Published by CQ Press, an Imprint of SAGE Publications, Inc. www.cqresearcher.com Controversies Should parents be required to immunize their children?

wo centuries of scientific evidence have proven conclusively that can prevent deadly diseases, but a small, vocal group of skeptics — T aided by high-profile celebrities — continues to fight mandatory , especially of babies and school-age children. more than 90 percent of Americans immunize their children against diseases such as measles, diphtheria and whooping cough, but the remainder either reject immunization or don’t get the vac - cinations on schedule. officials say refusing to follow vaccine protocols allows diseases to spread rapidly, as happened Jennifer Wonnacott, with her son Henry, is among the California parents who supported a new law requiring schoolchildren in the state to be vaccinated. The law in December 2014 when a measles outbreak began at Disneyland bans most immunization exemptions and is among the nation’s strictest. and spread to seven states. But opponents of mandatory contend that the escalating number of vaccines poses safety concerns and that requiring parents to immunize their children impinges on parental rights and personal freedom. The conflict I extends beyond school-age children to include mandatory immu - THIS REPORT N THE ISSUES ...... 171 nization against the influenza virus for health care workers and S BACKGROUND ...... 177 military requirements that recruits be vaccinated against yellow fever , I CHRONOLOGY ...... 179 anthrax and other dangers. D CURRENT SITUATION ...... 181 E CQ Researcher • Feb. 19, 2016 • www.cqresearcher.com OUTLOOK ...... 184 Volume 26, Number 8 • Pages 169-192 AT ISSUE ...... 185 RECIPIENT Of SOCIETY Of PROfESSIONAL JOURNALISTS AwARD fOR BIBLIOGRAPHY ...... 190 EXCELLENCE N AmERICAN BAR ASSOCIATION SILvER GAvEL AwARD THE NEXT STEP ...... 191 vACCINE CONTROvERSIES

Feb. 19, 2016 THE ISSUES SIDEBARS AND GRAPHICS Volume 26, Number 8 EXECUTIVE EDITOR: Thomas J. Billitteri • Are vaccines safe? 172 Most States Allow [email protected] 171 • Should parents be required Vaccination Exemptions ASSISTANT MANAGING EDITORS: Kathy Koch , to vaccinate their children? Only three have banned [email protected], • Does the pharmaceutical exceptions. Chuck mcCutcheon , [email protected], industry have too much in - Scott Rohrer, [email protected] fluence over vaccine policy? 173 Vaccination Support Rises After Measles Outbreak SENIOR CONTRIBUTING EDITOR: Eighty-seven percent of adults Thomas J. Colin BACKGROUND said childhood vaccines are [email protected] safe. CONTRIBUTING WRITERS: Brian Beary, Early marcia Clemmitt, Sarah Glazer, Kenneth Jost, 177 Chinese Emperor K’ang inocu - 176 Most Adults See Reed Karaim, Peter Katel , Barbara mantel, lated his children against Vaccinations as Tom Price smallpox in the 17th century. Important Safeguard Twenty percent of adults SENIOR PROJECT EDITOR: Olu B. Davis Discovery of Vaccines believe parents should be ASSISTANT EDITOR: Ethan mcLeod 177 free to decide. In 1796, British physician INTERN: molly mcGinnis discovered exposure to cowpox could 179 Chronology FACT CHECKERS: Eva P. Dasher, prevent smallpox. Key events since 1809. michelle Harris, Nancie majkowski, Robin Palmer Modern Fears 180 Vaccine Compensation 178 Tainted vaccines and Program Faulted negative side effects stoked It has been “astonishingly public distrust. slow and surprisingly com - bative.” An Imprint of SAGE Publications, Inc. CURRENT SITUATION Vaccination Mandates for 182 Adults on the Rise VICE PRESIDENT AND EDITORIAL DIRECTOR, “more should be done to HIGHER EDUCATION GROUP: State Legislation michele Sordi 181 five states have tightened protect the most vulnerable vaccination requirements populations.” EXECUTIVE DIRECTOR, ONLINE LIBRARY AND since a 2014 measles out - REFERENCE PUBLISHING: At Issue: Todd Baldwin break. 185 Should children have to be vaccinated to attend school? Copyright © 2016 CQ Press, an Imprint of SAGE Pub - 183 Congressional Vote lications, Inc. SAGE reserves all copyright and other Some worry that proposed rights herein, unless pre vi ous ly spec i fied in writing. federal health legislation FOR FURTHER RESEARCH No part of this publication may be reproduced could compromise vaccine electronically or otherwise, without prior written safety. For More Information permission. Un au tho rized re pro duc tion or trans mis - 189 sion of SAGE copy right ed material is a violation of HPV Vaccine Organizations to contact. 184 Adolescent vaccination rates federal law car ry ing civil fines of up to $100,000. Bibliography against the virus remain low. 190 CQ Press is a registered trademark of Congressional Selected sources used. Quarterly Inc. OUTLOOK The Next Step CQ Researcher (ISSN 1056-2036) is printed on acid-free 191 Additional articles . paper. Pub lished weekly, except: (march wk. 4) (may Pipeline Expanding wk. 4) (July wks. 1, 2) (Aug. wks. 2, 3) (Nov. wk. 4) 184 Drug makers are researching 191 Citing CQ Researcher and (Dec. wks. 3, 4). Published by SAGE Publications, or developing vaccines Sample bibliography formats. Inc., 2455 Teller Rd., Thousand Oaks, CA 91320. Annual against Ebola, Zika and full -service subscriptions start at $1,131. for pricing, other diseases. call 1-800-818-7243. To purchase a CQ Researcher report in print or electronic format (PDf), visit www.cqpress. com or call 866-427-7737. Single reports start at $15. Bulk purchase discounts and electronic-rights licensing are also available. Periodicals postage paid at Thousand Oaks, California, and at additional mailing offices . POST - AP Photo/Rich Pedroncelli mAST ER: Send ad dress chang es to CQ Re search er , 2600 virginia Ave., N.w., Suite 600, wash ing ton, DC 20037.

170 CQ Researcher vaccine Controversies BY JANE FULLERTON LEMONS

such as measles and pertussis THE ISSUES (whooping cough), have led to medical and legislative efforts hen facebook co- to increase vaccination rates. founder mark In 2014, 23 measles out - w Zuckerberg took breaks occurred in 27 states, his infant daughter, max, to the according to the federal Cen - doctor for a check-up in Jan - ters for Disease Control and uary, he posted a cute picture Prevention (CDC) — causing with this comment: “Doctor’s the highest number of cases visit — time for vaccines! ” 1 since the disease had sup - The post ignited a social posedly been eliminated in media firestorm over the high- 2000. Recorded cases of tech billionaire’s decision to vac - whooping cough, which hit cinate his daughter and his pub - a low in 1975, have been lic advocacy on the issue. 2 It increasing as well. 5 a

generated more than 3.4 million n Those outbreaks illustrate a

“likes” and was shared more g how vulnerable people still are a M than 36,000 times, with com - to infectious diseases, says Amy s i ments that reflected all sides of u L Pisani, executive director of

e the vaccine safety issue. Zucker - s , a vaccine o J

berg, whose wife is a pediatri - / advocacy organization. The im - o t cian, has more than 49 million o munization effort has, in some h

3 P followers on facebook. ways, been a victim of its own P

The more than 79,000 com - A success because many of Celebrity vaccine skeptics, including actors Jim Carrey menters ranged from being and Jenny McCarthy, who has an autistic son, have today’s parents have never ex - supportive (“Thank you for helped anti-vaccine activists garner attention. Although perienced the infectious dis - doing what’s right and also the scientific community backs vaccines as effective and eases that vaccines keep at bay. for showing everyone else that safe, skeptics worry about injuries vaccines can cause “Just keeping up those it’s the right thing to do as and say mandatory policies violate parents’ right to immunization rates, even decide for themselves about vaccinating their children. well”) to critical (“I am sorry though we don’t see the dis - to see you unnecessarily putting your icans continue to vaccinate their chil - eases, is important because the diseases kid at risk by responding to faux dren, studies have found that as many are still out there,” Pisani says. “we’re and propaganda”) to concerned about as 1 in 10 parents are delaying or for - just doing such a great job vaccinating individual rights (“I’m for informed con - going some or all recommended vac - that they’re not circulating as much as sent for any medical procedure, no cines for their children. 4 they used to be. So we have to just matter how small the risk”). As scientists have sought to quell stay diligent.” Hailed by the scientific community those controversies, particularly the one Some parents object to the rising as one of history’s most successful surrounding , at - number of shots their infants are being breakthroughs, virtually eradicating tention among the skeptical has turned given. Today, the CDC recommends that once-dreaded diseases, vaccines have to individual rights. with an increasing children receive vaccines for 10 diseases come under fire from a small but ardent number of vaccines recommended for — plus the flu vaccine — by age 6, group of skeptics who have long ques - children, coupled with mandates for which can mean up to 37 separate tioned the safety and necessity of in - students — and sometimes health care shots. That compares to five vaccines oculations. They continue to express workers — to get vaccinated, opponents for the same age group in 1995 . 6 concerns about whether vaccines are worry their rights are being eroded. The federal government does not man - linked to adverse reactions and illnesses, Those fears, propelled by high-profile date vaccination, but all 50 states and and some adhere to the notion — opponents and heated online discussions, the District of Columbia require certain widely discredited in scientific circles have translated into lower vaccination rates for children entering public — that vaccines can cause autism. in some places. meanwhile, growing out - schools. Every state allows exemptions Although the vast majority of Amer - breaks of certain communicable diseases, for medical reasons. And all but California,

www.cqresearcher.com Feb. 19, 2016 171 vACCINE CONTROvERSIES

who haven’t been vaccinated. more than Most States Allow Vaccination Exemptions 6 percent of kindergartners there had Beginning this July, 47 states and the District of Columbia will allow personal-belief exemptions allowing them to bypass state laws requiring religious exemptions from requirements that children receive certain vaccinations — nearly three times the childhood vaccines before attending public school. Eighteen of those statewide average of 2.5 percent. 12 states also will allow exemptions for philosophical reasons. California, “If you choose not to immunize your Mississippi and West Virginia allow no exemptions. own child and your own child dies be - cause they get measles, OK, that’s your States that Allow Childhood Vaccine Exemptions, as of July 2016 responsibility, that’s your choice,” said

N.D. N.H. Rhett’s father, Carl Krawitt. “But if your Wash. Mont. Minn. Vt. child gets sick and gets my child sick Maine S.D. Wis. and my child dies, then . . . your action Ore. Idaho Wyo. Mich. N.Y. Mass. 13 Iowa has harmed my child .” Neb. R.I. Pa. In the wake of the outbreak, Demo - Ill. Ind. Ohio Conn. Calif. Nev. Utah Colo. Kan. Mo. W.Va. N.J. cratic Gov. Jerry Brown signed one of Ky. Va. Del. the nation’s strictest vaccine laws, mak - Okla. Tenn. N.C. ing California the third state to bar re - Ariz. Ark. Md. N.M. S.C. D.C. Miss. ligious and other personal-belief ex - Ala. Ga. 14 Texas La. emptions for schoolchildren.

Fla. Religious vaccines work by exposing individuals Alaska Exemptions safely to a germ, such as from a particular Philosophical virus, so their immune system can pro - Exemptions duce antibodies to fend off a particular Hawaii No Exemptions virus. 15 Research is continuing into ways to improve existing vaccines and expand Source: “States with Religious and Philosophical Exemptions from School Immuni - zation Requirements,” National Conference of State Legislatures, Jan. 21, 2016, underused ones such as the vaccine http://tinyurl.com/mhxgt6w against human papillomavirus (HPv). Scientists are also seeking vaccines for mississippi and west virginia allow for The Pew poll was conducted shortly newer diseases such as the Zika virus, exemptions based on religious or philo - after a measles outbreak began in De - which is suspected of causing birth de - sophical reasons. 7 (See map, above. ) cember 2014, caused by a single visitor fects, and Ebola, which is often fatal. most U.S. children still get their vac - to Disneyland in Anaheim, Calif., whose Despite scientific certainty about the cinations. According to the most recent led to 141 cases in seven states safety and effectiveness of vaccination, CDC numbers, among children ages plus Canada and mexico — an outbreak some Americans still doubt the benefits 19 months through 35 months, more fueled by immunization rates as low as of vaccines and remain concerned than 90 percent were vaccinated for 50 percent in some areas . 10 about the government’s role in advo - measles-mumps-rubella (mmR), polio, A study of the Disneyland outbreak cating and mandating immunizations. hepatitis B and varicella (chicken pox). found that “substandard vaccination They also distrust the pharmaceutical The percentage of children who do compliance” led to the measles out - industry, which has been exempted not receive any vaccinations was less break. To prevent the spread of by Congress from liability for harms than 1 percent. 8 measles and maintain what scientists caused by vaccines . 16 At the same time, polls consistently call “herd immunity” — vaccinating One ardent foe is Barbara Loe fisher, show that the public strongly favors a large percentage of people to prevent who became worried about vaccine vaccines: 83 percent believe vaccines the spread of a disease — vaccination safety when her 2-year-old son suffered are safe, although some groups are rates need to be between 96 percent a convulsion and collapsed within hours more skeptical than others, according and 99 percent. 11 of a routine diphtheria-pertussis-tetanus to the Pew Research Center. Younger One of those at risk was 6-year-old (DPT) vaccination. He was left with adults are more likely to say vaccines Rhett Krawitt, who has leukemia and, multiple learning disabilities and atten - are not safe and that parents should as a result, can’t be vaccinated for ti on deficit disorder. She joined with have the right to decide whether to measles. His family called for schools other parents in 1982 to create the Na - vaccinate their children. 9 in marin County, Calif., to ban students tional vaccine Information Center (NvIC),

