the vaccine war

Transcript

The Vaccine War

PRODUCED BY
Jon Palfreman

CO-PRODUCER
Kate McMahon

WRITTEN AND DIRECTED BY
Jon Palfreman

ANNOUNCER: Tonight on FRONTLINE: They're hailed as medicine's greatest triumph, conquering smallpox, diphtheria, polio and more.

PAUL OFFIT, M.D., Children's Hospital of Philadelphia: If you look at vaccines over the past hundred years, they've increased our lifespan by 30 years.

ANNOUNCER: But today some Americans question if all those vaccines are worth the risk.

JENNIFER MARGULIS, Parent, Ashland, OR: And I said, "Why am I supposed to vaccinate my newborn baby against a sexually transmitted disease?" And the nurse got really mad.

ANNOUNCER: And some parent groups attack vaccines as the cause of chronic diseases from ADHD to autism.

J.B. HANDLEY, Founder, Generation Rescue: My kid got six vaccines in one day and he regressed.

JENNY MCCARTHY, Spokesperson, Generation Rescue: Would I rather have the measles versus autism? We'll sign up for the measles.

ANNOUNCER: Despite numerous scientific studies that say vaccines are safe, public concern persists. The result: outbreaks of infectious diseases not seen for a generation.

DONNA BRADSHAW-WALTERS, M.D., Pediatrician, Ashland, OR: We are not living in a bubble. It's just a matter of time before someone brings that disease into our community.

ANNOUNCER: As public health officials struggle to communicate with a skeptical public, they face a radically changed social media environment, where YouTube videos spread virally across the Internet.

REPORTER: A regular flu shot gone horribly wrong.

Dr. PAUL OFFIT: These people were much more likely to believe something they had seen on YouTube than the Centers for Disease Control and the FDA. That's a little frightening.

ANNOUNCER: Tonight, FRONTLINE reports on the science and politics of the bitter Vaccine War.

DELIVERY ROOM STAFF: [home video] What a cute little face. Here we come! It's a girl! She's beautiful. What's her name? Rachel.

NARRATOR: A new life begins. Out of her mother's womb, Rachel Murphy is now surrounded by a new world filled with countless germs. Modern medicine will do what it can to protect her. Barely an hour old, Rachel gets her first shot, against hepatitis B. This is the first of up to 35 inoculations she will get in the next six years of her life to fight 14 diseases.

[on screen: diphtheria, Hib disease, hepatitis A, hepatitis B, influenza, measles, meningitis, mumps, pertussis, pneumonia, polio, rotavirus, rubella, tetanus]

NARRATOR: Public health doctors celebrate vaccines as one of medicine's shining achievements.

PAUL OFFIT, M.D., Children's Hospital of Philadelphia: They've increased our lifespan by 30 years. Hib would cause 20,000 to 25,000 cases a year. Gone. I mean, polio would paralyze, you know, tens of thousands of children every year. Gone. I mean, diphtheria was the most common killer of teenagers in the 1920s. Gone. I mean, you know, vaccines- the benefit of vaccines is clear.

MELINDA WHARTON, M.D., M.P.H., Centers for Disease Control and Prevention: Well, there's now 16 diseases that are preventable by vaccination for children. Fourteen of those are diseases that we vaccinate infants and young children for, and two of them are diseases that we vaccinate adolescents. From my point of view, being able to prevent 16 diseases by vaccination is a really good thing.

NARRATOR: But not everyone agrees. Across America, the CDC has discovered certain communities where parents are hesitating to vaccinate their children. One is Ashland, Oregon.

JENNIFER MARGULIS, Parent, Ashland, OR: This is our neighborhood and we love it because we can walk everywhere. Ashland is a very safe town compared to almost every place else in America.

NARRATOR: It's a college town, the home of an annual Shakespeare festival, where a well-off, educated populace has easy access to alternative medicines, an organic food co-op and yoga centers. Jennifer Margulis, a writer with a Ph.D. in English literature, is the mother of four children.

JENNIFER MARGULIS: When my daughter was born in 1999, the nurse bustled in with her tray and said, "OK, it's time for your hepatitis B vaccine." And I looked at my daughter and I looked at the nurse and I said, "Isn't hepatitis B a sexually transmitted disease?" And I said, "Why am I supposed to vaccine my newborn baby against a sexually transmitted disease?" And the nurse got really mad.

NARRATOR: Margulis went on to research and write about vaccines, and in 2009 published a long article about the vaccine debate in Mothering magazine, a magazine promoting a natural lifestyle.

JENNIFER MARGULIS: Why are we giving children so many vaccines? They get four times the number of vaccines than I got when I was child growing up in the '70s. As a parent, I would rather see my child get a natural illness and contract that the way that illnesses have been contracted for at least 200,000 years that homo sapiens have been around. I'm not afraid of my children getting chicken pox. There are reasons that children get sick. Getting sick is not a bad thing.

NARRATOR: In common with many other Ashland parents, Margulis decided not to fully vaccinate her other children. Ashland has one of the lowest vaccination rates in the country…. an estimated 28% of its children lack some or all of their recommended vaccines.

DONNA BRADSHAW-WALTERS, M.D., Pediatrician, Ashland, OR: So we're going to need today the D-TAP number 5, your final polio-

NARRATOR: Pediatrician Dr. Donna Bradshaw-Walters worries that these parents may unwittingly bring back diseases that haven't been seen for decades.

Dr. DONNA BRADSHAW-WALTERS: The possibility of an outbreak is real here in Ashland. We are not living in a bubble, especially in this day and age of international travel. Our Shakespeare festival draws people from all over the world, and it's just a matter of time before someone comes to here from another area who is unimmunized and who has the disease and brings that disease into our community.

