Deadly Choices: How the Anti-Vaccine Movement Threatens Us All - Paul A. Offit (2010)

Chapter 11. Trust

Leave the gun. Take the cannolies.

—PETER CLEMENZA, THE GODFATHER

We’ve reached a tipping point. Children are suffering and dying because some parents are more frightened by vaccines than by the diseases they prevent. It’s time to put an end to this. Several solutions have been proposed. The first would be effective but is too awful to imagine; the second, given the history of the American legal system, will never happen; the third, while possible, would require a sea change in our culture.

In 1998, Robert Chen, then head of immunization safety at the Centers for Disease Control and Prevention, created a graph titled “The Natural History of an Immunization Program.” Chen described what happens when vaccines are used for a long time, partitioning the public’s reaction into distinct phases.

In the first phase, people are afraid of infections. In the 1940s, parents readily accepted the diphtheria and pertussis vaccines because diphtheria and pertussis commonly killed young children; and the tetanus vaccine because many people died of tetanus, especially during World Wars I and II. In the 1950s, parents rushed to get the polio vaccine because they saw what polio could do; everyone knew someone who had been paralyzed or killed by the virus. In the 1960s, parents gave their children measles, mumps, and rubella vaccines because they had witnessed firsthand the devastation wrought by those diseases: pneumonia and encephalitis from measles, deafness from mumps, and severe birth defects from rubella. During this phase of Chen’s graph, immunization rates rise.

In the next phase, as vaccines cause a dramatic reduction in disease, a new line appears: “Fear of Vaccines.” Vaccines become a victim of their own success. Now the focus is on vaccine side effects, real or imagined. Immunization rates plateau.

In the next phase, as fear of vaccines continues to rise, immunization rates fall. And preventable diseases increase. It’s in this phase that America now finds itself. When Chen showed this graph to colleagues at the CDC, he used statistics to support his argument. And, like most thoughtful scientists, he remained dispassionate, referring to children as numbers on a graph. But there was emotion in those numbers. (“Statistics are people with their eyes wiped dry,” said former Surgeon General Julius Richmond.)

The last and most disturbing phase of Chen’s graph offers a solution to the problem posed by unvaccinated children. In this phase, the incidence of preventable deaths becomes so high that parents again seek solace in vaccines. Immunization rates rise. In a more perfect world, we would never get to this part of Robert Chen’s graph. We would learn from history—learn from the smallpox deaths in England in the late 1800s following widespread anti-vaccine activity, learn from pertussis deaths in England and Japan in the mid-1970s following unfounded fears that the vaccine caused brain damage, learn from measles deaths in England and Ireland in the late 1990s caused by the false notion that MMR caused autism, and learn from bacterial meningitis deaths in Minnesota and Pennsylvania in 2009 caused by the fear that children were getting too many vaccines.

Although renewed fears of fatal infections caused by the reemergence of these diseases would undoubtedly increase vaccination rates, the price is far too great.

Another solution to the problem of unvaccinated children would be to eliminate religious and philosophical exemptions.

Religious exemptions would be impossible to eliminate. That’s because parents have been letting their children die in the name of religion for decades, without consequence. And these children have been denied treatments that would have saved their lives, not vaccines that might have saved their lives. For example:

• In the late 1890s and early 1900s, many children of Christian Scientists died from diphtheria, even though diphtheria antitoxin was widely available. Christian Science healers were unrepentant, one stating, “We do not feel bound to the laws of hygiene, but to the laws of God.” Several parents were charged with manslaughter, none successfully.

• In 1937, Edward Whitney, a widowed insurance salesman, left his ten-year-old daughter, Aubrey, in the care of her aunt in Chicago. Aubrey was a diabetic. The aunt, a Christian Scientist, took Aubrey to her practitioner, William Rubert, who immediately took her off insulin. On December 10, 1937, Aubrey Whitney died in a diabetic coma; Rubert wasn’t held accountable for her death. Twenty-two years later, Edward Whitney walked into Rubert’s office, pulled out a 32-caliber handgun, and shot him at point-blank range.