172 CQ Researcher which advocates for vaccine safety and refuse to vaccinate their children. 26 informed consent. 17 Vaccination Support Compared with under-vaccinated chil - It’s informed consent — the right Rises After Measles dren, “the unvaccinated children were to choose immunization — that fisher more likely to be male, to be white, particularly advocates. 18 Outbreak to belong to households with higher “vaccines should be available for Eighty-seven percent of U.S. income, to have a married mother with anyone who wants to use them, [and] adults surveyed in February a college education and to live with we should have high standards for 2015 said commonly adminis- four or more children,” according to proof of safety and effectiveness of a study published in The New England tered childhood vaccines are these products,” fisher says. But the Journal of Medicine. 27 bottom line, she says, is that people safe or very safe, up from “Other studies have shown that chil - should be able to make their own 77 percent seven months dren who are unvaccinated are likely choices. “I defend without compromise ea rlier. Support for vaccinations to belong to families that intentionally the ethical principle of informed con - increased after a measles refuse vaccines,” the study added, sent in medical risk-taking. At our peril outbreak began in December “whereas children who are undervac - do we abandon that ethical principle.” 2014 in Anaheim, Calif., and cinated are likely to have missed some Those who remain skeptical of vac - spread to seven U.S. states, vaccinations because of factors related cines have garnered attention in part Canada and Mexico. to the health care system or sociodemo - because of high-profile support from graphic characteristics.” Hollywood celebrities, such as actors Percentage of U.S. Adults Who many of these parents also tend to Jim Carrey and Jenny mcCarthy, who Say Common Vaccines Are Safe trust their own online research or the has an autistic son, and environmental or Very Safe, 2014 Versus 2015 experiences of others more than they activist Robert f. Kennedy Jr., who has trust research conducted by the scientific questioned the roles of the government 100% 87% and medical communities. 28 and pharmaceutical industry in ensuring 80 777%7 % “Right now,” said Jacklyn Smoot, a the safety of . 19 California mother trying to decide whether 60 Opposition is not limited to the to vaccinate her baby, “the people telling . 20 Countries ranging from 40 their personal stories influence me more. Australia and Canada to france and 20 I feel like the data could be flawed for Saudia Arabia have dealt with issues one reason or another, but I feel like surrounding their vaccine policies. 21 0 someone’s story, because they’ve gone July 2014 February 2015 “There is opposition to vaccine, I through something, and they don’t want think, in every country around the Source: Amy Norton, “More Americans other people to go through it, I feel like world,” said Dr. Alan Hinman, a public Embracing Vaccines: HealthDay/ I trust that more.” 29 health scientist with the Task force for Harris Poll,” Harris Poll, March 12, many of these parents are clustered Global Health, an international charity 2015, http://tinyurl.com/zzqzzlu in certain cities or towns, which can affiliated with Emory University. 22 lead to pockets with lower immunization As advocates and critics debate vac - question the vaccines’ effectiveness and rates. In one study, researchers identified cines, here are some of the questions worry children get too many shots at five statistically significant clusters of being asked: one time or could develop autism. They underimmunization among preschoolers also are more distrustful of the medical in 13 Northern California counties . 30 Are vaccines safe? community than those who vaccinate. 24 much of the skepticism started in Those who hesitate to get vaccines According to the CDC, any vaccine can 1998 with a now-discredited report in cite a number of concerns, but many cause side effects. with that in mind, the British weekly medical journal Lancet boil down to safety. Congress created the National vaccine that cited the measles-mumps-rubella Studies indicate that parents who Injury Compensation Program to provide (mmR) vaccine as a potential cause of delay or refuse vaccination are signif - damages to victims while shielding man - autism. The journal retracted the study icantly less likely to believe that vaccines ufacturers from liability in order to main - in february 2010, and the lead author, are safe or necessary to protect chil - tain a steady vaccine supply. 25 (See Andrew wakefield, lost his medical li - dren’s health. 23 sidebar, p. 180. ) cense. 31 In retracting wakefield’s work, Specifically, these parents fear vac - Studies have found some consistent Dr. fiona Godlee, editor in chief of the cines could have serious side effects, demographic trends among those who British Medical Journal , said “the mmR

www.cqresearcher.com Feb. 19, 2016 173 vACCINE CONTROvERSIES

scare was based not on bad science “However, the elements of the sched - power under the 14th Amendment to but on a deliberate fraud” and that ule — the number, frequency, timing, the U.S. Constitution. 46 such “clear evidence of falsification of order and age at which vaccines are • In Zucht v. King , the court ruled data should now close the door on given — are not well-defined in existing in 1922 that children could be barred this damaging vaccine scare.” research and should be improved,” the from attending school if they didn’t But concerns about a link between report found. 39 get their vaccinations. 47 vaccines and autism have lingered. 32 The medical community as a whole, The judicial system also recognizes “Unfortunately, one thing we’ve learned however, doesn’t support delaying or parens patriae , the doctrine under is that it’s far easier to scare people than skipping any of the shots outlined on which the court protects the interests it is to reassure them, and once a specific the CDC schedule. 40 various studies of a juvenile. 48 fear has been raised it will take on a have found no problems based on the Under that principle, the Supreme life of its own — almost like a virus,” current immunization schedule. 41 Court said in 1944 that “neither rights said Seth mnookin, an assistant professor “we don’t advocate for spread-out of religion nor rights of parenthood are of science writing at the massachusetts schedules because they leave children beyond limitation,” and the government Institute of Technology . 33 vulnerable,” said Dr. Deborah Lehman, can restrict a parent’s rights in order to Another concern focused on the use associate director of pediatric infec - safeguard a child’s well-being. 49 of thimerosal — a mercury-containing tious diseases at Cedars-Sinai medical If the issue involved individuals mak - preservative used in vaccines since the Center in Los Angeles. “The schedule ing a choice that only affected them - 1930s — in some childhood vaccines. is set up the way it is because it’s selves, such as whether to take antibi - Although studies have shown thimerosal been tested on tens of thousands of otics or undergo chemotherapy, the to be safe and to have no links to children. If you make up your own debate would be different, says Paul autism, it has not been used in child - schedule, you are flying by the seat Offit, a pediatrician who heads the hood vaccines since 2001 as a result of your pants.” 42 vaccine Education Center at the Chil - of concerns raised by parents. 34 Some pediatricians refuse to treat dren’s Hospital of Philadelphia. In addition, some parents who gen - patients who are not up-to-date on “Is it your right as a parent in this erally support vaccination contend young their vaccines because most parents country to expose your child to a po - children receive too many shots too soon, want to be sure they won’t expose tentially fatal infection? I think the answer so they advocate delaying or spreading their children to disease simply by tak - to that question is no,” Offit says. “we out the immunization schedule . 35 ing them to the doctor’s office. 43 talk endlessly about parents’ rights. How Some of them are abiding by recom - “we decided that the patients who about children’s rights? There’s not a mendations outlined by Dr. Bob Sears, are not vaccinated are presenting a clear year that goes by at our hospital where a California pediatrician who advocates and present danger,” said Dr. Charles we don’t see a child suffer and die from giving parents the option to follow a Goodman, a California pediatrician. “It a vaccine-preventable disease.” delayed schedule. 36 “I created just wasn’t fair for a small number of Offit compares immunization man - my alternative vaccine schedule that al - patients to put those many patients, dates to child car-seat and seat-belt laws, lows parents to go ahead and vaccinate, who either couldn’t be vaccinated be - which require parents to use them for simply in a more gradual manner,” Sears cause they’re too young or had a weak - their children’s protection. “frankly, this said. “And I find a lot of worried parents ened immune system, at risk.” 44 is a civil-rights issue, and the civil rights who otherwise would refuse vaccines are those of the child,” he says. altogether are very happy to go ahead Should parents be required to Similar views come from a range of and vaccinate if they’re doing it in a vaccinate their children? voices on the ideological spectrum, from way that they feel safer about.” 37 The issue of how to balance the the liberal Center for American Progress A study by the Institute of medicine, rights of the individual with the larger to the libertarian Cato Institute to the a division of the National Academies public good lies at the center of debate conservative American Ideas Institute. 50 of , Engineering and medicine, over health laws, including mandatory “vaccination is communitarianism in examined the current vaccine schedule. vaccines. 45 its purest, laboratory form,” wrote con - It concluded the schedule results in The Supreme Court has twice upheld servative columnist michael Gerson. fewer illnesses, deaths and hospital the government’s right to require im - “The choices of citizens are restricted stays, and that new vaccines are eval - munizations: for a clearly (even mathematically) de - uated before the federal Advisory Com - • In 1905, the court held that man - fined social good.” 51 mittee for Immunization Practices adds dating smallpox vaccination was a rea - But for those skeptical of vaccines, the them to the schedule. 38 sonable exercise of the state’s police issue of individual liberty is crucial . 52

174 CQ Researcher “The question isn’t whether to vac - over them because children aren’t able new vaccines, and industry happily cinate or not to vaccinate. The question to exercise their own decisions.” supplies them. Because of the many is whether parents should have the “In the end,” Tanner says, “I favor ties between them, everyone profits, right to make an informed medical de - these mandatory vaccine laws, but they according to industry critics. They often cision for their child’s health,” said don’t make me comfortable because it cite the case of Julie Gerberding, who Shannon Kroner and Tim Donnelly, is a little bit gray, and it is an area resigned as CDC director in 2009 to backers of a referendum to overturn where you are granting the state certain become president of drug manufacturer California’s new law banning most im - rights of intervention to override indi - merck’s vaccine division. 61 munization exemptions. (The effort vidual choice, and I want a pretty high Several federal agencies are involved failed to get enough signatures to put bar for that.” in vaccine research and regulation. At the the question on the ballot.) 53 A study by Indiana University re - Department of Health and Human Services fisher, of the National vaccine Infor - searchers tried to determine whether (HHS), the National vaccine Program mation Center, uses words like oppression the concept of “benefit to others” — Office coordinates vaccine-related activities, and tyranny when she talks about vaccine in the form of the herd immunity need - and the food and Drug Administration mandates. She sees vaccination as a civil- ed to prevent the spread of disease (fDA) is responsible for regulating vaccines rights issue, encompassing freedom of — influences parents’ decisions about and other biologics. Also involved in vac - thought, speech and religion. “You have immunization. 56 cine activities are the National Institutes people who feel that they are oppressed, what they found was the need for of Health, the CDC and the Health Re - that they are losing their ability to protect more study. “There appears to be some sources and Services Administration, all their children,” she says. parental willingness to immunize chil - of which are within HHS. 62 fisher cites efforts in California and dren for the benefit of others, but its The fDA’s vaccines and Related Bi - elsewhere to restrict religious or philo - relative importance as a motivator is ological Products Advisory Committee sophical exemptions to school vaccine largely unknown,” the Indiana Univer - recommends whether new vaccines are requirements. Given the well-defined sity team wrote. 57 safe and effective. The CDC’s Advisory legal precedent that allows the state Committee on Immunization Practices to impose mandates for children, op - Does the pharmaceutical indus - recommends which vaccines should be ponents have focused on maintaining try have too much influence over included on the national Childhood Im - these exemptions. 54 ? munization Schedule, the list that states “A system that will not bend will break,” The distrust of government ex - follow in requiring certain vaccines as fisher says. “You cannot oppress the peo - pressed by those opposed to mandatory a prerequisite for school admission. 63 ple, when they believe their lives and immunization extends to the pharma - Critics — including, but not limited their health are on the line, with a policy ceutical companies that produce the to, vaccine skeptics — have long ques - that’s so inflexible that they cannot protect vaccines. Numerous opinion polls show tioned the revolving-door relationships themselves or their children from harm. Americans don’t hold drug manufac - between these public agencies, the You cannot expect anything but resistance turers in high regard, in large part be - drug manufacturers they regulate and to that kind of oppressive policy.” cause they see drug prices as too high the medical research community. 64 That sentiment echoes comments and industry profits as too big. 58 Dr. marcia Angell, the former editor- Sen. Rand Paul, R-Ky., made during the A Kaiser family foundation poll, for in-chief of The New England Journal early days of the presidential campaign instance, found fewer than half held a of Medicine , traces the rise of the phar - last year when he was still a candidate. favorable opinion of pharmaceutical maceutical industry’s influence to the Paul, an ophthalmologist who holds companies — below doctors, food man - early 1980s, when changes in tax and libertarian views, said most vaccines ufacturers, banks, airlines and health in - patent laws altered the relationships should be voluntary, and he called man - surance companies. Only oil companies between the drug manufacturers, private dates government overreach . 55 ranked lower in public opinion. 59 researchers and government institutions. But that view contrasts with the po - “You have real animosities about The result was a research atmosphere sition of another libertarian, who says pharmaceutical companies making that enabled more players to cash in, that while the rights of the state are massive profits,” said mark Largent, a said Angell, author of The Truth About limited, so are the rights of the parents. historian at michigan State University the Drug Companies: How They Deceive “Parents have agency over their chil - who wrote Vaccine: The Debate in Us and What to Do About It. dren, but it’s not unlimited,” says michael Modern America. 60 Since then, “the pharmaceutical in - Tanner, a senior fellow at the Cato In - vaccination skeptics say government dustry has moved very far from its original stitute. “They just have a certain agency researchers and regulators push for high purpose of discovering and pro -

www.cqresearcher.com Feb. 19, 2016 175 vACCINE CONTROvERSIES

Most Adults See Vaccinations as Important Safeguard More than nine in 10 U.S. adults agree that vaccines are important to fight diseases from abroad and that families unable to afford vaccines for their children should not have to pay for them. One-fifth believe that because most children get vaccinated, parents should be free to decide whether to vacci - nate their own children. Yet 85 percent agree that vaccinations should be required of teachers and other school personnel, and 72 percent say non-vaccinated students should not be permitted to attend school. Percentage of U.S. Adults Who Agree or Disagree That Vaccinations . . . 100% 93% 93% 92% 85% 79% 82% 80 72% 60

