by Richard Moskowitz, M.D.

Precisely the same difficulties complicate the generally favorable record of tetanus toxoid, which has clearly had at least some impact on the decline of this dreadful disease in its classic form, yet presumably also survives in the body for years or decades as a potent foreign antigen, with long-term effects on the immune system and elsewhere that as yet we can only imagine.

Like diphtheria and tetanus, whooping cough as a public health threat had already begun to decline precipitously well before the pertussis vaccine was introduced. Moreover, the latter has not been very effective, as even its proponents concede, and both the extent and the severity of its side effects have been disturbingly high. Its power to damage the central nervous system, for example, has received increasing attention since Stewart and his colleagues reported an alarmingly high incidence of encephalopathy and serious convulsive disorders in British children that were directly traceable to the pertussis vaccine. [note 41] My own cases, of which a few were reported earlier, suggest that hematological disturbances may be equally prevalent. In any event, the complications that are known clearly represent only a small fraction of the total, and the vaccine has become controversial even in the United States, where medical opinion has remained virtually unanimous in favor of vaccines generally, while several other countries, such as West Germany, have discontinued it as a routine practice. [note 42]

Clinically, whooping cough is extremely variable in severity, ranging from asymptomatic, mild, or in apparent infections, which are quite common, to very rare and sometimes fatal cases in young infants less than 5 months old, in whom the mortality is said to approach 40%.[note 43] In children over a year old, it is rarely fatal or even all that serious, and antibiotics have little to do with the outcome. [note 44]

Much of the pressure to immunize at present must therefore be ascribed to the higher death rate in young infants, which has led to the terrifying practice of giving this most dangerous of vaccines to babies at 2, 4, and 6 months, when their mothers' milk could have protected them from all infections about as well as it can ever be done, [note 45] and its effect on the developing blood and nervous systems could well be catastrophic. For all of these reasons, the practice of mandatory immunization against pertussis should be discontinued immediately, and studies undertaken to assess and compensate the damage that it has already done.

Poliomyelitis and the two main polio vaccines present an entirely different situation. The standard Sabin vaccine is trivalent, consisting of attenuated live polio viruses of each of the three strains associated with paralytic disease, and seems quite safe, partly because it is administered orally, the same way the infection is acquired, thus allowing recipients to develop a kind of natural immunity at the normal portal of entry, the GI tract.

On the other hand, the wild-type poliovirus elicits no symptoms of any kind in over 95% of the people exposed to it, even under epidemic conditions, [note 46] and only 1 or 2% of those who become symptomatic ever progress to the neurological picture of poliomyelitis, with its destructive lesions in the motor tracts of the spinal cord and medulla oblongata. [note 47] Poliomyelitis thus cannot develop without a particular anatomical susceptibility in the host. Even in the full-scale epidemics of the 1950's, the attack rate of the poliovirus remained very low, and the number of cases resulting in death or permanent impairment remarkably small, in comparison with the huge number of people exposed and at risk for it. [note 48]

Since the virus was more or less ubiquitous in the pre-vaccine era, and could be found routinely in samples of city sewage wherever it was looked for, [note 49] effective natural immunity to it was already about as close to being universal as it could ever be, and it remains highly doubtful if any artificial substitute could equal or even approximate that result. Indeed, because the virulence of the wild-type virus was so low to begin with, it is difficult to see what further attenuation of it could possibly accomplish other than weaken the natural vigor of the immune response at the same time. For the fact remains that even the attenuated virus is still alive, and the people who were anatomically susceptible to the wild type are presumably still susceptible to it now, so that some of them will develop paralytic disease from the vaccine, [note 50] while others may continue to harbor the virus in latent form, perhaps within the same target cells.

Seemingly the only advantage of giving the vaccine, then, would be to introduce the virus during infancy, when its virulence would normally be lowest anyway, [note 51] a benefit more than offset by the risk of weakening the immune response, as above. In any case, even for the polio vaccine, which is about as safe as any vaccine can ever be, the whole matter is clearly one of enormous complexity, and well illustrates the hidden pitfalls and miscalculations inherent in the temptation to beat nature at her own game, by trying to eliminate a problem that can't be eliminated, namely, the susceptibility to disease itself. Perhaps the day may come when we can face the consequences of having fed live viruses to babies by the hundreds of millions, and can admit that we should have left well enough alone by addressing the art of healing the sick when we have to, instead of the technology of erasing the possibility of sickness when we don't have to and can't possibly succeed in any case.

Vaccination and the Path of Medical Technology

In conclusion, I want to go back to the essentially political aspects of the vaccine question, to our common obligation as citizens in a democratic polity to reason and deliberate together about matters of mutual concern and to reach a clear and wise decision about how we choose to live. Now that I have stated my views on the safety and effectiveness of the usual childhood vaccines, I hope that others of differing views will come forward and do the same. That is why I am deeply troubled by the air of fanaticism in which vaccines are imposed on the public and serious discussion of them is ignored or stifled by the medical authorities as if the question had already been settled definitively and for all time. In the words of Sir Macfarlane Burnet,

It is our pride that in a civilized country the only infectious diseases that anyone is likely to suffer are either trivial or easily cured by available drugs. The diseases that killed in the past have been rendered impotent, and general principles of control have been developed that should be applicable to any unexpected outbreak in the future. [note 52]

Apart from the truth or falseness of these claims, they exemplify the smug self-righteousness of a profession that worships its power to manipulate and control Nature itself, and of a society in which, as Robert Mendelsohn has said, "we are quick to pull the trigger, but slow to examine the consequences of our actions." [note 53] Indeed, in the case of vaccines, one would have to say methodically slow. In 1978, for example, when charged by Congress to formulate guidelines for Federal compensation of "vaccine-related injuries," the American Academy of Pediatrics issued the following restrictions on eligibility:

1) Compensation should be made available to any child or young person under the age of 18 years, or a contact of such person of any age, who suffers a major reaction to a vaccine mandated for school in his or her state of residence.