NARRATOR: There are many pro-vaccine parents in Ashland who agree, like Lorie Anderson, whose adopted son, Evan, is fully vaccinated.

LORIE ANDERSON: It's an outbreak waiting to happen. And so I don't just care about my own child. My child may be well protected because of his vaccination. But I hate to see people get hurt, injured, die, have to be quarantined, isolated because of an outbreak that is preventable with a vaccine. All they have to do is sign an exemption and their kid is exempt from immunization before they go to school.

I will try not to be angry. I hope it doesn't get contentious. It will, though. It will get contentious if there's an outbreak. If vaccinated children start to get breakthrough disease because of the high rate of unvaccinated children, it will probably get ugly.

NARRATOR: The CDC tracks outbreaks of infectious diseases around the country from its center in Atlanta. In 2008, for example, there were numerous small pockets of infection. One involving measles erupted in an under-vaccinated area of San Diego.

Like most measles outbreaks, it came from abroad. It began when an infected 7-year-old returned from a family vacation in Switzerland on January 15th. The child gave measles to two siblings, and collectively, they infected classmates at the San Diego Cooperative Charter School in Linda Vista. A visit to the Children's Clinic of La Jolla spread the infection to four others. One of these, an infant, flew on a plane to Hawaii, where she was intercepted and quarantined. Her fellow 250 passengers had to be contacted and tracked.

Dr. Wilma Wooten is San Diego County's public health officer.

WILMA WOOTEN, M.D., M.P.H., Public Health Officer, San Diego: This entire process resulted in exposures of almost 1,000 individuals, 90 with no proof of immunization, 73 were quarantined, 12 additional actual cases of measles in San Diego.

NARRATOR: Public health officials determined that what allowed measles to enter the community was the number of vaccine-hesitant parents who took advantage of the personal belief exemption allowed by California.

School principals find themselves caught on the front lines.

WENDY RANCK-BUHR, Principal, SD Cooperative Charter School: The fact is that some families choose not to immunize their children. And then there are families who have children who are particularly medically sensitive, and they're in jeopardy because they could get sick from unimmunized children. So it's a very emotional issue on both sides.

NARRATOR: A vast public health infrastructure is committed to preventing such outbreaks, the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control and Prevention, large vaccine manufacturers. The mainstream medical establishment speaks with one voice: Vaccines are a public health miracle far too valuable to put at risk.

Emilio Emini has spent his life making vaccines in America's pharmaceutical companies. He heads Pfizer's vaccine operation.

EMILIO EMINI, Ph.D., Pfizer, Inc.: People haven't seen these diseases in a while, so people become complacent. They don't vaccinate. And what they wind up doing is putting their children and themselves in considerable risk of a severe disease and infection. Polio, even though people aren't worried about it because they haven't seen much of it, is still present in many parts of the world, and it can easily be introduced into a non-vaccinated population. And from what we've seen in other parts of the world, once it's introduced, it will spread very rapidly and cause a lot of disease.

[public service commercial]

LUCILLE BALL: The fear, my friends, is polio. But soon, perhaps within a year, there may be a vaccine.

DESI ARNAZ: Thanks for visiting with us. Hey, kids, how bout saying good-bye, huh?

KIDS: Good-bye!

ANTHONY FAUCI, M.D., Dir., Natl. Inst. of Allergy and Infectious Disease: When I was a child and the big scare was polio, where you would see your friends playing ball outside with you, baseball and basketball, and all of a sudden get sick and be in bed, be in an iron lung, and then come out with a deformity, a serious limp or a serious physical disability- that is absolutely frozen in your mind as a very scary scenario.

PAUL OFFIT, M.D., Children's Hospital of Philadelphia: I think we're compelled by our own fears. And certainly, for my parents, who- you know, who grew up in the 1920s and '30s and '40s, saw these infections. They saw what they could do. For them, vaccines was an easy sell.

NARRATOR: Paul Offit is a pediatrician and co-inventor of a vaccine against rotavirus, a pathogen that causes serious fever, vomiting and diarrhea.

Dr. PAUL OFFIT: I grew up in the 1950s and '60s. I saw measles. I had measles. I had mumps. I had German measles. I mean, I knew what those diseases could do. I watched my friends also be sickened by those diseases. And so for me, vaccines was an easy sell. I think for people now, young mothers today not only don't see these diseases, they didn't even grow up with these diseases. So for them, vaccination becomes a matter of faith.

NARRATOR: But the faith of some parents has eroded. Offit, for example, is seen in some quarters not as a hero for inventing a successful vaccine but as a self-interested entrepreneur whom skeptics call "Dr. Profit."

ROBERT F. KENNEDY, Jr.: They all have this guy, Paul Offit. You guys know him?

CROWD: Boo!

ROBERT F. KENNEDY, Jr.: And he is the poster child for the term "biostitute." Does not disclose the millions of dollars-

NARRATOR: For such critics, the fact that vaccines have made Offit rich is enough to discount what he is saying. But Offit, a prolific author, makes no apologies.

Dr. PAUL OFFIT: I'm the co-inventor of a rotavirus vaccine, a vaccine that I made in collaboration with Merck, and it's a vaccine which has caused a dramatic decrease in this country in hospitalization, and has caused already a dramatic decrease in hospitalization and death in some countries in the developing world. I'm enormously proud of that. I would argue that I have an expertise in rotaviruses and-

INTERVIEWER: But you also financially benefit from that vaccine.