40 28% 21% 15% 18% 20 7% 7% 8% 0 Should be a Are an important Are important Should be free to Should be Should be Non-vaccinated choice for some safeguard for children children whose mandatory for mandatory children should parents because against families cannot all teachers/ for all not be allowed to most other children diseases afford them school staff children attend private/ get vaccinated from abroad public schools

Source: Amy Norton, “More Americans Embracing Vaccines: HealthDay/Harris Poll,” Harris Poll, Agree March 12, 2015, http://tinyurl.com/zzqzzlu Disagree

ducing useful new drugs,” Angell said. his argument that thimerosal can be In addition to questions about con - “Now primarily a marketing machine to linked to childhood neurological disorders, flicts of interest, drug manufacturers sell drugs of dubious benefit, this industry including autism. He also contends phar - face criticism over their profits and how uses its wealth and power to co-opt maceutical profits, not medical progress, expensive vaccines are. 71 every institution that might stand in its are behind the increasing number of vaccines were once considered some - way, including the U.S. Congress, the vaccines children are required to get. 68 thing of a stepchild in the manufacturing fDA, academic medical centers and the He outlined his theories in a 2005 industry because they cost more to pro - medical profession itself. ” 65 article, called “Deadly Immunity,” published duce than conventional drugs. Now, According to several studies, the in Rolling Stone and Salon magazines. however, they can be a profitable prod - pharmaceutical industry’s influence also But both publications soon backtracked. uct. The average cost to fully vaccinate can be found in medical journals, where Rolling Stone issued corrections, while a child with private insurance to the medical professionals rely on objective Salon retracted the purported exposé. 69 age of 18 increased from $100 in 1986 data to make decisions about prescrip - Other critics, such as fisher’s group, to $2,192 in 2014 . 72 tion drugs and vaccines. 66 note that in the early 1980s, the phar - The result has been that previous fisher, of the NvIC, points to a study maceutical companies were so powerful concerns about low prices driving man - about industry influence that was pub - that they threatened to stop producing ufacturers out of the market and leading lished in the British Medical Journal . 67 vaccines unless Congress passed a law to shortages have been replaced by “The public voices that are question - exempting them from liability for harms new concerns about high prices, par - ing the system, that want reform of the caused by their products. At the time ticularly in developing countries with system, have a legitimate argument,” she Americans were suing drug companies an acute need for vaccines. 73 says. “They have been marginalized and for problems allegedly caused by vac - On the other hand, a recent study demonized by special interest groups cines, particularly those for whooping examining the economic ramifications who don’t want to truly consider the cough and polio. 70 Congress in 1986 of vaccination found that “from a so - legitimate questions that have arisen.” created the National vaccine Injury cietal perspective, every dollar spent Kennedy, the environmental activist, Compensation Program, which set up ultimately saves at least 10 dollars.” 74 is one of the industry’s harshest critics. a federal fund to compensate victims Because of vaccination, the study es - His celebrity status and political connec - who claim they were harmed by vac - timated, U.S. children born in 2009 would tions have helped him gain attention for cines. ( See sidebar, p. 180. ) have 20 million fewer cases of vaccine-

176 CQ Researcher preventable diseases and 42,000 fewer Cuba, carried by an infected African early deaths related to those diseases dur - slave. Ultimately those diseases spread Discovery of Vaccines ing their lifetimes. That means with an throughout the Americas, killing some investment of $7.5 billion, the routine im - 95 percent of the native population t about the same time the founders munization schedule would save $76 bil - — up to 20 million people. 78 A were building a new nation, British lion in direct and indirect costs, resulting In 1694, Queen mary II of England physician Edward Jenner was revolu - in a net savings of $69 billion . died of smallpox. In 1713, measles tionizing medicine by ushering in the The pharmaceutical industry also killed three children and the wife of era of vaccination with his discovery in notes how expensive and complicated Cotton mather, a prominent Boston 1796 that infection with cowpox could it is to develop a vaccine. Sally Beatty, clergyman who became an inoculation protect a person from smallpox, and its a spokeswoman for Pfizer, said it can advocate. Eight years later, when a use quickly spread . 82 take five years and $600 million to build smallpox outbreak in Boston left 844 Key among the scientists working a lab where a vaccine is manufactured, people dead, mather promoted vario - in the 19th century was , and that another two years are needed lation but was widely criticized for it. a french chemist and microbiologist to produce just one vaccine batch. 75 At one point, a primitive grenade was who developed vaccines for anthrax thrown through a window of his house, and rabies. work also began on finding with this note attached: “Cotton mather, vaccines for such diseases as diphtheria, you dog, dam you. I’ll inoculate you rubella, tuberculosis, cholera and ty - BACKGROUND with this, with a pox to you.” 79 phoid fever. In 1782, King George III of England In the 20th century, researchers began lost a son who died after receiving to focus on finding a vaccine for polio. Early Vaccinations the smallpox variolation. In 1953, American medical researcher Benjamin franklin also lost a son to Dr. injected himself, his wife he use of vaccines to prevent disease smallpox. Rumors abounded that he and their three sons with his experimental T dates to early times, when the first died from failed variolation, rather than poliovirus vaccine. Soon after, large-scale were done in China in the the disease itself, which franklin denied. trials were underway, and by 1955, public 11th century. while immunizations have In his autobiography, franklin wrote vaccination began. saved millions of lives, especially in the about the death, discussing the kind of while Salk’s vaccine used a “killed” past 200 years, they’ve also been con - parental quandary that resonates today. form of the virus, another American troversial from the beginning . 76 “In 1736 I lost one of my sons, a researcher, Dr. Albert Sabin, developed In 1661, when Chinese Emperor fu- fine boy of four years old, by the an oral that used a live lin died of smallpox, his third son became small-pox, taken in the common way,” version of the virus, which became Emperor K’ang. The boy had already he wrote. “I long regretted . . . that I commercially available in 1961. The survived a case of smallpox, and he had not given it to him by inoculation. live vaccine largely replaced Salk’s earlier eventually supported inoculation in its This I mention for the sake of parents, version in the United States until 1999. earliest known form. Called variolation, who omit that operation on the sup - Neither Salk nor Sabin patented his the process involved deliberate infection position that they should never forgive vaccine, donating the rights as gifts to with smallpox using dried scabs or fluid themselves if a child died under it; my humanity . 83 from the pustules; it usually resulted in example showing that the regret may During the same time period the a milder form of the disease that would be the same either way, and that there - race was on for a polio vaccine, Amer - leave the person immune, although it fore the safer should be chosen.” 80 ican microbiologist also could lead to death. The emperor franklin wasn’t alone. Dr. Howard began work that resulted in creating immunized his children, but not without markel, a historian of medicine, wrote or improving more than 25 other vac - facing some criticism . 77 that “John Adams was inoculated in 1764. cines, including nine of those now for hundreds of years, diseases such Twelve years later, while he was in routinely recommended for children. as smallpox, measles, whooping cough Philadelphia declaring American inde - At his death in 2005, other researchers and yellow fever took their toll across pendence, his wife and children were credited him with having saved more the globe. when European colonists inoculated as an epidemic raged in lives than any other scientist in the came to the Americas, they brought Boston. Gen. George washington ordered 20th century. 84 those diseases with them. Smallpox is his soldiers to be inoculated in 1777 be - But opposition to vaccines began believed to have arrived in mexico in cause more men were falling to smallpox even before they were fully developed. 1520 on a Spanish ship sailing from than to Redcoat muskets .” 81 After Jenner developed the smallpox

www.cqresearcher.com Feb. 19, 2016 177 vACCINE CONTROvERSIES

vaccine, it was met with suspicion and purple blotches, foetid ulcers, and filthy have the power “[t]o regulate Commerce mistrust. Some objected that it was ad - running sores covering his body.” 86 with foreign Nations, and among the ministered by piercing the skin, while In 1879, the Anti-vaccination Society several States.” In certain situations, this others did not like that the vaccine of America was founded. Two other has applied to vaccines, such as re - came from an animal. Other skeptics leagues, the New England Anti-Compulsory quirements that military personal and had a general distrust of medicine. vaccination League and the Anti-vaccination immigrants be vaccinated. 89 And many opposed the vaccine because League of New York City, soon followed. The federal role is more limited when they believed it violated their personal In 1898, the British vaccination law it comes to requiring vaccines: It does liberty. 85 was amended to allow exemptions to not mandate the use of any childhood when Britain implemented laws be - the smallpox mandate for parents, based vaccines; it only provides recommenda - tween 1840 and 1853 making vacci - on conscience, which introduced the tions. Generally, the decision to mandate a vaccine falls to state and local gov - ernments, where the authority to enact laws for protecting public health derives from the state’s general police powers. when it comes to communicable disease outbreaks, these powers may include the enactment of mandatory vaccination laws. massachusetts was the first, in 1809, when it passed a smallpox vaccination law. In 1827, Boston became the first city to require vaccination against smallpox for public

G school students, and the law was ex - I

U 90

/ panded to the entire state in 1855. e v i The other 49 states and the District h c r of Columbia eventually passed laws A

y

r requiring mandatory vaccinations for o t s

i children entering school, with varying H

l exemptions. many states also have a s r

e laws providing for mandatory vacci - v i

n nations during a public health emer - U /

s gency or the outbreak of a commu - e

g nicable disease. a m I

y t t e G American medical researcher Albert Sabin developed an oral polio vaccine that Modern Fears became commercially available in 1961, largely replacing a vaccine developed by another American, Jonas Salk, that was dispensed by injection. By 1979 n 1955, just weeks after the Salk the last U.S. cases of polio had occurred among unvaccinated persons. I polio vaccine became available for widespread use, a production error led nation compulsory, almost immediately concept of “conscientious objector” into to one of the worst pharmaceutical dis - anti-vaccination leagues challenged English law. 87 asters in U.S. history, causing some vac - them as a violation of civil liberty. The federal government’s role in cines from Cutter Laboratories to be One article characterized the “vac - vaccine policy is extensive, particularly tainted with live polio virus. Ten people cination monster” with this vivid de - in the development of guidelines for died while more than 150 others were scription: “A mighty and horrible mon - when to administer specific vaccines paralyzed . 91 ster, with the horns of a bull, the hind — and when not to — and to which Public trust in official reassurances of a horse, the jaws of a krakin, the populations . 88 about vaccine safety eroded again in teeth and claws of a tyger, the tail of Its role in public health matters stems 1976, when people contracted Guillain- a cow, all the evils of Pandora’s box from the U.S. Constitution’s Commerce Barre syndrome after receiving a vacci - in his belly, plague, pestilence, leprosy, Clause, which states that Congress shall Continued on p. 180

178 CQ Researcher Chronology

tories causes deaths and paralysis 1996 1800s Smallpox vacci - from tainted polio vaccine, one of Parental concerns about the DPT nations become widespread. the worst pharmaceutical disasters (diphtheria-pertussis-tetanus) vac - in U.S. history. cine lead to different formulation. 1809 massachusetts is first jurisdiction to 1961 1998 mandate smallpox vaccination. Dr. Albert Sabin develops oral polio British medical journal Lancet pub - vaccine. lishes study by Dr. Andrew wakefield 1898 linking the mmR (measles-mumps- Britain allows conscience exemptions 1962 rubella) vaccine to autism, fueling to its smallpox vaccination mandate. vaccination Assistance Act allows anti-vaccination sentiment. for mass immunizations. • • 1963 licensed. 1900s-1940s 2000s The number of Vaccines are licensed for rabies, 1976 parents not vaccinating their pertussis, influenza, diphtheria Public trust in vaccine safety erodes children grows, leading to and typhoid fever. Immunization when people contract Guillain-Barre outbreaks of diseases such as opposition continues. syndrome after receiving the swine measles and pertussis. flu vaccination. 1905 2000 Supreme Court upholds state law 1977 measles declared no longer endemic mandating smallpox vaccinations. federal government undertakes the in the United States. Childhood Immunization Initiative 1922 with a goal of achieving 90 percen t 2001 Supreme Court declares unvaccinated vaccination levels. After complaints from parents, children can be kept out of school. thimerosal is removed from child - 1979 hood vaccines, but it continues to 1949 The last U.S. cases of polio occur be used in flu vaccines. The last case of smallpox in the among unvaccinated persons. United States is reported. 2004 • wakefield study discredited over • fraudulent research. 1980s-1990s 2010 1950s-1970s Concern about vaccine safety Britain’s General medical Council Vaccine development continues increases. rules that wakefield engaged in with focus on polio and measles. professional misconduct; Lancet Modern school immunization 1980 retracts his paper; wakefield subse - policies developed. world Health Organization declares quently loses his medical license. smallpox eradicated. 1952 2014 worst recorded polio epidemic in 1986 measles outbreak at Disneyland U.S. history occurs. National Childhood vaccine Injury raises awareness about the number Act reduces vaccine manufacturers’ of unvaccinated people. 1955 liability over vaccine injuries. Polio vaccine developed by Dr. 2015 Jonas Salk becomes available. 1988 California becomes third state to vaccine Injury Compensation Program eliminate religious or philosophical 1955 provides alternative to civil litigation. vaccination exemptions from school Production error at Cutter Labora - vaccination mandates.

www.cqresearcher.com Feb. 19, 2016 179 vACCINE CONTROvERSIES

vaccine Compensation Program faulted It has been “astonishingly slow and surprisingly combative.”

