author = Davies P, Chapman S, Leask J | title = Antivaccination activists on the world wide web | journal = Arch Dis Child | volume = 87 | issue = 1 | pages = 22–5 | year = 2002 | pmid = 12089115 | url=http://adc.bmjjournals.com/cgi/content/full/87/1/22 | doi = 10.1136/adc.87.1.22}} * {{cite journal | author= Elliman D, Bedford H |url=http://bmj.bmjjournals.com/cgi/content/full/329/7473/1049 |title= MMR: Science and Fiction. Exploring the Vaccine Crisis; MMR and Autism: What Parents Need to Know |journal=BMJ |date=2004 |volume=329 |issue=7473 |pages=1049 |doi=10.1136/bmj.329.7473.1049}} * {{cite web |author= Friedlander E | title= The anti-immunization activists: a pattern of deception |url=http://www.pathguy.com/antiimmu.htm |date=2007 |accessdate=2007-11-13}} * {{cite journal | author = Hanratty B, Holt T, Duffell E, Patterson W, Ramsay M, White J, Jin L, Litton P | title = UK measles outbreak in non-immune anthroposophic communities: the implications for the elimination of measles from Europe | journal = Epidemiol Infect | volume = 125 | issue = 2 | pages = 377–83 | year = 2000 | month=Oct | pmid = 11117961 | doi = 10.1017/S0950268899004525}} * Miller, C.L. ''Deaths from Measles in England and Wales. 1970-83.''], Epidemiological Research Laboratory, Public Health Laboratory Service, London; measles mortality statistics published in the ''British Medical Journal'', Vol 290, [[February 9]], [[1985]] * {{cite journal | author = Orenstein W, Hinman A | title = The immunization system in the United States - the role of school immunization laws | journal = Vaccine | volume = 17 Suppl 3 | issue = | pages = S19–24 | year = 1999 | month=October 29 | pmid = 10559531 | doi = 10.1016/S0264-410X(99)00290-X}} * {{cite journal | author = Poland G, Jacobson R | title = Understanding those who do not understand: a brief review of the anti-vaccine movement | journal = Vaccine | volume = 19 | issue = 17-19 | pages = 2440–5 | year = 2001 | month=Mar 21 | pmid = 11257375 | doi = 10.1016/S0264-410X(00)00469-2}} * {{cite book |author= Sears R |title= The Vaccine Book: Making the Right Decision for Your Child |publisher= Little, Brown |date=2007 |isbn=0316017507}} * {{cite journal | author = Spier R | title = Ethical aspects of vaccines and vaccination | journal = Vaccine | volume = 16 | issue = 19 | pages = 1788–94 | year = 1998 | month=Nov | pmid = 9795382 | doi = 10.1016/S0264-410X(98)00169-8}} * {{cite journal | author = Vermeersch E | title = Individual rights versus societal duties | journal = Vaccine | volume = 17 Suppl 3 | issue = | pages = S14–7 | year = 1999 | month=Oct 29 | pmid = 10627239}} * {{cite journal |author= Wolfe RM, Sharp LK, Lipsky MS |title= Content and design attributes of antivaccination web sites |journal=JAMA |volume=287 |issue=24 |pages=3245–8 |year=2002 |pmid=12076221 |url=http://jama.ama-assn.org/cgi/content/full/287/24/3245 |doi= 10.1001/jama.287.24.3245}} * {{cite web | title= Six common misconceptions about immunization | url=http://www.who.int/immunization_safety/aefi/immunization_misconceptions/en/ |date= [[16 February]] [[2006]] | publisher= World Health Organization | accessdate=2006-11-02}} ;Anti-vaccinationist publications *1884 ''Compulsory Vaccination in England'' by William Tebb *1885 ''The Story of a Great Delusion'' by William White *1898 ''Vaccination A Delusion'' by [[Alfred Russel Wallace]] *1936 ''The Case Against Vaccination'' by M. [[Beddow Bayly]] M.R.C.S., L.R.C.P. *1951 ''The Truth About Vaccination and Immunization'' by Lily Loat *1957 ''The Poisoned Needle'' by Eleanor McBean *1990 ''Universal Immunization: Miracle or Masterful Mirage'' by Dr. Raymond Obomsawin * 1993 ''Vaccination: 100 years of orthodox research shows that vaccines represent an assault on the immune system'' by [[Viera Scheibner]]. ISBN 0-646-15124-X * 2000 ''[[Behavior|Behavioural]] Problems in Childhood'' by [[Viera Scheibner]]. ISBN 0-9578007-0-3 </div> ==External links== * {{dmoz|Society/Issues/Health/Vaccination|Vaccination}} * [http://www.who.int/immunization/en/ Immunizations, vaccines and biologicals] - [[World Health Organization]] * [http://www.cdc.gov/vaccines/ Vaccines & immunizations] - [[Centers for Disease Control and Prevention]] {{Vaccines}} [[Category:Vaccination]] [[Category:Medical controversies]] [[pl:Kontrowersja szczepionkowa]] [[ru:Антивакцинаторство]]