Dr. PAUL OFFIT:: It's- it's- I know this isn't going to- going to sell. But it doesn't matter. It doesn't matter whether I financially have benefited or not. The only thing that mattered is- is- did the vaccine that we created at Children's Hospital of Philadelphia do what it was claimed to do? Has it prevented hospitalization and suffering and death? And the answer to that question is yes.

JENNIFER MARGULIS: It's a mistake that we have a vaccine against rotavirus, the vaccine that Paul Offit helped to develop. In the third world, maybe people are dying of rotavirus, but in this country, you have to do back flips to show a death toll of people from rotavirus.

ARTHUR CAPLAN, Ph.D., Center for Bioethics, Univ. of Pennsylvania: Well, one of the bitter ironies of vaccination is it carries with it the problems of its own success.

NARRATOR: Author and bioethicist Arthur Caplan runs a special program at U. Penn. on the ethical issues surrounding vaccines.

ARTHUR CAPLAN: Many parents are not thinking about the risk side of disease because they don't see those diseases. They've never seen any child rendered deaf by the mumps. They've never seen somebody who's had a case of polio. I had polio. I was in the hospital, paralyzed legs and neck, for about a year. So I know firsthand what the polio epidemic looked like. I was sort of at the last outbreak before the vaccines really came on line and eliminated it.

NARRATOR: Vaccine-preventable diseases like polio have become vanishingly rare in the United States, so rare, in fact, that most younger doctors have never seen a case. This is one of the few places where you can see what vaccine-preventable diseases look like. This is a case of pertussis, also known as whooping cough. The audience is made up of paramedic students.

CYNTHIA CRISTOFANI, M.D., Pediatric Intensivist: She can't breathe, and that's horrifying for any patient at any age to discover that your airway has closed and you can't inhale.

NARRATOR: The teacher, Dr. Cynthia Cristofani, is a pediatric intensivist who treats children in need of critical care. She decided several years ago to document the rare cases of vaccine-preventable illness that turned up in her Portland, Oregon, ICU. She uses the footage to teach other medics how to recognize these diseases.

Dr. CYNTHIA CRISTOFANI: I'm old enough to have seen most of the serious life-threatening illnesses that are largely suppressed and some almost eradicated by the modern vaccines.

This baby was a victim of rotavirus. There's major fluid deficiency in this child's tissues. Actually kills over half a million humans annually, most of them elsewhere on the planet.

The community recollection for these diseases has largely disappeared, and so the parents of younger kids who are of vaccine age are unlikely to have had any personal experience. And unless the grandparents or others can tell them what it was like and happen to have had knowledge of somebody who had a severe complication, it's easy to imagine that these diseases are eradicated.

Those spots are actually something probably none of you have ever seen. They're chicken pox. This patient had one of the commoner potentially lethal complications of chicken pox. He got strep sepsis from an infected lesion. This child came as close to dying of chicken pox as you can come without doing it. And so I encourage you remember that chicken pox also can cause fatalities, even though most people used to think of it as a rite of passage in childhood and we all got it. You can do better than that. There's a vaccine.

This one's a scary one. This is haemophilus influenza type B meningitis. And he was actually the last patient I ever saw with this disease. I can tell you it was the scourge of pediatrics when I was in training because there was no vaccine. But beware. It could come back if people stop vaccinating.

JENNIFER MARGULIS: Why are we giving children so many vaccines? There's no more polio in the United States and there's no more diphtheria in the United States. And no one, no child, has contracted wild polio since 1979 in the United States. So when do we take polio off the vaccine schedule? When do we say, "Fantastic. The vaccine worked. We figured it out. We don't have a polio epidemic anymore. Let's stop vaccinating against polio."

NARRATOR: As vaccine-preventable diseases have become less visible, some Americans have become more concerned about the risks posed by vaccines than by the diseases they prevent. Public health officials like NIH's Anthony Fauci have struggled with how to communicate the risks of vaccines without causing undue fear of common side effects, such as mild fevers, and serious adverse events that are extremely rare.

ANTHONY FAUCI, M.D., Dir., Natl. Inst. of Allergy and Infectious Disease: To say that there is no risk in any vaccine would not be truthful. What is the risk of injecting something into someone's arm? The risk is that a certain proportion of people will get swelling and a little bit of pain, lasting from an hour to a day. That is a very acceptable risk.

A very, very, very small percentage of people will get an allergic reaction. Namely, there's a component to the vaccine that they didn't realize that they were allergic to.

And then there's a subset of a very, very, very, very small percentage of those who actually can get a serious reaction. But if you look at that, the risk of that is so minusculely small as to be completely outweighed by the benefit.

[www.pbs.org: Fauci's extended interview]

NARRATOR: The CDC's Web site tries to convey all these risks accurately. even when scientists are not sure the vaccines are, in fact, responsible. Here's what it says about the measles vaccine:

["Severe problems very rare. Several other severe problems have been known to occur after a child gets MMR vaccine. But this happens so rarely, experts cannot be sure whether they are caused by the vaccine or not. These include deafness, long-term seizures, coma, or lowered consciousness, permanent brain damage."]

Dr. PAUL OFFIT: When the CDC communicates risks, they fall into two groups. One is- are those risks that are very rare but, in fact, are real.

DONNA BRADSHAW-WALTERS, M.D., Pediatrician, Ashland, OR: Sometimes very rarely can cause a rash later on.

Dr. PAUL OFFIT: And the other are those risks that have been reported following a vaccine but for which we have no evidence that the vaccine actually caused the problem. Those, I would argue, are at best theoretical.