hen Tarah Gramza’s daughter was diagnosed with an vaccine Injury Program. while recognizing that vaccines occasionally autoimmune disorder, the last thing on the Phoenix cause harm, lawmakers sought to find a balance between ensuring w nurse’s mind was the human papillomavirus (HPv) im - a steady supply of vaccines and providing a financial remedy munization her teenager had received more than a year earlier. But to those injured. The program’s no-fault compensation plan then Gramza found research linking the disorder to the vaccine. capped damage awards for pain and suffering. 6 “I did not think in a million years it would have been a But those who have studied the system say only half that vaccine,” Gramza said. 1 equation has worked. By shielding manufacturers from liability, Now she finds herself in a legal battle to win compensation the program has ensured that vaccines remain available to the from the National vaccine Injury Compensation Program, a public. But according to an Associated Press investigation, the federal program designed to provide efficient and fair support program has failed to keep its promise of “quickly and generously” to vaccine victims. But congressional researchers, vaccine skeptics compensating those harmed by vaccines because the process and some legal observers say the nearly 30-year-old program often takes years, has a high standard of proof and has led to has failed to live up to its mission. 2 the very courtroom litigation it sought to avoid. 7 The compensation process has evolved since 1902, when A report by the Government Office (GAO), the Congress passed the U.S. Biologics Control Act, the first measure independent watchdog agency of Congress, found similar problems. designed to regulate vaccines. After that, product-liability laws A 2014 GAO study into vaccine injury claims found an “adversarial were passed throughout the 20th century, allowing individuals environment” in which more than half of the 9,800 claims filed who claimed they had been harmed by vaccines to sue the since 1999 took several years to resolve . 8 manufacturer or the physician. 3 Here’s how the vaccine compensation process works: 9 In 1955, that process was tested by lawsuits arising from a • An individual, parent or legal guardian can file a claim disaster in which, just weeks after the polio vaccine became for an injury that lasted more than six months after the vaccine available, some tainted lots caused by a Cutter Laboratories was given, resulted in a hospital stay and surgery or led to production error led to 10 deaths and more than 150 cases of death. Claims must be filed with the U.S. Court of federal paralysis. A key lawsuit stemming from the incident had a Claims, commonly known as vaccine court. 10 lasting effect on liability law. 4 • Compensation varies, depending on the injury, and can Lawsuits against drug makers increased in the 1970s and include as much as $250,000 for pain and suffering, lost earnings, ’80s, with many cases related to the diphtheria-pertussis-tetanus legal fees and/or a reasonable amount for past and future care. (DPT) vaccine. facing mounting legal fees and large jury awards, for a death, the payout is capped at $250,000. many pharmaceutical companies stopped vaccine production, • Under a statute of limitations, claims must be filed within and health officials worried that a shortage would develop. 5 three years for an injury or two years for a death. Sixteen vaccines In 1986, Congress stepped in, passing the National vaccine currently are covered under the program, although people can Injury Compensation Act, which led to the creation of the National petition to have their cases reviewed if another vaccine is involved.

Continued from p. 178 critic fisher to join with other parents led to the mysterious ailments known nation for the H1N1 influenza, known in forming what would become the ad - as Gulf war syndrome that afflicted many as swine flu. Health officials had pre - vocacy group NvIC. In 1985, she pub - veterans, although the Defense Depart - dicted an epidemic, which never ma - lished DTP: A Shot in the Dark , a book ment countered with studies supporting terialized, but it prompted massive im - detailing the impact the vaccine had on the vaccine’s safety . 95 munizations. The episode triggered a her son’s life . 93 Parents’ concerns also surrounded public backlash against flu vaccination, Since then, the DPT vaccine has been the use in vaccines of thimerosal — a embarrassed the federal government replaced with a formulation that does not form of mercury known as ethylmercury and cost the CDC director his job. 92 produce the same adverse reactions . 94 that had been used as a preservative In the mid-1970s, controversy over the During the Persian Gulf war in the for decades. Since 2001, childhood vac - safety of the DTP vaccine erupted in early 1990s, controversy surrounded the cines in the United States have contained Europe, Asia, Australia and North Amer - military’s program to vaccinate troops for no thimerosal, or only trace amounts, ica. In the United States, a television anthrax in anticipation of potential bio - although flu vaccines continue to contain documentary about the dangers of the logical attacks. Critics questioned its safety, thimerosal . 96 vaccine spurred a flurry of lawsuits against contending the vaccine, with a history In 1998, the mmR vaccine came under manufacturers. It also prompted vaccine of manufacturing problems, may have scrutiny after British gastroenterologist

180 CQ Researcher • The Court of federal Claims makes the final decision re - of California, Hastings, law professor, because they would have garding claims, compensation and the amount of the award. to prove the vaccine is defective, and they would have to prove To win a claim, petitioners must prove they received a a link between the injury and the vaccine. 14 vaccine and developed a condition included on the government’s vaccine injury table, which lists the vaccines and the associated — Jane Fullerton Lemons illness, disability or injury covered. They don’t have to prove the immunization caused their condition. 11 1 Jessica Boehm, “vaccine injury funds climbs, patients struggle to get But if the injury is not listed in the table, the burden of payment,” The Arizona Republic , may 23, 2015, http://tinyurl.com/nntph72. 2 “National vaccine Injury Compensation Program,” Department of Health proof is higher. Some critics contend it is too high, especially and Human Services, undated, http://tinyurl.com/mkwh7m8. in cases where the harm is clear but the scientific evidence 3 “vaccine Injury Compensation Programs,” History of vaccines, http://tinyurl. is not. The Associated Press investigation found many claims com/nbp56c4. fall into such a gray area. The science is clear on only nine 4 Sabin Russell, “when polio vaccine backfired / Tainted batches killed 10 and paralyzed 164,” San Francisco Chronicle , April 25, 2005, http://tinyurl.com/ of 144 vaccine-injury combinations that a vaccine could cause heydzca. the illness. 5 “vaccine Injury Compensation Programs,” op. cit. According to Department of Health and Human Services 6 Sarah A. Lister et al. , “Selected federal Compensation Programs for Physical (HHS) data, more than 16,729 claims have been filed since 1988. Injury or Death,” Congressional Research Service, march 2007, http://tinyurl. Of those, 9,915 were dismissed and 4,482 received compensation com/zdrll4d. 7 12 mitch weiss, Justin Pritchard and Troy Thibodeaux, “AP Impact: ‘vaccine from the $3.3 billion paid out over the program’s lifetime . court’ keeps claimants waiting,” Salon , Nov. 17, 2014, http://tinyurl.com/zk4f6e8. when Stanford University law professor Nora freeman Engstrom 8 “vaccine Injury Compensation: most Claims Took multiple Years and many examined how well the injury compensation program had fared were Settled through Negotiation,” Government Accountability Office, Nov. 21, as an alternative to traditional litigation, she found the system 2014, http://tinyurl.com/mql68yz. 9 “How to file a Claim,” National vaccine Injury Compensation Program, Health wanting. Resources and Services Administration, Department of Health and Human Services, “The results are discouraging,” Engstrom said. “Despite initial http://tinyurl.com/c3glfzl. optimism in Congress and beyond that such a fund could 10 “vaccine Claims/Office of Special masters,” U.S. Court of federal Claims, resolve claims efficiently and amicably, in operation the program http://tinyurl.com/dm7fnt. 11 13 “vaccine Injury Table,” National vaccine Injury Compensation Program, Health has been astonishingly slow and surprisingly combative.” Resources and Services Administration , http://tinyurl.com/6sxm3mb. But those who defend the vaccine compensation program 12 “Data and Statistics,” Montly Statistics Report , National vaccine Injury Com - say that while the system has room for improvement, it has pensation Program, updated feb. 3, 2016, http://tinyurl.com/jpswrg2. helped ensure a steady availability of vaccines, and it has made 13 Clifton B. Parker, “federal program for vaccine-injured children is failing, Stanford scholar says,” Stanford News , July 6, 2015, http://tinyurl.com/jrrwe4q. it easier for vaccine victims to get compensation. 14 Dorit Rubinstein Reiss, “ ‘A Dose of Reality’ Does Not Support Abolishing Going through the regular courts is “much harder” for those vICP,” Shot of Prevention , Aug. 11, 2015, http://tinyurl.com/zdc6na3. Also seeking compensation, said Dorit Rubinstein Reiss, a University see http://tinyurl.com/hwyn7do. wakefield linked the routinely recom - from opposite angles: Physicians and mended shot to the rising incidence public health leaders turn to the scientific of autism. process and research reports, while vac - CURRENT In 2004, the study was called into cine opponents reject these studies, question amid reports of fraudulent re - charging that the data have been ma - SITUATION search and conflicts of interest. In 2010, nipulated for political reasons . 98 Britain’s General medical Council ruled “A polarized debate both draws upon that wakefield was guilty of misconduct, and contributes to polarized understand - State Legislation and The Lancet formally retracted the ings of history,” Baker wrote. As a result, paper. In may 2010, wakefield was banned participants “judged the same data using s California prepares to begin en - from practicing medicine in Britain. 97 different sets of assumptions, each A forcing its new law tightening re - An analysis of these long-running shaped by history. Articulating and shar - strictions on vaccine exemptions later vaccine controversies by Dr. Jeffrey P. ing these narratives represent a first this year, other states will be considering Baker, a Duke University pediatrician step toward transcending the powerful vaccine-related proposals. Congress, and medical historian, noted how the boundaries shaping today’s vaccine con - meanwhile, continues work on a bill two sides approach the controversy troversies.” containing funding for critical health

www.cqresearcher.com Feb. 19, 2016 181 vACCINE CONTROvERSIES

vaccination mandates for Adults on the Rise “More should be done to protect the most vulnerable populations.”

t’s not just schoolchildren who have to roll up their sleeves. 500 facilities have followed suit with exemptions for medical, many adults do, too. In California, a new law requires philosophical and religious reasons. 9 I daycare workers to be vaccinated for measles, whooping CDC data show that vaccination rates are higher when immu - cough and influenza by Sept. 1, although exemptions for religious nization is required or recommended. for the early part of the and other reasons are allowed. 1 They join soldiers, hospital 2014-15 flu season, vaccination coverage among health care workers workers and other adults required to be immunized against averaged 64.3 percent. The coverage increased to 85.8 percent many common communicable diseases. among workers whose employers required the flu vaccine and “Public health officials have been sounding the alarm that more 68.4 percent for those where vaccination was recommended. 10 should be done to protect the most vulnerable populations such In 2010, Children’s Hospital of Philadelphia began requiring as children and seniors,” said Democratic state Sen. Tony mendoza, all employees to get the flu vaccine after two young patients in explaining his sponsorship of the California measure. on chemotherapy died after becoming infected with influenza That rationale has led an increasing number of health care from health care workers. “It’s not your inalienable right to not facilities to require their employees to be immunized for various get a vaccine if you’re helping care for vulnerable patients,” said diseases. 2 In 2013, Rhode Island became the first state to Dr. , director of the hospital’s vaccine Education Center. mandate flu shots for health care workers, although 17 states These two patients “died from getting the flu at the hospital. ” 11 have laws related to flu shots for adults, such as requiring But nine Children’s Hospital workers, five of whom belonged hospitals to offer vaccination. 3 to a local health care workers union, refused the flu shot and The Centers for Disease Control and Prevention (CDC) recom - were fired. 12 In 2012, an Indiana hospital fired eight workers mends health care workers be vaccinated to reduce the chance for refusing to be vaccinated. At least 15 hospital workers in they will get or spread vaccine-preventable diseases. 4 The CDC four states were fired in early 2013 as well. 13 estimates that more than 200,000 people are hospitalized from A number of organized labor groups, including National Nurses seasonal flu-related complications annually, although cases vary. United, oppose mandatory flu shots. They contend hospitals should Between 1976 and 2006, the number of deaths attributed annually take other measures, such as hand washing and sanitizing of to the flu ranged from 3,000 to 49,000. 5 surfaces, which can help curb the spread of influenza. 14 vaccination reduces the flu risk by 50 percent to 60 percent, “I work at a hospital that currently has a seasonal flu according to the CDC. 6 mandatory vaccine policy, and I know from experience that But the issue of mandatory vaccination raises questions about this kind of punitive policy only fosters resentment on the part whose rights come first — those of health care workers or of of the bedside caregivers,” said Rajini Raj, a registered nurse their patients. 7 who works at the medStar washington Hospital Center in wash - when virginia mason Hospital in Seattle began requiring its ington, D.C. She and others who oppose mandates point out employees to receive an annual flu shot in 2005, the staff vac - the vaccine is not wholly effective. 15 cination rate went from 54 percent to 98 percent, although the But others say workers’ individual rights should not come nurses’ union successfully challenged the policy. 8 more than before public health and the medical tenet to “do no harm.” 16 care research and regulation that could California removed both personal and • In South Dakota, a Senate com - affect vaccine policy. religious exemptions, while vermont re - mittee approved a measure in January Between 2009 and 2012, lawmakers moved its philosophical exemption. 100 to require sixth-graders to get a in 18 states introduced 36 bills involving Several other states also considered legis - . vaccine exemptions, 31 of which would lation in 2015 dealing with exemptions. • In Hawaii, lawmakers killed a bill have made opting out of shots easier, This year, states will consider related in february designed to speed up the according to the National Conference issues: state’s process for adopting federal vac - of State Legislatures. None of those 31 • In washington, a bill that would cination guidelines, after residents spoke bills passed. 99 eliminate the state’s personal belief ex - out against vaccines. 101 In 2015, following the Disneyland emption is awaiting a floor vote in the Emory University researchers studied measles outbreak, six states — California, House after being passed out of com - the correlation between state exemption Connecticut, Illinois, South Dakota, ver - mittee last year. laws and vaccination rates and found mont and west virginia — passed leg - • In Pennsylvania, a similar bill, intro - that exemptions for nonmedical reasons islation related to exemptions, all but duced in 2015, to eliminate the philosophical increased at a heightened rate from one of which tightened requirements. exemption awaits committee action. 2005 to 2011. 102

182 CQ Researcher e k A

“It is in the highest tradition of the healing professions to d i v

set aside our own self-interests and preferences in the moral a D

.

