restricted access 1. Risk and Reward

From: Vaccine

The Johns Hopkins University Press colophon
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Risk and Reward Annabelle, Fiona, and the millions of other American children born over the last twenty years have received an unprecedented number of vaccines. Between 1983 and 2005, the number of diseases against which children are routinely vaccinated doubled, and the number of mandated and recommended vaccinations tripled. New vaccines are added to states’ lists of mandated vaccines through a process that begins with the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. The committee, made up of fifteen members drawn from the scientific and medical communities, meets three times a year. It offers official recommendations for the use of vaccines to be adopted by state legislatures and by physicians . But it is up to individual state legislatures to adopt the committee’s recommendations and make a particular vaccine mandatory, and it is up to pediatricians to recommend vaccines that are not on their states’ lists of mandated vaccines to their patients’ parents. A century ago, children received only the smallpox vaccine. By the early 1980s, vaccines for diphtheria, pertussis, tetanus (administered together in the DPT vaccine), polio, and measles, mumps, and rubella (administered together in the MMR vaccine) were developed and adopted in most states as mandatory (table 1). Over the last twenty years, six more vaccines were added to the list along with the annual influenza vaccine. Today, by the time they are six years old, fully vaccinated American children receive about three dozen immunizations consisting of nearly fifty vaccines (table 2). At the same time, vaccine compliance rates are at record highs. In 2007, among two- and three-year-olds in the United States, vaccine coverage topped 90 percent each for polio, measles, mumps, rubella, Haemophilus influenzae type b, hepatitis B, varicella, and pneumococcus. Today, over 80 percent of American threeyear -olds have received all of their state-mandated vaccines. At the opening of the twenty-first century, more children are receiving far more vaccines than ever before in American history. 1 16 Vaccine Along with the rapidly growing number of vaccines have come increasing worries among parents about the number of shots, their frequency, and the possible unintended negative consequences. Lately we have seen escalating concerns among Americans about pharmaceutical companies putting profitability before safety as well as fears about the potentially harmful effects of the medical community’s one-size-fits-all approach to vaccinations. Criticism of vaccines is coming from both ends of the political spectrum and from points in between. Left-leaning parents mingle concerns about vaccines with their environmental activism, health-conscious lifestyles, and anxieties about corporate power and profit motives. They are joined by rightwing libertarians who dislike governmental interference with what they consider personal decisions and by conspiracy theorists that see in vaccines a government plot to oppress or eliminate certain segments of the population. Individuals who might be political rivals on other issues frequently borrow from one another in making their arguments. Add to that the incredible amount of information on the subject now available through a variety of media outlets including the Internet—much of it unfiltered by accredited experts and repeated by various celebrity advocates—and you have an entire generation of parents Table 1. Diseases the CDC Recommends Children Be Vaccinated against by Age Six, 1983 and 2008 1983 2008 Diphtheria Diphtheria Pertussis Pertussis Tetanus Tetanus Polio Polio Measles Measles Mumps Mumps Rubella Rubella Hepatitis A Hepatitis B Rotavirus Haemophilus influenzae type B Pneumococcus Annual influenza Varicella Total number of diseases 7 14 Table 2. Vaccines Recommended by the CDC from Birth to Age Six, 1983 and 2008 1983 2008 DPT (2 mo.) Hepatitis B (birth) Polio (2 mo.) Hepatitis B (1–2 mo.) DPT (4 mo.) Rotavirus (2 mo.) Polio (3 mo.) DTaP (2 mo.) DPT (6 mo.) Haemophilus influenzae type B (2 mo.)* MMR (15 mo.) Pneumococcus (2 mo.) DPT (18 mo.) Polio (2 mo.)* Polio (18 mo.) Haemophilus influenzae type B (4 mo.)† DPT (4–6 yr) Pneumococcus (4 mo.) DTaP (4 mo.) Polio (4 mo.)* Rotavirus (4 mo.) Influenza (6 mo.) DTaP (6 mo.) Haemophilus influenzae type B (6 mo.)* Pneumococcus (6 mo.) Hepatitis B (6–18 mo.) Polio (6–18 mo.)* Rotavirus (8 mo.) Varicella (12–15 mo.)† Hepatitis A (12–15 mo.) Haemophilus influenzae type B (12–15 mo.)* Pneumococcus (12–15 mo.) MMR (12–15 mo.) DTaP (15–18 mo.) Influenza (18 mo.) Hepatitis A (18–24 mo.) Influenza (2–3 yr) Influenza (3–4 yr) Influenza (4–5 yr) Polio (4–6 yr...