BARBARA LOE FISHER, Pres., National Vaccine Info. Ctr.: My son was a bright, precocious, healthy 2-and-a-half-year-old child in 1980 when I took him in for his fourth DPT shot.

NARRATOR: Barbara Loe Fisher runs an independent watchdog organization dedicated to vaccine safety issues. It's an organization she helped found in 1982 after her son suffered a serious vaccine side effect.

BARBARA LOE FISHER: To make a long story short, after that, he regressed physically, mentally and emotionally and became a totally different child. He was actually diagnosed with multiple learning disabilities and attention deficit disorder and had to remain in a classroom for the learning disabled throughout his public school.

NARRATOR: Fisher's organization lobbied successfully for laws that promote vaccine safety. Today, a much safer vaccine has replaced DPT. The laws also created a special vaccine court to evaluate and compensate victims of adverse vaccine side effects.

BARBARA LOE FISHER: Vaccines are pharmaceutical products that inherently carry a risk of injury or death. And that risk can be greater for some than others, particularly for genetic or biological high risk reasons that have- some of which have been identified and some which have not been identified.

NARRATOR: Surveys show about one third of Americans worry about rare but serious vaccine side effects. But one fear has come to dominate the vaccine war, the fear that vaccines are responsible for autism, a mysterious disorder that appears to be on the rise. The theory that vaccines could cause autism has become well known, partly due to the advocacy of vocal celebrities like Jenny McCarthy and Jim Carrey.

JIM CARREY, Actor/Activist: You're a shining example of unconditional love, and we're so proud to be here.

JENNY MCCARTHY, Spokesperson, Generation Rescue: Today I am not a celebrity. Today I am a mom of a child who had autism.

NARRATOR: Former Playboy playmate Jenny McCarthy knew little about autism until her son, Evan, received a series of vaccines, including the shot for mumps measles and rubella, the MMR triple shot. A few weeks later, Evan developed seizures and was diagnosed with autism.

JENNY MCCARTHY: So I left that office devastated, hopeless. The next day, or maybe it was even that night, went on Google and typed in "autism."

NARRATOR: She found the site for Generation Rescue.

JENNY MCCARTHY: So I clicked on Generation Rescue, and I found this community of parents.

NARRATOR: Generation Rescue is run by businessman J.B. Handley. Handley's son was diagnosed with autism following a series of shots in 2004. At the time, he'd also gone on the Web and discovered a community of parents with stories to share.

J.B. HANDLEY, Founder, Generation Rescue: There were literally tens of thousands of parental reports of children regressing and changing after vaccine appointments.

["My child was fine before the vaccine." "The vaccine made Sam autistic." "He completely changed." "After the MMR, he wouldn't look at us." "Cole just stopped speaking." "He got the shot. We started losing him."]

NARRATOR: The vaccine most often blamed in these stories was the MMR triple shot for measles, mumps and rubella.

DONNA BRADSHAW-WALTERS, M.D., Pediatrician, Ashland, OR: Then she would get her second MMR-

J.B. HANDLEY: Few people without kids today realize that when a child goes in for a doctor's appointment - and they're required to go in at 2 months, 4 months, 6 months and 12 months to get their initial vaccines - there are literally somewhere between five and seven vaccines lined up on the table that are all given simultaneously within about 12 minutes.

PHYSICIAN: Your daughter will be protected against five things- diphtheria, tetanus, whooping cough, polio and Hib.

J.B. HANDLEY: Well, tens of thousands of parents have reported that their kid was never the same after those appointments. The second data point is the knowledge that vaccines cause brain injury in a small segment of the population. We know that. The federal government knows it. They pay money to kids who've been injured that way. This is something that's been known for years. And then we also know that the number of vaccines given has risen dramatically. So it does not take a rocket scientist to draw a possible correlation between the vaccines being given and the brain injury that our children are suffering because autism is brain injury.

NARRATOR: Combining his resources and her celebrity, Handley and McCarthy have been highly effective at organizing a movement of concerned parents.

JENNY McCARTHY: Hi. I'm Jenny McCarthy. I am here today to beg you guys-

NARRATOR: The science that gave the movement its original impetus was a 1998 article by British gastroenterologist Andrew Wakefield in the medical journal The Lancet. He reported on 12 children with gastrointestinal problems, 8 of whom developed symptoms of autism following an MMR shot. Wakefield's theory was that the measles vaccine inflamed the intestines, causing harmful proteins to leak into the bloodstream, eventually damaging the brain and causing autism.

Dr. ANDREW WAKEFIELD: Measles, mumps and rubella given together may be too much for the immune system of some children to handle. Clearly, for the vast majority, it is protective, and we must emphasize that it is just a small cohort of children, we don't know how large, but who have appeared to have developed the syndrome.

NARRATOR: News of Wakefield's provocative Lancet article spread across the world, creating fear that measles shots might cause autism.

ERIC FOMBONNE, M.D., McGill University: There was a dramatic decline in the coverage of young children with measles vaccines.

NARRATOR: Autism expert Eric Fombonne was working in London at the time.

Dr. ERIC FOMBONNE: There were areas, like in urban areas, where it was even lower than 80 percent. And in Ireland, in particular, vaccine coverage fell to close to 70 percent, and there was a big outbreak of measles occurring as a result of that fear. One hundred and ten infants were admitted in hospitals in critical conditions, and I think three of them died from measles. And measles is a preventable disease.

Dr. PAUL OFFIT: Parents reasonably thought, "My child was fine. They got an MMR vaccine, then they developed the first symptoms of autism. Could it have been the MMR vaccine that caused that autism?" That's a perfectly reasonable question.