imperative to best protect and care for our patients — even if J / o

it means accepting some level of self-harm (real or imagined),” t o

wrote Dr. Gregory A. Poland, a vaccine researcher at the mayo h P 17 Clinic and editor-in-chief of the journal Vaccine. P A Those in the U.S. military constitute another group of adults Dr. Thomas Frieden, director of the Centers for Disease who face mandatory vaccinations. military regulations require Control and Prevention, receives a flu shot following a U.S. troops to be immunized against a number of diseases, in - Sept. 18, 2014, news conference in which he cluding diphtheria and yellow fever. These inoculations begin stressed the importance of flu vaccinations for adults. when soldiers enter into service. Depending on their specialties or locations of deployment, troops may be required to get other 8 John Tozzi, “Can Your Boss make You Get vaccinated?” Bloomberg Business, Jan. 22, 2015, http://tinyurl.com/h2tdypu; Lisa Schnirring, “first hospital to vaccinations as well. Courts have upheld the legality of the mandate flu vaccination reports on challenges, success,” Center for Infectious military’s mandatory vaccination orders. 18 Disease Research and Policy, Aug. 3, 2010, http://tinyurl.com/ja8krgh. 9 “Influenza vaccination Honor Roll,” Immunization Action Coalition, Dec. 10, — Jane Fullerton Lemons 2015, http://tinyurl.com/nbhag2d. 10 “Influenza vaccination Information for Health Care workers,” Centers for 1 Rong-Gong Lin II and Rosanna Xia, “vaccines required for daycare workers Disease Control and Prevention, Sept. 17, 2015, http://tinyurl.com/qj9ke4u. under new California law,” Los Angeles Times , Oct. 13, 2015, http://tinyurl.com/z9kl9cs. 11 marcia Stone, vaccine Coverage: Individual rights versus the Common 2 “Requirements & Laws,” Centers for Disease Control and Prevention, Jan. Good,” microbe magazine, September 2011, http://tinyurl.com/h8b75en; Janice 25, 2016, http://tinyurl.com/z3rlqca; “Healthcare Personnel and Immunization,” Lloyd, “mandatory flu shots opposed by some health care workers,” USA Immunization Action Coalition, Sept. 20, 2013, http://tinyurl.com/gweb2ax. Today , Jan. 16, 2013, http://tinyurl.com/j5y72vk. 12 3 “HEALTH Adopts Regulations to Require flu Shots for Healthcare workers Stone, op. cit. in Rhode Island,” press release, Rhode Island Department of Health, Oct. 5, 13 Brad Tuttle, “workers Are Being fired for Refusing to Get flu Shots,” 2012, http://tinyurl.com/8ao8q6j; “menu of State Hospital Influenza vaccination Money , Nov. 5, 2015, http://tinyurl.com/hcmfxvk. Laws,” Public Health Law, Centers for Disease Control and Prevention, Nov. 23 , 14 Genevieve m. Clavreul, “Should the flu Shot be mandatory for Nurses?” 2015, http://tinyurl.com/zphs3us. Working Nurse , undated, http://tinyurl.com/mye3ntu. 4 “Recommended vaccines for Healthcare workers,” Centers for Disease 15 “Largest National Nurses Union Opposes mandatory flu vaccination as Control and Prevention, April 15, 2014, http://tinyurl.com/hvah352. Condition of Employment,” press release, National Nurses United, feb. 8, 2012 , 5 “Seasonal Influenza Q&A,” Centers for Disease Control and Prevention, http://tinyurl.com/zhguk3d. Sept. 18, 2015, http://tinyurl.com/z6pud4l. 16 J. J. m. van Delden et al. , “The ethics of mandatory vaccination against influenza 6 “vaccine Effectiveness — How well Does the flu vaccine work?” Centers for health care workers,” Vaccine , Aug. 21, 2008, http://tinyurl.com/htnqbet. for Disease Control and Prevention, Dec. 21, 2015, http://tinyurl.com/26ozkb. 17 Gregory A. Poland, “mandating influenza vaccination for health care 7 Daniel Goodman and Christopher webster, “The mandatory vaccination workers: Putting patients and professional ethics over personal preference,” of Health Care workers,” Law Practice Today , April 2011, http://tinyurl. Vaccine , July 13, 2010, http://tinyurl.com/zx69uca. com/h72asxl; Robert I. field, “mandatory vaccination of Health Care workers: 18 Jared P. Cole and Kathleen S. Swendiman, “mandatory vaccinations: whose Rights Should Come first?” Pharmacy and Therapeutics , November Precedent and Current Laws,” Congressional Research Service, may 21, 2014, 2009, http://tinyurl.com/gn4h8yg. http://tinyurl.com/j7n6ag4.

“Since school immunization require - ceutical and medical trade industries process for approving drugs, including ments play a major role in controlling to restrict or remove personal-belief vaccines, and other medical devices . 105 vaccine -preventable diseases in the Unit - vaccine exemptions, expand electronic Rather than vote on the entire mea - ed States, studies like this underscore vaccine tracking systems and require sure, the Senate plans to break it into the need for states to examine their cur - more vaccines for children in school a series of smaller bills this year. 106 rent exemption policies,” said Saad B . and adults in the workplace.” Despite its overwhelming bipartisan Omer, the study’s lead author . 103 vote, 344-77, the House bill has drawn The National vaccine Information mixed reviews. And it may be an issue Center monitors state legislative activity Congressional Vote where those on different sides of the involving vaccine- related issues, in - vaccine debate are in agreement. 107 cluding bills already filed for 2016. 104 n Capitol Hill, the House in July fisher of NvIC worries that the bill, Dawn Richardson, the NvIC’s advocacy O passed a massive health care bill aimed at speeding up the drug-approval director, said that state legislatures last — the 21st Century Cures Act — that process, “seriously compromises the in - year experienced “an unprecedented would increase funding for the National tegrity of the fDA drug and vaccine flood of bills backed by the pharma - Institutes of Health and streamline the licensing process.” She added, in an

www.cqresearcher.com Feb. 19, 2016 183 vACCINE CONTROvERSIES interview with CQ Researcher , “we can’t Paul — drew criticism for saying parents the opposition, saying the vaccine would allow these standards to be lowered should decide whether to vaccinate their encourage inappropriate sexual activity anymore.” 108 children. Paul, a member of the com - and override parental autonomy. 120 fisher isn’t alone in her concerns. mittee, did not attend the hearing. As a result, HPv vaccine coverage former fDA Commissioner David The topic resurfaced in a September remains lower than for other teen im - Kessler joined with leaders of the 2015 Republican debate, with comments munizations, according to the CDC. HIv/AIDS community to urge Congress by several candidates including front- four out of 10 adolescent girls and to reject the bill. The legislation “could runner Donald Trump, who has linked six out of 10 adolescent boys have substantially lower the standards for vaccines to autism, despite scientific not started the HPv vaccine series. 121 approval of many medical products, evidence to the contrary. He favors A study showing implementation of potentially placing patients at unnec - smaller doses over a longer period of the HPv vaccine has lagged behind other essary risk of injury or death,” they time, saying the number of vaccinations new vaccines indicated that early efforts wrote in a New York Times op-ed. 109 “looks just like it’s meant for a horse, to mandate its use may have backfired. Other critics have cited provisions not for a child.” 115 Despite the issues surrounding it, the HPv of the bill that would allow researchers vaccine “should not be viewed or treated to rely on “clinical experience” rather differently than other routinely recom - than clinical trials in evaluating the safety HPV Vaccine mended vaccines ,” the study said. 122 and efficacy of new drugs. That “smacks of being a payoff to pharmaceutical urr ently, only three jurisdictions companies,” wrote Dr. David Gorski, a C mandate the HPv vaccine. virginia michigan surgical oncologist. 110 and the District of Columbia require it OUTLOOK House and Commerce Chair - for girls entering the sixth grade, while man fred Upton, R-mich., and Rep. Rhode Island requires it for seventh- Diana DeGette, D-Colo. led the push grade girls and boys. All three allow for the bill, which they said will bring broad exemptions for the vaccine . 116 Pipeline Expanding the nation’s health care system into As of february, at least nine states the 21st century, invest in science and have proposed HPv-related legislation s vaccine development continues, medical innovation, incorporate the pa - for the 2015-16 sessions, but only A research is encompassing not only tient perspective and modernize clinical Hawaii has a bill that would mandate infectious diseases but also chronic trials to deliver better, faster cures. 111 use of the vaccine. 117 conditions. But with new viruses such “Every family is impacted by disease; HPv is the most common sexually as Zika and Ebola cropping up, finding they just are,” Upton said. “my wife transmitted disease in the United States. a way to prevent the spread of disease has lupus, my dad has diabetes, my Every year, more than 27,000 cases of remains the central mission. mom’s a cancer survivor. And I’m no HPv-caused cancer occur in women and for the scientific and medical com - different than anyone else.” 112 men, according to the CDC, HPv is linked munities, such research represents con - During the peak of the Disneyland to virtually all cervical cancer. In 2012, tinued progress. Dr. Candice Robinson, measles outbreak, lawmakers from both the most recent year statistics are available, a medical officer with CDC’s Immu - parties stressed vaccines’ importance . 113 cervical cancer was diagnosed in more nization Services Division, says recent The Senate Health, Education, Labor than 12,000 cases, and more than 4,000 developments encompass vaccinations and Pensions Committee heard top im - patients died. 118 The CDC recommends for traditional childhood illnesses and munization officials testify about vac - the vaccine, a series of three shots, for emerging infectious diseases. cine-preventable diseases. members em - preteen boys and girls at age 11 or 12 “There have been some new vac - phasized the safety of and need for so they are protected before ever being cines coming down the pipeline, and inoculations while questioning assertions exposed to the virus. 119 there’s been lots of innovation in terms that vaccines can harm children . 114 when the vaccine received approval of Ebola virus vaccines or Zika virus “Too many parents are turning away in 2006, some states moved quickly to vaccines,” Robinson says. from sound science,” said committee Chair - make inoculations mandatory for school According to the world Health Or - man Lamar Alexander, R-Tenn. “Sound attendance. But reactions to an aggressive ganization (wHO), vaccines for the science is this: vaccines save lives.” lobbying campaign by vaccine manufac - Zika virus might be ready for large The hearing came just as a pair of turer merck, coupled with safety concerns, trials in about 18 months. Possible vac - Republican presidential candidates — stalled efforts to mandate the shots in cines at the most advanced stage include New Jersey Gov. Chris Christie and Sen. many states. Conservative groups joined Continued on p. 186

184 CQ Researcher At Issue:

Shoyes uld children have to be vaccinated to attend school?

AMY PISANI BARBARA LOE FISHER EXECUTIVE DIRECTOR , PRESIDENT , N ATIONAL VACCINE EVERY CHILD BY TWO INFORMATION CENTER

WRITTEN FOR CQ RESEARCHER , FEBRUARY 2016 WRITTEN FOR CQ RESEARCHER , FEBRUARY 2016

hen parents enroll their children in day care or arents have the right to exercise freedom of con - w kindergarten, they should feel secure knowing their p science and informed consent to medical risk-taking little ones will be safe from preventable infectious diseases. Every on behalf of their children, and children have the Child By Two’s co-founders, former first lady Rosalynn Carter and civil right to a school education. vaccine risks are not being former Arkansas first lady Betty Bumpers, were instrumental in borne equally by all, and vaccine laws that do not include flexible helping to pass laws in every state requiring proof of immuniza - medical, religious and conscientious-belief exemptions are oppres - tion for school attendance. States passed these laws to protect all sive, inhumane and in violation of civil and human rights. children from deadly and debilitating vaccine-preventable diseases. vaccines are pharmaceutical products that carry a risk of massachusetts enacted the first school vaccination require - injury or death. There are genetic, biological and environmental ment in 1809 to prevent smallpox transmission. Today, all 50 high-risk factors that make some people more susceptible to states have legislation requiring vaccines for students. In 1905, vaccine harm than others, a fact Congress acknowledged in the Supreme Court upheld the constitutionality of mandatory 1986 in the National Childhood vaccine Injury Act when it vaccination. Unfortunately, these laws have been eroded over shielded vaccine manufacturers from civil liability. The National the years, as states have expanded exemptions from immuniza - Academy of Sciences’ Institute of medicine states that often tion requirements. Although exemptions vary from state to state, doctors cannot predict who will be injured because of long- all states grant exemptions to children for medical reasons such standing gaps in vaccine science knowledge. Yet there are al - as allergies. All states, other than mississippi and west virginia, most no federal exemptions for vaccination, which is one grant religious exemptions, while 20 states allow philosophical reason more than $3 billion has been paid to vaccine-injured exemptions for those who object to immunizations because of children and adults under the 1986 law. personal, moral or other beliefs. (California and vermont will no Like the freedoms of speech and the press, the legal right longer allow ythese exemptioens as of Julys .) to exercise freendom of consciencoe and religious belief is em - Continued outbreaks of diseases, including measles, mumps, bodied in the Constitution. Internationally, these freedoms are pertussis and influenza, are jeopardizing public health, prompt - considered basic human rights belonging to all people. In ing state legislators to re-evaluate the wisdom of allowing addition, the legal right to informed consent to medical risk- nonmedical exemptions. One study found that children ex - taking is the centerpiece of the ethical practice of modern empt from vaccination requirements were more than 35 times medicine. more likely to contract measles and nearly six times more Although the Supreme Court in 1905 affirmed the authority likely to contract pertussis than vaccinated children. In a 2006 of state legislatures to require smallpox vaccination during “an study, states with loose exemption policies had approximately epidemic of disease,” the court warned that vaccine mandates 50 percent more whooping cough cases than stricter states. should not go beyond “what was reasonably required for the As executive director of Every Child By Two, I have traveled safety of the public” because excessive mandates could lead to dozens of states and as far as Africa. we strive to ensure to “injustice, oppression or absurd consequence” or be “cruel that all children have access to life-saving vaccines and help and inhuman to the last degree.” A century later, the mandate initiate and implement policies that remove financial and other for one dose of has been replaced by a fed - barriers. I have come to know many families who have lost eral directive that children get 69 doses of 16 vaccines starting children to vaccine-preventable diseases and individuals who on the day of birth, with 49 doses of 14 vaccines given by have survived these diseases but are left with lifelong, debilitating ag e 6. State legislatures have mandated multiple doses of at least illnesses. These families are a reminder that the United States 10 of these vaccines for children, but many are for diseases cannot let its guard down, as diseases know no borders. that, unlike smallpox, do not have a high complication and while vaccines are not 100 percent effective, families should mortality rate, are not widespread or are not transmitted in a feel confident in knowing that their children are surrounded by public setting. a high percentage of vaccinated classmates and personnel. Hundreds of new vaccines are being developed, and many “Herd immunity” — vaccinating large numbers of people — is will be mandated. vaccine mandates lacking informed-consent the finnoal barrier to deadly diseases. protections should be repealed.