• In 1951, Cora Sutherland, a fifty-year-old Christian Scientist who taught shorthand at Van Nuys High School in Los Angeles, argued successfully that she should be exempt from the periodic X-rays required by her school to detect tuberculosis. Three years later, in March 1954, she died of tuberculosis, but not before exposing thousands of students. The health department petitioned the board of education to eliminate religious exemptions, without success.

• In 1955, seven-year-old David Cornelius became ill; his parents, Edward and Anne Cornelius, took him to a doctor who diagnosed diabetes and started insulin. Later, a Christian Science clinician stopped the insulin, causing David to die in a diabetic coma. The district attorney indicted Edward and Anne Cornelius for involuntary manslaughter, but dropped the charges when a senior church official persuaded him that the Corneliuses “had sincerely believed that they could save their son through prayer.”

• In 1967, Lisa Sheridan, the five-year-old daughter of Dorothy Sheridan, contracted strep throat. For the next three weeks Lisa found it harder and harder to breathe. Dorothy, a Christian Scientist, prayed but to no avail; Lisa Sheridan died of pneumonia on March 18, 1967. At autopsy, the pathologist found a quart of pus in Lisa’s chest that had collapsed her lung—pus that could have been removed easily had Dorothy sought medical attention. Sheridan was convicted of manslaughter and sentenced to five years in jail. The church, frightened by the verdict, issued a scathing rebuke: “We must not yield to the mesmeric claims of medicine by calling a doctor and being forced to worship a false God.” Christian Science officials successfully lobbied the Department of Health and Human Services to exempt faith healers from prosecution. In 1974, when the federal exemption was made, eleven states already had a religious exemption statute; ten years later, all fifty states and the District of Columbia had it.

• In 1977, Matthew Swan, the second child of Rita and Douglas Swan, had a high fever. The Swans asked their Christian Science practitioner, Jeanne Laitner, to treat him. Laitner complied; sitting next to Matthew’s crib she said, “Matthew, God is your life. God didn’t make disease, and disease is unreal.” Matthew continued to scream in pain. On July 7, Matthew Swan was pronounced dead from bacterial meningitis. Unlike other Christian Science parents, Rita Swan saw the death of her son as a wake-up call. She founded Children’s Health Care Is a Legal Duty (CHILD), an organization devoted to changing religious exemption laws.

But the neglect continued:

• On March 9, 1984, Shauntay Walker died of bacterial meningitis. Her mother, Laurie, a Christian Scientist, had kept her home for seventeen days. At the time of death, Shauntay, who was five years old, weighed only twenty-nine pounds. In 1990, Walker was convicted of manslaughter, but the conviction was overturned with the help of her lawyer, Warren Christopher, who would later become Bill Clinton’s secretary of state.

• On April 8, 1986, Robyn Twitchell—the two-year-old son of David and Ginger Twitchell—died of a bowel obstruction. David and Ginger had graduated from a Christian Science college in Missouri. After the bowel obstruction ruptured, Robyn vomited stool and portions of his bowel. He died in his father’s arms. At trial, Dr. Burton Harris, chief of surgery at Boston’s Floating Hospital for Infants and Children, testified, “It’s beyond comprehension that the parents of a child who’s vomiting stool wouldn’t seek medical help.” The Twitchells were found guilty; the verdict was overturned on appeal.

• On June 5, 1988, twelve-year-old Ashley King died of bone cancer. The only child of John and Catherine King, Ashley lay at home for months without medical care. At the time of her death, the tumor was the size of a watermelon; her hemoglobin level was incompatible with life, and she was covered with bedsores. John and Catherine King each pleaded no contest to one charge of reckless endangerment: a misdemeanor. They were sentenced to three years’ probation.