NARRATOR: The fact that two events happen close together might mean they are causally related, but it could also be simple coincidence.

Dr. ERIC FOMBONNE: This vaccination is given at an age where often the first symptoms of autism emerge. And typically, it occurs around 15 or 18 month of age, when these children start to walk, also when we expect them to develop language, which they usually fail to do.

Dr. ANTHONY FAUCI: There are a certain set of diseases that become apparent when children reach a certain age. That's not cause and effect.

Dr. PAUL OFFIT: Just because one event followed another, it doesn't mean it was caused by the other. I mean, every morning, the rooster crows, the sun comes up. It doesn't mean the rooster's causing the sun to come up. The question is, was it caused by it?

["Larry King Live"]

JIM CARREY, Actor, Parent: Autism is the canary in the coal mine. I believe that it's telling people that this vaccine program is imbalanced. It's a good thing that's gone too far.

LARRY KING: Isn't the problem here, Jenny, that people sometimes casual or listen with one ear are going to panic and not vaccine at all?

JENNY McCARTHY: Probably. But guess what? It's not my fault. The reason why they're not vaccinating is because the vaccines are not safe.

What we are saying is that the number of vaccines given, and the ingredients, like the fricking mercury, the ether, the aluminum, the-

NARRATOR: Vaccine critics questioned not only MMR but the many ingredients in vaccines. These included aluminum, formaldehyde, formalin, yeast protein and a mercury-based preservative called thimerosal used in multi-dose vaccines. One very influential critic is environmental lawyer Robert Kennedy, Jr.

ROBERT F. KENNEDY, Jr.: So the government scientists are acknowledging that even tiny, infinitesimal amounts of mercury, parts per billion, will cause profound neurological injury in children. The biggest exposure is coming from our own vaccine. When I was a little boy, we only got three vaccines. But my children, five of my six children, got 22 vaccines, beginning in 1989. That's the Thimerosal generation. That's the vaccine generation.

Dr. ERIC FOMBONNE: So the mercury hypothesis had more plausibility than that for MMR because of the nature of mercury, which is known to be a neurotoxicant. But mercury poisoning doesn't resemble autism at all. The fact that mercury is a toxicant is not sufficient is to claim that the mercury contained in vaccines can lead to autism. So it was critical therefore to follow this hypothesis with properly conducted epidemiological studies.

NARRATOR: Under public pressure, public health agencies decided to act on the side of caution, rather than wait for the results of such epidemiological studies. In 1999, the FDA asked manufacturers to reduce or eliminate thimerosal in vaccines as soon as possible.

Dr. PAUL OFFIT: Unfortunately, I think it precipitated the notion that the thimerosal was doing harm. And from a parent's standpoint, that again was very understandable. Why would you take something out of vaccines in such a precipitous and frightening manner unless there was a problem?

JENNY MCCARTHY: When I began my crusade for autism, one of the first speeches gave was, "Is it mercury? Is it the schedule? Is there just too many?" My answer to people, and what I've been telling them, is it's all of the above. We don't know for sure, which is why we keep saying, "Study it." But they won't.

[www.pbs.org: McCarthy's extended interview]

NARRATOR: In fact, around the world, scientists had been studying groups of children, searching for a possible link between vaccines and autism, using the same epidemiological methods that linked smoking to lung cancer. One country renowned for its epidemiology is Denmark. Unlike the U.S., Danish authorities collect demographic and health data routinely on the entire population in a series of national registers. They know when every child was born, when every child was vaccinated, and when every case of autism was diagnosed.

ANDERS HVIID, Dr. Med. Sci., Statens Serum Institut: It's sort of a paradise for epidemiologists because we don't have to work to collect this data. It is available to us.

NARRATOR: Anders Hviid and colleagues at the Statens Serum Institut analyzed data on all the Danish children born between 1991 and 1998, over half a million. They compared two groups, those who had received the MMR triple shot and those who hadn't. Then they counted the cases of autism in each group and calculated the autism rate. They found no difference. Children who didn't get the shot had the same risk of developing autism as those who did. The team published the findings in The New England Journal of Medicine.

Other studies carried out by researchers in Sweden, Britain, Finland and the U.S. also found no association between MMR and autism. Additional evidence came from Japan. The Japanese changed their vaccine schedule in 1993, replacing the MMR triple shot with three separate vaccinations. But following the change, autism rates did not fall. In fact, they appeared to rise, thus making the triple shot an unlikely cause of autism.

The Danish team now went on to investigate the second theory, the mercury preservative thimerosal. It turned out that in Denmark, there was a simple way to test this, as well.

ANDERS HVIID: In Denmark, since the '70s, only one vaccine has contained thimerosal, and that was a pertussis vaccine. It contained thimerosal until May-June '92. Then the same vaccine continued but without thimerosal.

NARRATOR: Hviid and colleagues found that children who were given pertussis vaccines with thimerosal before 1992 had identical autism rates as children who received mercury-free vaccines after that date.

ANDERS HVIID: We did not find any association between being vaccinated with the thimerosal-containing vaccine and the risk of autism.

NARRATOR: Other studies in the U.S., the U.K. and Canada also found no association between autism and thimerosal. In 2004, the Institute of Medicine carried out its own analysis of the research and concluded, "The body of epidemiological evidence favors rejection of a causal relationship between the MMR vaccine and autism and also between thimerosal-containing vaccines and autism."

Dr. ANDREW WAKEFIELD: The allegations against me are both unfounded and unjust.