www.cqresearcher.com Feb. 19, 2016 185 vACCINE CONTROvERSIES

Continued from p. 184 velopment as evidence of the pharma - New England Journal of Medicine. while one from the National Institutes of ceutical industry’s continued drive for prof - old vaccines need updating, and new Health and another from India-based its. vaccine safety advocate Kennedy said ones are being developed, he said, the Bharat Biotech, said marie-Paule Kieny, such research is aimed at “boosting vaccine key is making them available, particularly wHO’s assistant director-general for revenues to $100 billion by 2025.” 125 in developing countries where more than health systems and innovation. 123 Kennedy cited market research 1.5 million children die from vaccine- In recent years, the pharmaceutical in - showing while vaccines represent only preventable diseases each year. 133 dustry had more than 270 vaccines in 2 percent to 3 percent of global drug development. These potential vaccines sales, “the growth rate in this market has were either in human clinical trials or been extraordinary. This segment has Notes under review by the food and Drug Ad - grown at a high rate of 10 to 15 percent ministration. They included 137 for infec - annually as compared to the overall 1 tious diseases, 99 for cancer, 15 for allergies pharmaceutical industry, which grows mark Zuckerberg, facebook post, Jan. 8, 2016 , http://tinyurl.com/hozeeq4 . and 10 for neurological disorders. 124 at 5 to 7 percent per year.” 126 2 Yanan wang, “mark Zuckerberg gets his baby Arthur Allen, a journalist and author vaccines are currently under devel - vaccinated. Anti-vaxxers go nuts,” The Washington of Vaccine: The Controversial Story of opment for the following diseases: Post , Jan. 11, 2016, http://tinyurl.com/jjuqbm6 . Medicine’s Greatest Lifesaver , believes • Zika virus, which is spread to peo - 3 Ian Sherr, “Zuckerberg injects himself into the charged atmosphere around vac - ple through mosquito bites. The world the vaccine controversy with his newborn,” cines is changing, due in large part to Health Organization (wHO) has declared CNet , Jan. 12, 2016, http://tinyurl.com/je4nd5n . the discrediting of the wakefield study an international public health emergency 4 Amanda f. Dempsey et al. , “Alternative vac - linking vaccines to autism, and that in connection with the outbreak of this cination Schedule Preferences Among Parents bodes well for continued developments. virus in more than 30 countries . 127 of Young Children,” Pediatrics , September 2011 , “The autism link was such a powerful • Ebola, which spreads through http://tinyurl.com/823wnaj . 5 idea,” says Allen, whose book looked at human-to-human transmission. Clinical “measles Cases and Outbreaks,” Centers for Disease Control and Prevention, http://tinyurl. the history of vaccine controversies. “Now trials for a vaccine are underway. 128 com/kyxc6pz ; “Pertussis (whooping Cough),” that that has really been laid to rest, • malaria, caused by parasites trans - Centers for Disease Control and Prevention, we’re sort of back at the general [anti- mitted to people through the bites of feb. 10, 2016, http://tinyurl.com/jgyxmet . vaccination] background noise level which infected mosquitoes. Several potential 6 “vaccine History: Developments by Year,” is always going to be there.” vaccines are undergoing . 129 Children’s Hospital of Philadelphia, Nov. 19, Pisani, of Every Child By Two, also • Dengue fever, also spread to people 2014, http://tinyurl.com/j9dqjfg ; “vaccine and believes the tone is different. She and through mosquito bites. Trials for a vac - Immunizations,” Centers for Disease Control others on both sides of the issue say cine are underway in Brazil. 130 and Prevention, feb. 11, 2016, http://tinyurl. that everyone wants to do the right • HIv/AIDS, which can be trans - com/gom37ve . 7 thing for their children. “People now mitted via the exchange of body fluids “Immunizations Policy Issues Overview,” Na - are having civil conversations,” she says. from infected individuals. wHO said tional Conference of State Legislatures, Jan. 12, 2015, http://tinyurl.com/zuyztg5 . when it comes to research, Pisani there are “a number of very encouraging 8 131 “National, State, and Selected Local Area says vaccines under development for leads” in the search for a vaccine. vaccination Coverage Among Children Aged childhood illnesses, such as respiratory In addition to infectious diseases, 19-35 months — United States, 2014,” “mor - syncytial virus, or RSv, would be game scientists see vaccines as a way to pre - bidity and mortality weekly Report,” Centers changers. “Everybody knows someone vent chronic diseases such as cancer for Disease Control and Prevention, Aug. 28, whose child had RSv, so that’s going and Alzheimer’s. 2015, http://tinyurl.com/zfcy8dz . to be a huge lifesaver,” she says. “The growing cost of caring for an 9 “83% Say measles vaccine Is Safe for Healthy But NvIC’s fisher worries mandates aging population, where noninfectious Children,” Pew Research Center, feb. 9, 2015, could accompany all these new vaccines. conditions like dementia will be in - http://tinyurl.com/morpgjh . 10 “You’re seeing hundreds of new vaccines creasingly common in older people, Karen Kaplan, “vaccine refusal helped fuel being developed that are on the horizon has added a new dimension to the Disneyland measles outbreak, study says,” Los Angeles Times , march 16, 2015, http://tinyurl. that are going to be added to the federal search for new vaccines,” wrote Gary 132 com/q6p9hxm . recommended schedule within a system finnegan, editor of Vaccines Today. 11 m.S. majumder et al. , “Substandard vacci - . . . that’s very oppressive,” because it limits Continued vaccine research remains nation Compliance and the 2015 measles Out - the exemptions available for parents. necessary because “infectious diseases break,” JAMA Pediatrics , may 2015, http://tiny Those skeptical about vaccines also still extract an extraordinary toll on hu - url.com/pvvmzu4 . see the number of vaccines under de - mans,” wrote Dr. Gary J. Nabel in The 12 Tamar Lewin, “Sick Child’s father Seeks vac -

186 CQ Researcher cination Requirement in California,” The New York 27 Saad B. Omer et al. , “vaccine Refusal, mandatory Benefits,” NPR, updated Sept. 18, 2015, http:// Times , Jan. 28, 2015, http://tinyurl.com/myfcqy9 . Immunization, and the Risks of vaccine-Preventable tinyurl.com/glawlb6 . 13 Lisa Aliferis, “To Protect His Son, A father Diseases,” The New England Journal of Medicine , 41 Simon J. Hambidge et al. , “Timely versus Asks School To Bar Unvaccinated Children,” NPR, may 7, 2009, http://tinyurl.com/hdohgcz . Delayed Early Childhood vaccination and updated Jan. 28, 2015, http://tinyurl.com/hoxdyxu . 28 Lenny Grant et al. , “vaccination Persuasion Seizures,” Pediatrics , may 2014, http://tinyurl. 14 Phil willon and melanie mason, “California Online: A Qualitative Study of Two Provaccine com/zl4z7tk . Gov. Jerry Brown signs new vaccination law, and Two vaccine-Skeptical websites,” Journal 42 Gary Baum, “Hollywood’s vaccine wars: L.A.’s one of nation’s toughest,” Los Angeles Times , of Medical Internet Research , may 29, 2015, ‘Entitled’ westsiders Behind City’s Epidemic,” June 30, 2015, http://tinyurl.com/oksmrx5 . http://tinyurl.com/j35xvk7 . The Hollywood Reporter , Sept. 10, 2014 , http:// 15 “why Are Childhood vaccines So Important? 29 vanessa wamsley, “The Psychology of Anti- tinyurl.com/o28tyax . Centers for Disease Control and Prevention, vaxers: How Story Trumps Science,” The At - 43 Steve Hendrix, “Parents with doubts about may 19, 2014, http://tinyurl.com/ck5g854 . lantic , Oct. 19, 2014, http://tinyurl.com/msvf8ku . vaccinations face backlash from pediatricians, 16 Laura Parker, “The Anti-vaccine Generation: 30 Tracy A. Lieu et al. , “Geographic Clusters peers,” The Washington Post , feb. 3, 2015, http:// How movement Against Shots Got Its Start,” in Underimmunization and vaccine Refusal,” tinyurl.com/hbzj4yf . National Geographic , feb. 6, 2015, http://tiny Pediatrics , february 2015, http://tinyurl.com/ 44 Brittny mejia, “Doctors turning away unvac - url.com/kmjdn8d ; Seth mnookin, “Talking to hbs2qxy . cinated children,” Los Angeles Times , feb. 10, vaccine Resisters,” The New Yorker , feb. 4, 2015 , 31 “BmJ declares mmR study ‘an elaborate fraud’ 2015, http://tinyurl.com/ztycqdz . http://tinyurl.com/od2gbjy . — Autism claims likened to “Piltdown man” 45 Lawrence O. Gostin, “Public Health,” The 17 National vaccine Information Center, http:// hoax,” press release, British Medical Journal , Hastings Center, http://tinyurl.com/hgw63oj ; tinyurl.com/5wtjae . June 26, 2012, http://tinyurl.com/omu52zt . for From Birth to Death and Bench to Clinic: The 18 Barbara Loe fisher, “The moral Right to more information, see Sarah Glazer, “Under - Hastings Center Bioethics Briefing Book for Jour - Conscientious, Philosophical and Personal Be - standing Autism,” CQ Researcher , Aug. 1, 2014, nalists, Policymakers, and Campaigns (2008). lief Exemption to vaccination,” National vac - pp. 649-672. 46 Jacobson v. Massachusetts , 197 US 11 — cine Information Center, 2015, http://tinyurl. 32 “Beyond the Autism/vaccine Hypothesis: Supreme Court 1905, http://tinyurl.com/h6yedr7 . com/he5tl5q . what Parents Need to Know about Autism 47 Zucht v. King , 260 US 174 — Supreme 19 Jeffrey Kluger, “meet the Heroes and villains Research,” Autism Science foundation, undated , Court 1922, http://tinyurl.com/hqgvhuc . of vaccine History,” Time , July 29, 2015, http:// http://tinyurl.com/z9ts9j5 . 48 “English Legal Glossary,” National Center tinyurl.com/o9wusv7 ; Phil Plait, “Robert f. 33 “Q&A: Seth mnookin on vaccination and for State Courts, undated, http://tinyurl.com/ Kennedy Jr.: Anti-vaxxer,” Bad Astronomy blog, public health,” MIT News , feb. 27, 2015, http:// zho8k5p . Slate , June 5, 2013, http://tinyurl.com/zfzor96 . tinyurl.com/jxfv2nr . 49 Prince v. Massachusetts , 321 US 158 — 20 “Addressing ,” world Health 34 “Thimerosal in vaccines,” Centers for Disease Supreme Court 1944, http://tinyurl.com/h96as69 . Organization, Nov. 16, 2015, http://tinyurl.com/ Control and Prevention, http://tinyurl.com/ 50 marina Olson, “Should the Government man - hn86evz ; “Global Immunization,” Children’s 25499vu . Also see Kathy Koch, “vaccine Con - date vaccinations?” The American Conservative , Hospital of Philadelphia, vaccine Education troversies,” CQ Researcher , Aug. 25, 2000, pp. Sept. 30, 2013, http://tinyurl.com/hmjdvye . Center, http://tinyurl.com/z7mj4uh . 641-672. 51 michael Gerson, “vaccines and what we 21 Amy Nordrum, “California measles Outbreak 35 Julia Belluz, “The vaccine delayers,” Vox , owe to our neighbors,” The Washington Post , Highlights Global Clash Between Anti-vaccine march 2, 2015, http://tinyurl.com/njcbubc . feb. 2, 2015, http://tinyurl.com/z2uom4h . Parents And Governments,” International Business 36 “vaccines,” Ask Dr. Sears, http://tinyurl.com/ 52 Patrick mcGreevy, “Opponents of new Cali - Times , feb. 5, 2015, http://tinyurl.com/zeckms3 . z9qp5gz ; Paloma Esquivel, “vaccination con - fornia vaccination law begin referendum drive,” 22 Teresa welsh, “Anti-vaccine movements Not troversy swirls around O.C.’s ‘Dr. Bob,’ ” Los Los Angeles Times , July 15, 2015, http://tiny Unique to the U.S.,” U.S. News & World Report , Angeles Times , Sept. 6, 2014, http://tinyurl.com/ url.com/o7dducu . feb. 18, 2015, http://tinyurl.com/pxoyq8l . jc5tbnz . 53 “Let Californians decide about vaccinations: 23 Philip J. Smith et al. , “Parental Delay or Refusal 37 Priyanka Boghani, “Dr. Robert w. Sears: Shannon Kroner and Tim Donnelly,” Los Angeles of vaccine Doses, Childhood vaccination Cov - why Partial vaccinations may Be an Answer,” Daily News , Aug. 3, 2015, http://tinyurl.com/ erage at 24 months of Age, and the Health “frontline,” march 23, 2015, http://tinyurl.com/ h6laukd . Belief model,” Public Health Reports , 2011, zdyhe7f . 54 Dawn Richardson, “The fallout from California http://tinyurl.com/z4ejjfs . 38 Institute of medicine, “The Childhood Im - SB277: what Happens Next?” National vaccine 24 Josh Levs, “The unvaccinated, by the numbers,” munization Schedule and Safety: Stakeholder Information Center, Aug. 5, 2015, http://tinyurl. CNN, feb. 4, 2015, http://tinyurl.com/o48veen . Concerns, Scientific Evidence, and future Stud - com/jn5kn3o . 25 “Possible Side-effects from vaccines,” vac - ies,” The National Academies Press, Jan. 16, 55 Elise viebeck, “Rand Paul: Parents ‘own’ cines and Immunizations, Centers for Disease 2013, http://tinyurl.com/no369fp . children, not the state,” The Hill , feb. 2, 2015, Control and Prevention, http://tinyurl.com/bn59fl . 39 “IOm Report Details Strategy for monitoring http://tinyurl.com/ku4wkue . 26 mariam Siddiqui, Daniel A. Salmon and Saad Safety of Childhood Immunization Schedule,” 56 Roxanne Palmer, “Do Parents weigh The B. Omer, “ of vaccine Hesitancy press release, National Academies Press, Jan. 16, Common Good In vaccine Choices?” Interna - in the United States,” Human Vaccines & Im - 2013, http://tinyurl.com/aeccu8t . tional Business Times , Sept. 5, 2012, http://tinyurl. munotherapeutics , Nov. 18, 2013, http://tinyurl. 40 Tara Haelle, “An Alternative vaccination com/h6e8gj5 . com/zpwy8an ; Yang et al. , op. cit. Schedule Actually Presents more Risks Than 57 maheen Quadri-Sheriff et al. , “The Role of