• On May 9, 1989, eleven-year-old Ian McKown—the son of Kathleen McKown—died in a diabetic coma. Doctors testified that insulin given even two hours before his death could have saved his life. The police officer called to the house said that the child was so emaciated that “he didn’t even look human.” Kathleen McKown was protected from prosecution by Minnesota’s religious exemption law.

Despite deaths at the hands of faith healers, religious exemptions have remained intact, causing prosecutors either to decline to file criminal charges or to lose in court. Only three states—Massachusetts, Hawaii, and Maryland—have repealed their religious exemption health laws; the rest continue to offer protection to parents who medically neglect their children in the name of God.

The notion that U.S. courts would eliminate religious exemptions to vaccination, when they haven’t eliminated religious exemptions to lifesaving medicines, is fanciful.

Philosophical exemptions, which have become increasingly more popular, would also be difficult to eliminate.

In the 1990s, philosophical exemptions were available in only a handful of states; now, they’re available in twenty-one. Alan Hinman, the CDC official interviewed for Vaccine Roulette who actively promoted state mandates in the 1970s, doesn’t see any hope of eliminating philosophical exemptions. “I don’t think that one would win the battle in the legislature on getting rid of philosophical or personal belief exemptions,” he said. “Looking at the trajectory of our society over the last several years, I find it hard to imagine. If anything, we’re going the other way.” Walter Orenstein thinks philosophical exemptions at the very least should be much more difficult to obtain. “I believe that a decision not to vaccinate is of equal gravitas to [the decision] to vaccinate,” he said. “And there should be a procedure whereby people have to read information, understand information, and sign that they understand the risks they are putting that child through. Right now, in some places, it’s a hell of a lot easier to get an exemption than to get your child vaccinated.” Orenstein sees his proposal as of value only for those who choose what he calls “exemptions of convenience.” “For people who are adamantly opposed to vaccines,” he says, “I don’t think this will make that much difference.”

Another solution would be for the medical community to respond more directly to the threat of decreasing immunization rates.

Recently, hospital administrators have been mandating influenza vaccines given yearly for healthcare providers. Regarding influenza, certain facts are unassailable: people sickened by influenza come into the hospital, healthcare providers can spread influenza virus from one patient to another, patients who catch influenza in the hospital can suffer severe and fatal illness, and hospitals with higher rates of immunization among healthcare providers have lower rates of influenza. Despite these facts, influenza vaccination rates among healthcare providers have been woeful—hovering around 40 percent. So, in the name of patient safety, hospital administrators are doing something about it.

In 2009, eight hospitals in the United States mandated influenza vaccine for their employees. Some took a softer approach: if a healthcare provider refused vaccination, administrators required a surgical mask to be worn throughout the day. Others took a harder line. At the Children’s Hospital of Philadelphia healthcare providers who refused influenza vaccination were given two weeks of unpaid leave to think about it. If they still refused, they were fired. As a consequence, immunization rates among healthcare providers at the hospital rose from 35 percent in 2000 to 99.9 percent in 2010. Administrators at Children’s Hospital knew they were responsible for a vulnerable population; so they stood up for them.

Doctors are also doing something that decades ago would have been unthinkable: they’re refusing to see parents who won’t vaccinate their children.

For doctors, it’s a lose-lose situation. Doctors who refuse to care for unimmunized children are sending a strong message. They’re saying vaccines are so important that they cannot be asked to withhold them. The problem with this approach is that by refusing to see unimmunized children, doctors lose any chance of convincing parents of the value of vaccines; worse still, these children will likely remain unimmunized and vulnerable. On the other hand, if doctors continue to see unimmunized children, they’re sending a tacit message that it’s an acceptable choice. And it’s not a choice that parents are making for their child only; it’s a choice they’re making for other children, including those in the doctor’s waiting room. The measles outbreaks in 2008 are a perfect example of how parents’ choices for their children affected others. When unimmunized children developed fever and a rash, parents brought them to their pediatricians’ offices, where other children, some too young to be immunized, were exposed. Doctors’ offices became epicenters of measles transmission. Now, doctors are asking: who will stand up for children in our waiting rooms if not us?