NARRATOR: Then something extraordinary happened. On February 2, 2010, The Lancet retracted Wakefield's landmark 1998 paper, saying it was scientifically flawed. Scientists around the world had not been able to replicate Wakefield's findings. And it turned out that some of the kids in his small study had been referred by a lawyer who was suing pharmaceutical manufacturers on the children's behalf. But in the wake of the retraction, organizations like Generation Rescue came out in strong support of Wakefield, continuing to believe in his science.

Soon after, parents of autistic children who brought class-action lawsuits based on the MMR and thimerosal theories had their hopes dashed by the federal vaccine court.

NEWSCASTER: And good evening to you. We begin tonight with a ruling that affects millions of parents with children who have autism. Families who went to a federal court over these vaccines were told that their case was without scientific or legal merit.

NARRATOR: The vaccine court that Barbara Loe Fisher's organization had helped set up issued a strongly worded ruling on March 12, 2010, denying a link between autism and vaccines.

ANDERS HVIID: Scientifically, I think the matter's settled. But I- I don't think that- I think there are a lot of people who don't listen to science and don't understand it. So they're going to be difficult to sway with the scientifical- scientific arguments.

J.B. HANDLEY: I don't give a [expletive] about what the MMR said! My kid got six vaccines in one day, and he regressed! You don't have any science that can show me that the regression wasn't triggered by the six vaccines. What the parents are saying is, "I went in for a vaccine appointment. My kid got six vaccines, and they regressed." We need to ask the question as to why the regression took place- not whether the regression took place, why the regression took place. The only way to do that is to look at that load of vaccines and compare a group of kids or a group of animals who got the load and who didn't.

[www.pbs.org: Handley's extended interview]

BARBARA LOE FISHER, Pres., National Vaccine Info. Ctr.: If you're going to do epidemiology, let's ask the right question. Let's not confine it to MMR and let's not confine it to one component in the vaccine, mercury. You have to do bench science. You have to look at the human body and what occurs in terms of changes in immune function, brain function. So you can't just do epidemiology where you're comparing groups of children against each other.

NARRATOR: Vaccine critics say many more studies are needed before scientists can rule out side effects like autism- studies of the other vaccines, studies of multiple additives, and studies to see if certain children are genetically predisposed to a vaccine reaction.

PAUL OFFIT, M.D., Children's Hospital of Philadelphia: The hypotheses continue to shift. The first hypothesis, which, you know, people bought into long and hard, is that the combination measles, mumps, rubella or MMR vaccine cause autism. Twelve epidemiological studies showed that that wasn't true. Then the hypothesis shifted to thimerosal, an ethylmercury-containing preservative that was in vaccines, that's no longer in vaccines except for some multi-dose preparations of flu vaccine, that that caused autism. And that clearly has been shown not to be true.

So now this is classic for pseudo-science, is you just keep moving the goal posts. So now the goal post is, "No, we didn't mean actually MMR caused autism or thimerosal caused autism, we just meant vaccines in general cause autism."

NARRATOR: In the vaccine war, two kinds of knowledge compete for the public attention, the collective but dry conclusions of the scientific community and the personal anecdotes of parents.

JENNY MCCARTHY, Spokesperson, Generation Rescue: Something happened. And when I say something, I mean a behavior, a trigger. Something different happened to our children, which then led to autism. Do I know that exact link? No. I don't have that proof, but I've got evidence in Evan. And I've got evidence in thousands and hundreds of thousands of parents all over the world. And these are the mommy warriors that will make change because we have to.

CYNTHIA CRISTOFANI, M.D., Pediatric Intensivist: It's a tragedy that there are kids who are unprotected because their parents are choosing not to vaccinate out of fears that are unfounded. The other tragedy is that the kids who have autism, who desperately need better research into why, and more important, what to do about it now- that research isn't being done, at least to the degree that it should have been, because most of the would-be research- those dollars and hours have been lost.

NARRATOR: CDC is involved in a five-year study called SEED - the Study to Explore Early Development - to help identify what might put children at risk for autism spectrum disorders and other developmental disabilities. But it's not clear that such scientific studies will settle the vaccine war. To the contrary, public skepticism of scientific authority seems to be growing, fueled in part by a new battleground where ideas fight for public attention, the Internet.

KRISTINE SHEEDY, Ph.D., Centers for Disease Control and Prevention: It's not just about the science. We wish it were. Unfortunately, the issue persists, and one of the challenges is that once something gets up on the Internet, it's there. There are new cohorts of parents every day going to the Internet, reading about that for the first time. The Web really has served to keep these controversies alive that really should be non-controversies.

Dr. CYNTHIA CRISTOFANI: There's absolutely no control over what appears on the Internet, and you can post anything you like, true or not.

PROTESTER: The Centers for Disease Control, a Nazi organization!

Dr. CYNTHIA CRISTOFANI: Those original myths are still there, and they're hard to counteract. You know, conspiracy theories tend to be popular and it's hard to undo that kind of damage.

Dr. PAUL OFFIT: I spoke recently at a high school near here. There were about 200 people in the audience, and I asked them how many had gotten the influenza vaccine. And about half raised their hands. Of the half that didn't raise their hands, they said that they didn't get it because on YouTube, they saw a Redskins cheerleader say that she had gotten the vaccine and had a so-called dystonic reaction.

[www.pbs.org: Offit's extended interview]

REPORTER: She's the beautiful cheerleader whose heartbreaking story is shocking the nation.

NARRATOR: This clip of Redskins cheerleader Desiree Jennings went viral on the Web after a local Fox News station broke the story. She reported a bizarre neurological reaction to a flu vaccine that caused her to be able only to walk backwards. Her story's been viewed and shared almost 2.5 million times.