www.cqresearcher.com Feb. 19, 2016 187 vACCINE CONTROvERSIES

Herd Immunity in Parents’ Decision to vac - National vaccine Information Center, march 2 , movement,” The Atlantic , July 15, 2015, http://tiny cinate Children: A Systematic Review,” Pedi - 2011, http://tinyurl.com/zokcqa7 . url.com/pvfdxev . atrics , August 2012, http://tinyurl.com/j4jxyjn . 71 Richard Anderson, “Pharmaceutical industry 86 Robert m. wolfe and Lisa K. Sharp, “Anti- 58 Jim Norman, “Americans’ views of Pharma - gets high on fat profits,” BBC News, Nov. 6, vaccinationists past and present,” British Med - ceutical Industry Take a Tumble,” Gallup Poll, 2014, http://tinyurl.com/q4v9qus . ical Journal , Aug. 24, 2002, http://tinyurl.com/ Sept. 14, 2015, http://tinyurl.com/zzr2aqg . 72 Elisabeth Rosenthal, “The Price of Prevention: 7x8sc2d . 59 Bianca DiJulio, Jamie firth and mollyann vaccine Costs Are Soaring,” The New York Times , 87 Daniel A. Salmon et al. , “Compulsory vac - Brodie, “Kaiser Health Tracking Poll: August July 2, 2014, http://tinyurl.com/kkxsplw . cination and conscientious or philosophical 2015,” Henry J. Kaiser family foundation, 73 Bourree Lam, “vaccines Are Profitable, So exemptions: past, present, and future,” The Aug. 20, 2015, http://tinyurl.com/hf96pdw . what?” The Atlantic , feb. 10, 2015, http://tiny Lancet , feb. 4, 2006, http://tinyurl.com/jsktekj ; 60 Baum, op. cit. url.com/nhwk98y . The History of Vaccines , op. cit. 61 “former CDC head lands vaccine job at merck,” 74 fangjun Zhou et al. , “Economic Evaluation 88 matthew B. Barry and Jared P. Cole, “The Reuters, Dec. 21, 2009, http://tinyurl.com/h2j3aek . of the Routine Childhood Immunization Pro - measles: Background and federal Role in 62 Susan Thaul, “vaccine Policy Issues,” Con - gram in the United States, 2009,” Pediatrics , vaccine Policy,” Congressional Research Ser - gressional Research Service, updated may 19, April 2014, http://tinyurl.com/qbtn8pb . vice, feb. 9, 2015, http://tinyurl.com/ha45gyx . 2005, http://tinyurl.com/zuxr9yw . 75 Rosenthal, op. cit. 89 Jared P. Cole and Kathleen S. Swendiman, 63 “vaccines and Related Biological Products 76 Alexandra minna Stern and Howard markel, “mandatory vaccinations: Precedent and Cur - Advisory Committee,” food and Drug Admin - “The History Of vaccines And Immunization: rent Laws,” Congressional Research Service, istration, updated Jan. 29, 2016, http://tinyurl. familiar Patterns, New Challenges,” Health may 21, 2014, http://tinyurl.com/j7n6ag4 . com/z46fhxp . Affairs , may 2005, http://tinyurl.com/6n4evnj . 90 Ibid. 64 David willman, “Stealth merger: Drug Com - 77 The History of Vaccines , ibid. ; “variolation,” 91 Sabin Russell, “when polio vaccine backfired/ panies and Government medical Research,” U.S. National Library of medicine, http://tinyurl. Tainted batches killed 10 and paralyzed 164,” Los Angeles Times , Dec. 7, 2003, http://tinyurl. com/ozra83w . The San Francisco Chronicle , April 25, 2005, com/66ql78v . 78 “The Story Of . . . Smallpox — and other http://tinyurl.com/heydzca . 65 marcia Angell, “The Truth About the Drug Deadly Eurasian Germs,” “Guns, Germs and 92 Shari Roan, “Swine flu ‘debacle’ of 1976 is Companies,” The New York Review of Books , Steel,” PBS, 2005, http://tinyurl.com/btqozjz . recalled,” Los Angeles Times , April 27, 2009, July 15, 2004, http://tinyurl.com/hrdofun . 79 “1721: Boston Smallpox Epidemic,” The http://tinyurl.com/nxq2d5 . 66 John Yaphe et al. , “The association between History of Vaccines , http://tinyurl.com/235bs3y . 93 “About National vaccine Information Center,” funding by commercial interests and study out - 80 m. Best, A. Katamba and D. Neuhauser, National vaccine Information Center, Biography, come in randomized controlled drug trials,” Family “making the right decision: Benjamin franklin’s Barbara Loe fisher, http://tinyurl.com/z4y7ab2 . Practice , July 9, 2001, http://tinyurl.com/j3xxx7o . son dies of smallpox in 1736,” Quality & Safety 94 “Pertussis vaccination: Use of Acellular Per - 67 “vaccine Studies: Under the Influence of in Health Care , December 2007, http://tinyurl. tussis vaccines Among Infants and Young Pharma,” National vaccine Information Center, com/mv6aqnw . Children Recommendations of the Advisory feb. 12, 2009, http://tinyurl.com/jttntf5 . 81 Howard markel, “Life, Liberty and the Pursuit Committee on Immunization Practices (ACIP),” 68 Robert f. Kennedy Jr. “mercury & vaccines,” of vaccines,” The New York Times , feb. 28, 2011 , Centers for Disease Control and Prevention, undated, http://tinyurl.com/zf3by23 ; Keith http://tinyurl.com/gmrdxlz . march 28, 1997, http://tinyurl.com/29uhx2k . Kloor, “Robert Kennedy Jr.’s belief in autism- 82 “vaccine Timeline,” Immunization Action 95 Salynn Boyles, “Controversy Surrounds An - vaccine connection, and its political peril,” The Coalition, undated, http://tinyurl.com/69qgqy7 . thrax vaccine,” WebMD Health News , Nov. 8, Washington Post , July 18, 2014, http://tinyurl. 83 “whatever Happened to Polio,” Smithsonian 2001, http://tinyurl.com/zkstfgn . com/o6wbwhg . National museum of American History, http:// 96 “Thimerosal and Childhood vaccines: what 69 Robert f. Kennedy Jr., “Deadly Immunity,” tinyurl.com/bxe8vcv . You Should Know,” minnesota Department of Rolling Stone , feb. 9, 2011, http://tinyurl.com/ 84 Richard Conniff, “A forgotten Pioneer of Health, http://tinyurl.com/hfawy82 ; “Thimerosal gsokt3t ; Kerry Lauerman, “Correcting our record,” vaccines,” The New York Times , may 6, 2013, in vaccines,” Centers for Disease Control and Salon , Jan. 16, 2011, http://tinyurl.com/op3j6p8 . http://tinyurl.com/j4k76vu . Prevention, July 2005, http://tinyurl.com/6qy7je3 ; 70 “No Pharma Liability? No vaccine mandates,” 85 Elizabeth Earl, “The victorian Anti-vaccination “Thimerosal in vaccines,” food and Drug Ad - ministration, http://tinyurl.com/mqyfkd . 97 “BmJ declares mmR study . . .,” op. cit. About the Author 98 Jeffrey P. Baker, “mercury, vaccines, and Autism: One Controversy, Three Histories,” Jane Fullerton Lemons is a freelance writer from Northern American Journal of Public Health (2008), Virginia with more than 25 years of journalism experience. A http://tinyurl.com/pqkexls . former Washington bureau chief for the Arkansas Democrat- 99 “Calling the Shots,” State Legislatures Magazine , Gazette and Farm Journal magazine, she has covered the feb. 1, 2015, http://tinyurl.com/hgn42l2 . White House, Congress, food policy and health care. She is 100 michael Specter, “vermont Says No to the currently seeking a master’s degree in creative nonfiction from Anti-vaccine movement,” The New Yorker , may Goucher College in Towson, Md. 29, 2015, http://tinyurl.com/nseb756 . 101 Rachel LaCorte, “Bill to tighten vaccine

188 CQ Researcher exemptions draws dozens of foes,” The Seattle Times , feb. 19, 2015, http://tinyurl.com/zo8prgv . 102 “vaccination Policies and Rates of Exemp - FOR MORE INFORMATION tion from Immunization, 2005-2011,” The New American Academy of Pediatrics , 141 Northwest Point Blvd., Elk Grove village, IL England Journal of Medicine , Sept. 20, 2012, 60007 ; 847-434-4000 ; www.aap.org/en-us/Pages/Contact.aspx . Association of pediatricians http://tinyurl.com/zwqd2n3 . concerned with the health of children, adolescents and young adults. 103 Saad B. Omer et al. , “School immunizations: Centers for Disease Control and Prevention , 1600 Clifton Rd., Atlanta, GA 30333 ; Study shows accelerated increase of non-medical 404-639-3311 ; www.cdc.gov . federal agency responsible for preventing disease, injury vaccine exemptions,” Emory News Center, and disability. makes recommendations for vaccinations. Sept. 19, 2012, http://tinyurl.com/z54u6rr . Every Child By Two , 1233 20th St., N.w., Suite 403, washington, DC 20036 ; 202- 104 Dawn Richardson “The Stand Against forced 783-7034 ; www.ecbt.org . National nonprofit co-founded by former first lady Rosalyn vaccination Across the States and the NvIC Carter and former Arkansas first lady Betty Bumpers that advocates for timely immu - Advocacy Portal,” National vaccine Information nizations to reduce vaccine-preventable diseases among people of all ages. Center, Jan. 19, 2016, http://tinyurl.com/guuuo9a . 105 Food and Drug Administration , 10903 New Hampshire Ave., Silver Spring, mD Jennifer Steinhauer and Sabrina Tavernise, 20993 ; 1-888-463-6332 ; www.fda.gov /. federal agency responsible for regulating drugs, “Bipartisan Partnership Produces a Health Bill biological products, medical devices, food and cosmetics. That Passes the House,” The New York Times , Generation Rescue , 13636 ventura Blvd., #259, Sherman Oaks, CA 91423 ; 877- July 10, 2015, http://tinyurl.com/j4rkj2q . 106 982-8847 ; www.generationrescue.org /. National organization founded by parents Sarah ferris, “Senate to break up House- that provides information about autism. Actress Jenny mcCarthy is president. passed ‘cures’ bill,” The Hill , Jan. 19, 2016, http:// National Institutes of Health , 10 Center Dr., Bethesda, mD 20892 ; 301-496- tinyurl.com/hdz7l9x . 107 4000 ; www.nih.gov /. Agency of the federal Department of Health and Human Julia Belluz, “This new bill would add $9 Services that serves as the focal point for medical research in the United States. billion for medical research. Here are 5 reasons , 204 mill St., Suite B1, vienna, vA 22180 ; critics are terrified,” Vox , July 14, 2015, http:// National Vaccine Information Center 703-938-0342 ; www.909shot.com . Advocates safety and informed-consent in the mass- tinyurl.com/jv4thvz . vaccination system. 108 “Here Comes the 21st Century Cures Act: Say Goodbye to vaccine Safety Science,” National World Health Organization , Avenue Appia 20m 1211, Geneva, 27, Switzerland ; 41-22-791-2111 ; www.who.int/en /. Coordinates global public health efforts. vaccine Information Center, July 21, 2015 , http:// tinyurl.com/prkud2c . 109 Gregg Gonsalves, mark Harrington and url.com/m7v89p4 . 126 “Global vaccine market Pipeline Analysis,” David A. Kessler, “Don’t weaken the f.D.A.’s 118 “Human Papillomavirus (HPv),” Centers Research and Markets , January 2014, http://tiny Drug Approval Process,” The New York Times , for Disease Control and Prevention, http://tiny url.com/jncptre . June 11, 2015, http://tinyurl.com/zylwyft . url.com/zlb63tt . 127 Noemie Bisserbe and Betsy mcKay, “Drug 110 David Gorski, “The 21st Century Cures 119 “HPv vaccines: vaccinating Your Preteen Industry Starts Race to Develop Zika vaccine,” Act: The (Somewhat) Good, The (mostly) Bad, or Teen,” Centers for Disease Control and The Wall Street Journal , feb. 2, 2016, http://tiny and The (very) Ugly,” Science-Based Medicine Prevention, http://tinyurl.com/jbn6gxa . url.com/zg48eur .; “All Countries and Territories blog, Aug. 10, 2015, http://tinyurl.com/z7tp8o6 . 120 “The HPv vaccine: Access and Use in the with Active Zika virus Transmission,” Centers 111 “House Approves 21st Century Cures Act,” U.S.,” The Henry J. Kaiser family foundation, for Disease Control and Prevention, feb. 5, House Energy and Commerce Committee, Sept. 3, 2015, http://tinyurl.com/jwusm67 . 2016, http://tinyurl.com/z7q6l43 . July 10, 2015, http://tinyurl.com/z3rc6xj . 121 “Teen vaccination Coverage,” Centers for 128 “Ebola vaccines, therapies, and diagnostics,” 112 Steinhauer and Tavernise, op. cit. Disease Control and Prevention, July 30, 2015, world Health Organization, Oct. 6, 2015, http:// 113 Peter Sullivan, “Senators: Science settled http://tinyurl.com/zj8779h . tinyurl.com/k5deeg4 . on vaccines,” The Hill , feb. 10, 2015, http://tiny 122 Jason L. Schwartz and Laurel A. Easterling, 129 “ technology roadmap,” world url.com/ndcowex . “State vaccination Requirements for HPv and Health Organization, November 2013, http://tiny 114 “The Reemergence of vaccine-Preventable Other vaccines for Adolescents, 1990-2015,” url.com/z9b5y27 . Diseases: Exploring the Public Health Successes JAMA , July 14, 2015, http://tinyurl.com/jbaqwmt . 130 “Dengue vaccine Enters Phase 3 Trial in and Challenges,” Senate Committee on Health, 123 Brian Blackstone, “wHO Says Possible Zika Brazil,” National Institute of Allergy and In - Education, Labor and Pensions, feb. 10, 2015, vaccines at Least 18 months Away from Broad fectious Diseases, Jan. 14, 2016, http://tinyurl. http://tinyurl.com/jcahj8x . Trials,” The Wall Street Journal , feb. 12, 2016, com/z3z5zym . 115 michael E. miller, “The GOP’s dangerous http://tinyurl.com/zgzt4jd . 131 “HIv/AIDS,” world Health Organization, ‘debate’ on vaccines and autism,” The Washington 124 “medicines in Development: vaccines,” press Jan. 27, 2014, http://tinyurl.com/gl66v5w . Post , Sept. 17, 2015, http://tinyurl.com/glvj84z . release, Pharmaceutical Research and manu - 132 Gary finnegan, “The future of vaccines,” 116 “HPv mandates for Children in Secondary facturers of America, Sept. 11, 2013, http://tinyurl. The Blog, Vaccines Today , march 27, 2014, Schools,” Immunization Action Coalition, http:// com/hz22kyp . http://tinyurl.com/ny4mjdu . tinyurl.com/zhd6uje . 125 Robert f. Kennedy Jr., “vaccines, government 133 Gary J. Nabel, “Designing Tomorrow’s vac - 117 HPv vaccine Policies,” blog, National Con - & Big Pharma’s dirty money,” WND , July 17, cines,” The New England Journal of Medicine , ference of State Legislatures, undated, http://tiny 2015, http://tinyurl.com/j7hbeyg . feb. 7, 2013, http://tinyurl.com/juaqym9 .