2) Such a reaction should have been previously recognized as a possible consequence of the vaccine given.

3) Such a reaction should have occurred no more than 30 days following the immunization. [note 54]

These restrictions would automatically exclude all of the chronic diseases and anything other than the very few adverse reactions that have been identified and documented thus far, which clearly represent only a small fraction of the problem.

Nor can the government or medical establishment be considered ignorant of the possibility that worries every parent, that vaccines cause cancer and other chronic diseases. Precisely that spectre was raised by Prof. Robert Simpson of Rutgers in a 1976 seminar for science writers:

Immunization programs against flu, measles, mumps, polio, and so forth may actually be seeding humans with RNA to form latent proviruses in cells throughout the body. These latent proviruses could be molecules in search of diseases: when activated under proper conditions, they could cause a variety of diseases, including rheumatoid arthritis, multiple sclerosis, systemic lupus, Parkinson's disease, and perhaps cancer. [note 55]

Unfortunately, this is the sort of warning that very few people are willing or able to take seriously at this point, least of all the American Cancer Society or the American Academy of Pediatrics. As René Dubos has said, we all want to believe in "the miracle," regardless of the evidence:

Faith in the magical power of drugs often blunts the critical senses and comes close to a mass hysteria at times, involving scientists and laymen alike. Men want miracles as much today as in the past. If they do not join one of the newer cults, they satisfy this need by worshipping at the altar of modern science. This faith in the magical power of drugs is not new. It has helped to give medicine the authority of a priesthood, and to recreate the glamor of ancient mysteries. [note 56]

The idea of eradicating measles or polio has become attractive to us simply because the power of medical science makes it seem technically possible: we worship every victory of technology over Nature, just as the bullfight celebrates the triumph of human intelligence over the brute beast. That is why we do not begrudge the drug companies their exorbitant profits and gladly volunteer the bodies of our children for their latest experiments. Vaccination is essentially a religious sacrament of our own participation in the miracle of medical science, a veritable auto-da-fé in the name of modern civilization itself.

Nobody in their right mind would seriously entertain the idea that if we could somehow eliminate one by one measles and polio and all of the known diseases of mankind, we would really be any the healthier for it, or that other diseases at least as terrible would not quickly take their place. Still less would a rational being imagine that the illnesses from which we suffer are "entities" separable from the individuals who suffer them, or that with the appropriate chemical or surgical sacrament the separation can literally be carried out. Yet these are precisely the miracles we are taught to believe in and the idolatries to which we in fact aspire. We prefer to forget the older and simpler but more difficult truths, that the susceptibility to illness is deeply rooted in our biological nature, and that the signs and symptoms of disease are the attempt of our own life energy to overcome whatever we are trying to overcome, trying, in short, to heal ourselves.

The myth that we can find technical solutions for all human ailments looks attractive at first precisely because it bypasses the problem of healing, which is a genuine miracle in the sense that it can always fail to occur. We are all truly at risk of illness and death at every moment; no amount of technology can change that. Yet the mission of technical medicine is precisely to try to change that, by standing always in the front line against disease, and by attacking and destroying it wherever and whenever it shows itself.

That is why, with all due respect, I cannot accept the sacraments of Merck, Sharp & Dohme or have faith in the miracles of the Centers for Disease Control. For myself, I prefer to stay with the miracle of life itself, which has given us not only illness and disease but also the arts of medicine and healing, through which we can acknowledge our pain and vulnerability and at times, with the grace of God and the help of our fellow humans, experience a sense of health and well-being that goes beyond tribe or country. That is my religion, and though I will gladly share it, I do not force it on anyone.

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Notes
41. Stewart, op. cit., p. 234.

42. Mortimer, op. cit., p. 111.

43. Feigin, R., "Pertussis," in Vaughan, op. cit., p. 769.

44. Ibid., p. 769.

45. Barness, L., "Breast Feeding," in Vaughan, op. cit., p. 191.

46. Burnet and White, op. cit., p. 91ff.

47. Davis, op. cit., p. 1290ff.

48. Ibid., p. 1280.

49. Burnet and White, op. cit., p. 93.

50. Fulginiti, V., "Problems of Poliovirus Immunization," Hospital Practice, Aug. 1980, pp. 61-62.

51. Burnet and White, op. cit., p. 95.

52. Burnet, op. cit., p. 128.

53. Mendelsohn, op. cit., p. 3.

54. Quoted in Wehrle, P., "Vaccines, Risks, and Compensations,"Infectious Diseases, Feb. 1982, p. 16.

55. Quoted in Mendelsohn, op. cit., p. 1.

56. Dubos, op. cit., p. 157.