The Confidence Gap

Why the Obama administration needs to restore public faith in the safety of childhood vaccines.

The mainstream media applauded the U.S. federal “vaccine court”‘s decision Feb. 12 that the MMR vaccine and vaccines containing ethyl mercury as a preservative did not cause autism in three children chosen as test cases. But that’s not enough to repair the damage already done to the U.S. vaccine program.

It’s hard for a single court decision to compete with ongoing allegations from grieving parents and celebrities that vaccines created an epidemic of autism. Those allegations have generated confusion and fear in the minds of many young parents, reduced public trust in the remarkable benefits and safety of U.S. immunization programs and put both vaccinated and unvaccinated children at increased risk from preventable diseases. Furthermore, significant unanswered questions about the safety of vaccines have been documented by the Institute of Medicine and the National Institutes of Health. For example, are some few individuals genetically more susceptible to adverse reactions from certain vaccines? A more common worry among parents is “Are too many vaccines given too soon?”

Parents of newborn infants can’t take two years of study, as did the vaccine court, to sort out sound science from junk, innuendo and unsubstantiated allegation. As a result, rates of vaccine refusal have climbed to levels allowing clustered outbreaks of vaccine-preventable diseases such as measles, pertussis and meningitis, posing a threat to those unvaccinated because of medical contraindications, age and parental choice. For example, in Washington, statewide refusal rates now exceed 5 percent, including rates exceeding 15 percent in some counties. Other states show doubling rates. Also worrisome is the disproportionate amount of time pediatricians must now spend to assure fearful parents that vaccination is the best choice for their child. At what level will the growing refusal rates put us at risk of major epidemics?

What has been missing in order to give parents confidence that immunization is one of the best ways to protect the health of their children? Our national failure falls into two categories. First, we’ve had inadequate ongoing, credible education of the public and health professions from trusted public-health officials concerning the known and unknown benefits and risks of vaccines. Today’s parents have little fear of diseases they mistakenly think have been eliminated by vaccines. Second, there’s been grossly insufficient investment in research on the safety of immunization. Together, these failures contributed to undermining of public confidence.

This is not the first time parental concern has threatened to deprive our children of the benefits of immunization. In the early 1980s, a spate of lawsuits threatened to drive vaccinemakers and doctors out of the immunization business. Then three highly polarized groups—parents who believed vaccines injured their children, vaccine companies and pediatricians—collaborated to create the National Childhood Vaccine Injury Act of 1986 (NCVIA). That law, a pragmatic, compromise solution, saved a then-fragile U.S. immunization effort. It offered financial relief to vaccine-injured children, prevented the demise of a vaccine industry that had dwindled rapidly from 26 to four companies and protected pediatricians whose careers then were being jeopardized by malpractice suits, even though they were properly administering vaccines. Over the past two decades, that law has distributed $1.8 billion with financial compensation to more than 2,200 families and individuals, encouraged dramatic expansion of the vaccine industry and allowed pediatricians to remain the mainstay of our successful immunization program.

The vaccine injury act put the secretary of the Department of Health and Human Services (HHS) in charge of planning and monitoring the effectiveness and safety of our national immunization program. There’s plenty of financial incentive for industry, venture capitalists, government agencies, clinicians and the academic community to develop and distribute vaccines. In contrast, without federal government investment, no such incentives are available to support research on vaccine safety.

The responsibility for development, licensing, purchase, distribution and monitoring of vaccines is divided among a handful of federal agencies. Because of the wide range of scientific skills needed to study the safety of vaccines, we need a coordinated plan with funds to match. But no such plan has ever been put in effect. (In the last few months of his tenure under President George W. Bush, HHS Secretary Michael Leavitt did make some progress, but the effort was unfunded, incomplete and hampered by his short, lame-duck status.)

What remains to be done? The incoming secretary of HHS, with the backing of the White House, must carry out aggressively the duties assigned by the 1986 law: development and implementation of a national vaccine plan that includes adequate funds for communication and vaccine-safety research. Given the current distrust of government, development and accountability for the plan deserves serious, transparent input, not just by scientists but also by more than token participation of the public. It is that public whose trust has been eroded.

As parents, grandparents and health professionals, we know how immunization has revolutionized child health. But to maintain that progress, we must restore public trust in vaccinations. Ignoring public anxiety about childhood vaccines—and the increase in parents who skip or stretch out immunizations—risks even more serious outbreaks of vaccine-preventable diseases. We need visible leadership from the incoming secretary of HHS, supported by President Obama. The new public-health team must describe clearly the known benefits and risks of vaccines—and take into account safety issues as perceived by the public and scientific community. We know the new administration has a long list of problems to confront, but there are few issues more urgent than the health of our children. We hope they act quickly.