Brad Dyer, a pediatrician in Lionville, Pennsylvania, has written a vaccine policy that is posted throughout his office. “We call it the manifesto,” he says. The document, titled “The Importance of Immunizing Children,” reads, in part, as follows:

We firmly believe in the effectiveness of vaccines to prevent serious illnesses and save lives.

We firmly believe in the safety of vaccines.

We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

We firmly believe based on all available literature, evidence, and current studies that vaccines do not cause autism or other developmental disabilities.

Furthermore, by not vaccinating your child you are taking selfish advantage of thousands of others who do vaccinate their children, which decreases the likelihood that your child will contract one of these diseases. We feel such an attitude to be self-centered and unacceptable.

We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccinating your child. We recognize that the choice may be an emotional one for some parents. We will do everything we can to convince you that vaccinating according to the schedule is the right thing to do. Please be advised, however, that delaying or “breaking up the vaccine” to give one or two at a time over two or more visits goes against expert recommendations and can put your child at risk for serious illness (or even death) and goes against our medical advice.

Finally, if you should absolutely refuse to vaccinate your child despite all our efforts, we will ask you to find another healthcare provider who shares your views. We do not keep a list of such providers nor would we recommend any such physician.

Following the posting of the policy, only a handful of parents left Dyer’s practice. “Parents have said, ‘Thank you for saying that. We feel much better about it,’” he says.

Unfortunately, nothing will change if the push to vaccinate comes only from doctors, vaccine advocates, public health officials, and hospital administrators. Some parents will always view these groups as biased; and it hasn’t been hard for anti-vaccine groups to appeal to the sentiment that they can’t be trusted.

When parents choose to vaccinate their children, one element is critical to the decision: trust. A choice not to vaccinate is a choice not to trust those who research, manufacture, license, recommend, promote, and administer vaccines—specifically, the government, pharmaceutical companies, and doctors. If we are to again believe that vaccines are safer than the diseases they prevent, we’re going to have to trust those responsible for them. This isn’t going to be easy.

The CDC has been a particularly useful target. The mere mention of the term the government conjures up images of labyrinthine red tape and career bureaucrats who don’t care about anything except their pensions. But anyone who spends time with the people at the CDC responsible for vaccines will come away with a far different impression. People like Walter Orenstein, a pediatrician and former director of the National Immunization Program, who early in his career worked to eradicate smallpox, caring for one of the last cases in India. Or Anne Schuchat, an internist and director of the National Center for Immunization and Respiratory Diseases, whose compassion toward those sickened and, in some cases, killed by the novel H1N1 virus was apparent at every CDC press briefing. Or Larry Pickering, a pediatrician, infectious diseases specialist, and executive secretary of the Advisory Committee on Immunization Practices, who dedicated his early career to understanding how infections in child-care centers could best be eliminated. Or Nancy Messonier, a tireless advocate for children who suffer meningococcal infections. John Salamone, a parent advocate who worked closely with CDC officials during his fight to change polio-vaccine policy, was impressed by what he saw: “They were all incredibly professional, all very caring, all wanting to do the right thing.”

Eventually, we are going to have to appreciate that CDC officials aren’t against us—they are us. Those involved with vaccines include doctors and scientists who are also parents, aunts, uncles, and grandparents. “We’re human,” says Walter Orenstein. “We have children. And we use the same vaccines in our own children as we recommend for anybody else.”

Another group targeted by anti-vaccine groups is vaccine advocates. People like Deborah Wexler, who visits housing projects to talk about the importance of vaccines, and provides free vaccines to Southeast Asian refugees, all through an organization she founded in St. Paul, Minnesota. Or David Tayloe, former president of the American Academy of Pediatrics, who has served his North Carolina community as a practicing pediatrician for more than four decades. Or Amy Pisani, who studied at Gallaudet University for the deaf before becoming executive director of Every Child by Two, an organization that provides vaccine services to low-income families.