REPORTER: Desiree can run just fine. It's only when she stops- you see, that's where the- that's where the spasms start. Now, you can walk backwards, though.

Dr. PAUL OFFIT: These students who sat in that room were much more likely to believe something they had seen on YouTube from a Washington Redskins cheerleader than they would have believed something that they would have heard from the Centers for Disease Control and Prevention or the American Academy of Pediatrics. That's a little frightening.

NARRATOR: After Jenny McCarthy saw Desiree on YouTube, Generation Rescue became involved in her treatment, connecting her with a controversial osteopath, Dr. Rashid Buttar in North Carolina.

JENNY MCCARTHY: She flew out to see this doctor. He chelated her and did hyperbaric chamber treatments and many other type of biomedical therapies that we do with our kids, and she got better quick. After a few days of treating her, she was down to about seven seizures a day and speaking and walking.

REPORTER: Look at Desiree now!

NARRATOR: Upon finding her cured of a supposedly incurable condition, the media now presented her story as a hoax.

REPORTER: We've been trying to reach you and you have not been returning our phone calls.

NARRATOR: By now, it had emerged that her admitting neurologist suspected Desiree's condition was psychogenic.

REPORTER: Is it all some kind of elaborate hoax?)

Dr. ANTHONY FAUCI: It's part of the turf in medicine. Inaccurate, misleading and destructive information can get widely spread. So it's- it is tough in the age of the Internet.

ARTHUR CAPLAN, Ph.D., Center for Bioethics, Univ. of Pennsylvania: I think the Internet has been the fuel on the fire of anti-vaccine fears. There's plenty of Web sites out there putting out information about people alleging all kinds of complications and problems with vaccines, their own pet theories about what might be dangerous about vaccines, so there are oodles of sources of lousy, dangerous information out there.

NARRATOR: But advocates like Barbara Loe Fisher see the Internet as a democratizing force that has empowered people to challenge medical dogma.

BARBARA LOE FISHER: When I first started this work in the early '80s, I had a Selectric typewriter and I had the post office. That's it. Today, you have access to the library of medicine on the Internet. You can communicate with people all over the world. So it has changed everything.

NARRATOR: In this new world, many parents are no longer willing to take the word of their doctor on faith, or to accept the conclusions of the medical establishment, frustrating public officials charged with protecting the health of the community.

GRETCHEN: I'm the mother of a 2-and-a-half-year-old, and I haven't done any vaccines at all. And I feel very safe and very comfortable with my decisions.

AUGUSTINE: I'm a midwife, and I'm also the co-leader of the Rogue Valley Holistic Moms Network.

NARRATOR: Ashland's public health officer, Dr. Jim Shames, meets periodically with parents to talk about their responsibilities for the public health.

Dr. JIM SHAMES: Do you feel that when you say "No, thank you," that you might be putting anybody else at risk besides your child?

AUGUSTINE: This is the major thing that we're always up against. Public health officials are looking at the good for all. Mothers are looking at the good for their one child. And that's very important for them. It's the most important thing. It's their world.

Dr. JIM SHAMES: When you make that decision, which you have a right to do, do you think you may be affecting other children?

AUGUSTINE: Do I believe that I'm causing harm by not vaccinating my child? No, I don't, because if the vaccines work, who am I putting at risk?

Dr. JIM SHAMES: So let's talk about that. Now, not everybody can get immunized. That child right there is probably too young to get immunized against pertussis. If your child gets pertussis by not getting the vaccine, and your child passes it onto a delicate newborn-

AUGUSTINE: I really don't believe it. I feel like- first of all, I feel like it would be responsible to then quarantine my child and not expose them to other, you know, potentially fragile populations.

Dr. JIM SHAMES: A lot of diseases are transmitted before you even know you're sick.

JENNIFER MARGULIS: It's my responsibility as a parent to keep my child safe, I think, and I don't think it's your responsibility to take a vaccine because I might be at the same party with you and you might cough on her. Honestly. I think your job is to protect your own health. And I mean, maybe I sound- I really don't mean to be sounding selfish in that way.

Dr. JIM SHAMES: There has to be some step beyond just "I take responsibility for me and my kids" because there's things that happen in the best of intentions that diseases do get transmitted.

NARRATOR: For these Ashland mothers, health is a private affair, not a public responsibility. For them, refusing a vaccine is no more significant than refusing any medication for your child. But scientists say vaccines are special.

ARTHUR CAPLAN: Vaccines have an odd power that drugs don't have. If I take a drug, it doesn't help you. But if I get vaccinated and some others get vaccinated, then you may be benefited by so-called herd immunity.

Dr. PAUL OFFIT: In other words, if a certain percentage of the population is vaccinated, that will stop infections from spreading because most of the people around that child are vaccinated, so therefore the virus can't really spread. However, when a critical number of people aren't vaccinated, when there's a critical drop in herd immunity, then the viruses can spread. And not only are those children who aren't vaccinated at risk, but those who can't be vaccinated are at risk.

NARRATOR: When enough people don't vaccinate, herd immunity begins to crumble. The first to suffer are vulnerable populations, those who because of age or illness can't be vaccinated. When Vanessa was 6 weeks old, too young for most vaccines, her only protection was from the herd. Then she came down with a severe cough.

ALVARO FONTAN, Father: She turned totally blue. She stopped breathing, and we didn't know what to do to have her breathing back again. I took outside, you know, bring her back. She wasn't responding.

NARRATOR: An ambulance brought her to the pediatric ICU in her home town of Portland, Oregon. Fortunately, the intensivist on call that night was Dr. Cynthia Cristofani. This was Vanessa.