www.cqresearcher.com Feb. 19, 2016 189 Bibliography Selected Sources

Books Parker , Laura , “The Anti-Vaccine Generation: How Move - ment Against Shots Got Its Start,” National Geographic , Donvan , John , and Caren Zucker , In a Different Key: The Feb. 6, 2015 , http://tinyurl.com/kmjdn8d . Story of Autism , Crown Publishers , 2016 . In a 50-year period, childhood vaccinations went from rep - Two television journalists examine the history and politics resenting breakthrough science to a topic of public policy of autism, including a look at concerns about the purported debate. link between autism and vaccines. Reports and Studies Mnookin , Seth , The Panic Virus: The True Story Behind the Vaccine-Autism Controversy , Simon & Schuster , 2012 . “The Childhood Immunization Schedule and Safety: A professor of science writing at the massachusetts Institute Stakeholder Concerns, Scientific Evidence, and Future of Technology examines the ramifications of a discredited Studies,” Institute of Medicine, The National Academies 1998 study linking vaccinations to autism. Press , Jan. 16, 2013 , http://tinyurl.com/no369fp . The Institute of medicine, a component of the National Offit , Paul A. , Deadly Choices: How the Anti-Vaccine Academy of Sciences, conducts a comprehensive review into Movement Threatens Us All , Basic Books , 2012 . the safety of the childhood immunization schedule. A pediatrician who heads the vaccine Education Center at Children’s Hospital of Philadelphia contends that the decision by “The State of the National Vaccine Plan — 2014,” De - some parents not to vaccinate their children endangers everyone. partment of Health and Human Services , 2015 , http://tiny url.com/qfdalmm . Sears , Robert , The Vaccine Book: Making the Right Decision The federal health agency provides its annual update on the for Your Child , Little, Brown , 2007 . department’s work toward meeting its goals of high nation wide A California pediatrician makes the case for an alternate vaccination levels. immunization schedule for young children that has become popular with many vaccine skeptics. “Vaccine Injury Compensation: Most Claims Took Multiple Years and Many Were Settled through Negotiation,” Gov - Articles ernment Accountability Office , Nov. 21, 2014 , http://tiny url.com/mql68yz . Barbash , Fred , “The saddest story Roald Dahl ever wrote The independent watchdog agency of Congress examines — about his daughter’s death from measles — is worth the agency overseeing vaccine injury claims and found nu - reading today,” The Washington Post , Feb. 2, 2015 , http:// merous problems with the process. tinyurl.com/mv7m4xw . A journalist recounts the story of how children’s book author Cole , Jared P. , and Kathleen S. Swendiman , “Mandatory Roald Dahl lost his 7-year-old daughter to measles. Vaccinations: Precedent and Current Laws,” Congressional Research Service , May 21, 2014 , http://tinyurl.com/j7n Earl , Elizabeth , “The Victorian Anti-Vaccination Movement,” 6ag4 . The Atlantic , July 15, 2015 , http://tinyurl.com/pvfdxev . A report by Congress’ independent research arm examines Current vaccine controversies are similar to 19th-century past and present laws concerning vaccination. protests against mandatory vaccinations. Documentaries Kloor , Keith , “Robert Kennedy Jr.’s belief in autism- vaccine connection, and its political peril,” The Wash - Palfreman , Jon , and Kate McMahon , “The Vaccine War,” ington Post , July 18, 2014, http://tinyurl.com/o6wbwhg. PBS/Frontline , March 24, 2015 , http://tinyurl.com/p5znqab . A science writer examines Robert f. Kennedy Jr.’s continued A pair of Oregon filmmakers examines the science and belief in the link between autism and vaccines and how he politics of vaccine safety in this multi-part documentary, with has become a leading vaccine skeptic. interviews and segments from all sides.

Omer , Saad B., Walter A. Orenstein and Jeffrey P. Koplan, Pemberton , Sonya , “Vaccines — Calling the Shots,” PBS/ “Go Big and Go Fast — Vaccine Refusal and Disease NOVA , Aug. 26, 2015 , http://tinyurl.com/hz9hl5u . Eradication,” New England Journal of Medicine , April 11 , An Australian journalist produces a television documentary 2013, http://tinyurl.com/z5mkhbo. that tracks global epidemics, explores the science behind A trio of Emory University doctors outlines obstacles to vaccines and airs the views of parents wrestling with vaccine- vaccination and how the medical community can work to related questions and concerns. overcome them.

190 CQ Researcher The Next Step: Additional Articles from Current Periodicals

Drug Companies O’Brien , Matt , “Move made to roll back HPV vaccine mandate for R.I. students,” The Associated Press , Jan. 18, 2016 , Bisserbe , Noemie , and Betsy McKay , “Drug Industry http://tinyurl.com/go2nxpr . Starts Race to Develop Zika Vaccine,” The Wall Street Rhode Island anti-vaccination activists are working with a Journal , Feb. 2, 2016 , http://tinyurl.com/zg48eur . state lawmaker to introduce legislation allowing parents to Pharmaceutical companies are competing to develop a request philosophical exemptions from a state requirement vaccine against the rapidly spreading Zika virus, an illness that students receive the HPv vaccine before entering seventh linked to birth defects and nerve damage, though a vaccine grade. will likely be unavailable for several years. Side Effects Keller , Jared , “Why the New Is a Minor Miracle,” Pacific Standard , Aug. 10, 2015, http://tinyurl. Fifield , Anna , “The science doesn’t support them, but com/zhrmpsc . Japanese anti-vaxxers are winning on HPV,” The Wash - The world Health Organization worked with drug companies ington Post , Nov. 10, 2015 , http://tinyurl.com/q8lwbz5 . to expedite development of an Ebola vaccine that achieved The Japanese government stopped recommending that girls a 100 percent success rate, accelerating a research process ages 12 to 16 receive HPv vaccines in 2013 after several that would normally take more than a decade. hundred girls among more than 1,700 who were vaccinated suffered severe pain or motor impairment. Exemptions Hutkin , Erinn , “Officials hope to dispel vaccine fears with Chambers , Jennifer , “Michigan’s school vaccination waiver new law,” The San Diego Union-Tribune , Aug.4, 2015 , rate drops 39%,” The Detroit News , Jan. 28, 2016 , http:// http://tinyurl.com/gn42trg . tinyurl.com/go2yr69 . California physicians hope that a new state law barring re - The number of non-medical vaccination exemptions requested ligious and other non-medical vaccination exemptions for by parents in michigan dropped 39 percent in the first five schoolchildren will help to dispel some parents’ fears about months of the 2015-16 school year after the state began re - vaccinations’ side effects. quiring parents in January 2015 to meet with local health department staff to obtain waivers. Neporent , Liz , “Serious Measles Vaccine Side Effects Ex - tremely Rare, Doctors Say,” ABC News , Feb. 3, 2015 , Feller , Stephen , “AMA supports tighter limit on non-medical http://tinyurl.com/las9wpp . vaccine exemptions,” United Press International , June 10, Adverse side effects of measles and mumps vaccines, such 2015 , http://tinyurl.com/jc6rx8d . as allergic reactions and brain damage, are extremely rare, The American medical Association issued a policy recom - while the dangers of contracting those diseases far outweigh mendation that states work with public health physicians to the risks of vaccination, say medical experts. create school vaccination policies that limit parents from re - questing non-medical vaccination exemptions. CITING CQ RESEARCHER Sample formats for citing these reports in a bibliography Kellner , Mark A. , “ ‘Religious’ objections to vaccinations? There really aren’t any,” Deseret News , Feb. 7, 2015 , http:// include the ones listed below. Preferred styles and formats tinyurl.com/hgrz8m9 . vary, so please check with your instructor or professor. Thousands of students in states such as Illinois received ex - emptions from vaccination requirements in 2012 for religious mLA STYLE reasons, yet no major religions explicitly forbid followers from Jost, Kenneth. “Remembering 9/11.” CQ Researcher 2 Sept. receiving immunizations, according to a vaccine researcher. 2011: 701-732.

Human Papillomavirus APA S TYLE Jost, K. (2011, September 2). Remembering 9/11. CQ Researcher, Haelle , Tara , “CDC Endorses A More Effective HPV Vaccine To Prevent Cancer,” NPR , Feb. 3, 2016 , http://tinyurl.com/ 9, 701-732. zwzhmfr . An updated vaccine schedule from the Centers for Disease CHICAGO STYLE Control and Prevention recommends that children ages 11 or Jost, Kenneth. “Remembering 9/11.” CQ Researcher , September 12 receive vaccines against nine strains of HPv and that children 2, 2011, 701-32. with histories of sexual abuse receive vaccines at ages 9 or 10.

www.cqresearcher.com Feb. 19, 2016 191 In-depth Reports on Issues in the News

Are you writing a paper? Need backup for a debate? Want to become an expert on an issue? for 90 years, students have turned to C?Q Researcher for in-depth reporting on issues in the news. Reports on a full range of political and social issues are now available. following is a selection of recent reports:

Civil Liberties Education Health/Safety Privacy and the Internet, 12/15 video Games and Learning, 2/16 fighting Cancer, 1/16 Intelligence Reform, 5/15 free Speech on Campus, 5/15 Dietary Supplements, 10/15 Religion and Law, 11/14 Teaching Critical Thinking, 4/15 Doctor Shortage, 8/15 Treating Alzheimer’s Disease, 7/15 Crime/Law Environment/Society manipulating the Human Genome, 6/15 Restorative Justice, 2/16 Racial Conflict, 1/16 Pesticide Controversies, 6/15 The Dark web, 1/16 Religious freedom, 1/16 Immigrant Detention, 10/15 Transgender Issues, 12/15 Politics/Economy fighting Gangs, 10/15 Air Pollution and Climate Change, 11/15 Unrest in Turkey, 1/16 Reforming Juvenile Justice, 9/15 Housing Discrimination, 11/15 Robotics and the Economy, 9/15 Police Tactics, 12/14 marijuana Industry, 10/15 European migration Crisis, 7/15 Campus Sexual Assault, 10/14 far-Right Extremism, 9/15 Restoring Ties with Cuba, 6/15 Upcoming Reports virtual Reality, 2/26/16 U.S.-Iran Relations, 3/4/16 Arbitration, 3/11/16

ACCESS CQ Researcher is available in print and online. for access, visit your library or www.cqresearcher.com.

STAY CURRENT for notice of upcoming CQ Researcher reports or to learn more about CQ Researcher products, subscribe to the free email newsletters, CQ Re - searcher Alert! and CQ Researcher News : http://cqpress.com/newsletters.

PURCHASE To purchase a CQ Researcher report in print or electronic format (PDf), visit www.cqpress.com or call 866-427-7737. Single reports start at $15. Bulk purchase discounts and electronic-rights licensing are also available.

SUBSCRIBE Annual full-service CQ Researcher subscriptions—including 44 reports a year, monthly index updates, and a bound volume—start at $1,131. Add $25 for domestic postage.

CQ Researcher Online offers a backfile from 1991 and a number of tools to simplify research. for pricing information, call 800-818-7243 or 805-499-9774 or email [email protected].