Despite the efforts of these advocates for children, journalists with a direct link to the anti-vaccine movement have tried to discredit them. For example, on July 25, 2008, Sharyl Attkisson aired a segment on the CBS Evening News with Katie Couric. (Attkisson also maintains an anti-vaccine blog site.) Attkisson had discovered what she believed really motivated people like Amy Pisani: money. “Every Child by Two,” said Attkisson, “a group that promotes early immunization for all children, admits the group takes money from the vaccine industry, too, but wouldn’t tell us how much. A spokesman [Amy Pisani] told us, ‘There are simply no conflicts to be unearthed.’ But guess who has been listed as the group’s treasurer?—an official from Wyeth and a paid advisor to big pharmaceutical clients.” Attkisson’s implication wasn’t subtle. Every Child by Two was a sham, merely fronting for the interests of Big Pharma. But Attkisson’s guilt-by-association reporting lacks one critical element: quid pro quo. Where is the evidence that Every Child by Two, an organization founded by the wives of a former U.S. president and a former senator (Rosalynn Carter and Betty Bumpers)—with minuscule salaries, a shoestring budget, and a tiny office in Washington, D.C.—is promoting vaccines for any reason other than its belief that they are lifesaving? And where is the evidence that the money that it receives from pharmaceutical companies is used for anything other than outreach to underprivileged children? Attkisson’s report was the worst kind of journalism: damning by association. Pharmaceutical companies provide unrestricted educational grants to groups like Every Child by Two all the time. The key part of those grants is the word unrestricted. Once given, the company has no say in how that money is spent.

Attkisson didn’t stop with Every Child by Two. She also attacked the American Academy of Pediatrics. “The vaccine industry gives millions to the American Academy of Pediatrics,” she said, “for conferences, grants, medical education classes, even to help pay to build their headquarters. The totals are kept secret, but public documents reveal bits and pieces; $342,000 was given to the academy by Wyeth, maker of the pneumococcal vaccine for a community grant program; $433,000 was contributed to the academy by Merck, the same year the academy endorsed Merck’s HPV vaccine. Another top donor, Sanofi-Aventis, maker of seventeen vaccines and a new five-in-one-combo shot just added to the vaccine schedule last month.” Attkisson implied that pharmaceutical companies bought the AAP’s support of vaccines. But the AAP’s recommendations are based on a careful review of safety and efficacy data. Is Attkisson saying that vaccines wouldn’t be recommended by the AAP unless pharmaceutical companies greased its palms? It’s a fantastic accusation. Isn’t it possible that the AAP promotes vaccines for the same reason that the FDA licenses them and the CDC recommends them—that vaccines save lives? Is there any evidence that members of the AAP or Every Child by Two, after looking at data on vaccine safety or effectiveness, have realized that the vaccines fell short of what is necessary to help children? And, if so, then turned a blind eye? Have representatives from any organization designed to further the health and welfare of children—goals that are directly in line with the promotion of vaccines—ever said to themselves, “Sure, the data on vaccine safety don’t look very good here, but we’ll ignore those studies because we receive unrestricted educational grants?” Because that’s what Attkisson was implying—that the relationship is bad for our nation’s children. But if she is going to make that accusation, she will need more evidence than the fact that an association exists.