Dr. CYNTHIA CRISTOFANI: I look at the video and I keep saying, "Vanessa, take a breath, please" because we knew that a child of that age with an already narrow airway baseline, who's not inhaling well, could easily lose consciousness from lack of oxygen and perhaps die.

NARRATOR: Dr. Cristofani opened the infant's airways and sucked copious secretions from her mouth. Vanessa had pertussis, whooping cough. Her status was so dire, a chaplain was brought into the ER.

ALVARO FONTAN: Vanessa was 40 days old when- when she was diagnosed with whooping cough. So we were probably a week away from having her vaccine for whooping cough. So the only thing that will protect a kid like that will be the herd immunity. And in that case, it failed. I mean, somebody in the community didn't vaccinate or got Vanessa infected with it.

[www.pbs.org: The Fontans' extended interview]

NARRATOR: After an exhaustive investigation, CDC traced Vanessa's pertussis to an infected student at her brother's high school.

From the very young to the very old, scientists say herd immunity matters.

DONNA BRADSHAW-WALTERS, M.D., Pediatrician, Ashland, OR: The more immunity we have in a community, the better it is. Fifty percent is better than nothing, and 100 percent- it's like building a brick wall around a city and protecting it against an enemy. It's excellent protection against something entering our community that could cause illness.

NARRATOR: Very strong herd immunity could completely eradicate many vaccine-preventable diseases, rendering vaccines unnecessary. This happened with smallpox in the 1970s. A decade ago, the World Health Organization had plans to eradicate polio, followed by measles. But vaccine scares around the world served to chip away at herd immunity, pushing these goals into the future.

Dr. CYNTHIA CRISTOFANI: Many of these germs belong to us only, which means if we can make enough humans immune simultaneously, we could eradicate them. And then, yes, we could stop vaccinating. There was actually a campaign hoping to eradicate polio from planet Earth, as we did smallpox. And notice we're not vaccinating for smallpox anymore because it's gone. But at the moment at least, while they're in the world, there's still the potential for outbreaks if people are willing to stop vaccinating prematurely.

NARRATOR: Why is it so hard for some Americans to embrace this communal aspect of vaccines? FRONTLINE turned to political scientist Hank Jenkins-Smith, who surveyed a representative sample of Americans on their views about vaccines.

HANK JENKINS-SMITH, Ph.D., University of Oklahoma: Are you required- do you feel like society requires you to vaccinate your children?

1st WOMAN: It never felt like a choice to me. I mean, from the moment I had in the hospital, it was never, "Would you like us to give your baby these shots?" You know, it was, like, "We're doing this now." So I never felt like it was ever an option to not.

HANK JENKINS-SMITH: Cynthia?

2nd WOMAN: There's that kind of odd pressure to vaccinate. And certainly, I get a lot of expectations from relatives and- I think we might go to the same pediatrician. [laughs]

HANK JENKINS-SMITH: So if you pose a question to people about whether the acquisition of vaccines is a societal responsibility or a parental choice, they lean very hard in the direction of having it be a parental choice.

And should the government be able to tell you that you have to vaccinate your child?

3rd WOMAN: I should do it for public health, but I don't think the government should require me to do that. I think I should have a choice.

4th WOMAN: It's a decision that every family should make. I think it should be left up to them.

HANK JENKINS-SMITH: When you make something compulsory, when the state can require a parent to have their children take a risk, you introduce a whole new aspect to the problem. I mean, you think of the front lines in this battle. It's pediatricians and family doctors and it's schools who will require that children have their vaccines up to date and that this- these institutions that we have in place put a price on not getting vaccines.

DONNA BRADSHAW-WALTERS, M.D., Pediatrician, Ashland, OR: It feels a little bit lonely because, sometimes, it just feels like it's- it's me, as the pediatrician, against the media, the world. I think it's the most difficult when I have a family come in who's already- because of the Internet, because of the news broadcast, because of something they've seen on YouTube, they already are coming in with their set ideas, and it's really hard sometimes to break through that.

JENNIFER MARGULIS, Parent, Ashland, OR: Pediatricians need to listen. They don't need to say, "Do it my way or take a walk." They need to say, "How can I accommodate you so that we can both get our needs met in this situation?"

BARBARA LOE FISHER, Pres., National Vaccine Info. Ctr.: The days of paternalism in medical policy are over. People are taking control of their own health. They want to be more in charge of the way that they live and not simply rely on a doctor. Physicians are going to have to get over the idea that they tell people what to do and people are going to do it without questioning.

ARTHUR CAPLAN, Ph.D., Center for Bioethics, Univ. of Pennsylvania: Parents don't have unlimited rights with respect to the welfare of their children. You can't put them at risk of fatal disease. You can't put them at risk of devastating disability. You know, the ethics isn't just on the side of the critics. The ethics is also on the side of those who say, "Do good in the name of children. Do good in the name of public health."

NARRATOR: One thing both sides can agree on, there's a lot at stake in the vaccine war- on the one hand, the fear that American communities will be exposed to serious diseases, on the other, something equally compelling, every parent's wish to do what's best for her child.

THE VACCINE WAR

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ANNOUNCER: There's much more on our Web site. Take our survey about whether this program changed your attitude toward vaccines and join the discussion, and watch the program again on line, read extended interviews with advocates and critics of vaccines, read the interview with baby Vanessa's parents, who watched her struggling with whooping cough, get more about the special vaccine court and its decisions, the autism-vaccine controversy and much more at PBS.org.

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posted april 27, 2010

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