Attkisson’s attacks weren’t unique. Pharmaceutical companies are often a target for cynicism and distrust. Indeed, few industries are more reviled. And, to some extent, it’s understandable. In order to sell their products, pharmaceutical companies have occasionally acted aggressively, unethically, and even illegally. Pfizer’s $2.3 billion settlement with the government for providing false information about Bextra, a pain medication, and Viagra, a well-known potency product, are probably the most extreme examples of how far companies will go to sell their products. So, by extension, it hasn’t been hard to tarnish the reputations of people who speak on behalf of vaccines. Lora Little, Barbara Loe Fisher, Jenny McCarthy, J. B. Handley, Jim Carrey, Bill Maher, and other anti-vaccine activists have consistently railed against the unholy alliance between vaccine makers and those who promote vaccines. The implication is clear—any association with vaccine makers is unacceptable. The media buy it; congressional committees buy it; parents buy it. And, once bought, the implication effectively eliminates a lot of expertise from the debate—leaving people like Robert Sears, a man with no published experience on vaccine science or vaccine safety, to do a lot of the talking.

There is, however, one problem with the image of the evil vaccine maker. At no time in history has a pharmaceutical company ever engaged in illicit marketing practices for vaccines. Not once. And it’s not because government regulators aren’t watching. They’re watching. Indeed, companies that make vaccines are often taken to task for improper marketing of drugs. It’s unclear why this is true. Maybe it’s because drugs are much more lucrative than vaccines. Or maybe it’s because company employees who make and promote vaccines are more likely than those who promote drugs to have a public health background, so they see vaccines as a public service. Whatever the explanation, it seems reasonable to suggest that if we are going to eliminate from the debate anyone who has come in contact with vaccine makers, we should at least get our money’s worth. It would be compelling if at some point in the two-hundred-year history of vaccine manufacture one shred of evidence existed that contact with a vaccine maker led to information that was misleading or incorrect. Sharyl Attkisson, in her hit piece against Every Child by Two and the AAP, never once showed how her unsubstantiated allegation of undue influence by vaccine makers led to anything other than better-educated physicians and healthier children.

At the heart of Attkisson’s attacks is the notion that the government, pharmaceutical companies, and doctors are part of a conspiracy. During his tenure at the CDC, Walter Orenstein was a target. “One of the most frustrating things about the anti-vaccine activity is the conspiracy theories,” recalled Orenstein. “Scientists often argue with each other. We say, ‘Your studies are poor; you’ve misinterpreted your data; you didn’t consider this study.’ But no one ever thinks in a scientific debate that if you say something with which someone else disagrees that you’re lying. I think one of the frustrations I find here is that if we say anything that doesn’t confirm [the anti-vaccine groups’] preconceived notions, we’re automatically labeled as liars.”

Conspiracy theories lie at the heart of the anti-vaccine movement, claiming that the pharmaceutical industry, using undue influence, causes eighty thousand practicing pediatricians and family physicians to lie about vaccine safety. “This season’s fashion in conspiracy theories—for those out of the loop of enlightenment—concerns health,” wrote David Aaronovitch, author of Voodoo Histories: The Role of Conspiracy Theory in Modern History, in the Wall Street Journal. “The Web sites, marginal cable shows, and radio phone-ins are full of tales about how Big Pharma and Bad Government are deliberately spreading diseases or manufacturing scares in order to sell us expensive drugs, gull us into dangerous vaccinations or just simply to create an atmosphere of panic which will allow ‘them’ to take over. We live in an age of conspiracies, or rather, we are more aware of conspiracies than we used to be. It is better to think that someone is in charge of everything than that the world is more often prey to accidents, madness, and coincidence. That’s why movies are full of dastardly but brilliant plotters, and hardly anything happens by chance.”

Probably the best example of the casual conspiracy theorist can be found after the decision by the VICP special masters that thimerosal in vaccines didn’t cause autism. Rebecca Estepp, a mother of a child with autism, said, “I was disappointed but not surprised. Vaccine court is a system where government attorneys defend a government program using government-funded science decided by government judges. I don’t think these children had much of a chance.” Estepp’s notion of a government conspiring to deny her child compensation through the VICP wasn’t supported by the facts. First: most of the research that failed to show that thimerosal caused autism was funded by academia, not the U.S. government. Second: the “government judges” who had denied her claim that vaccines caused autism had awarded almost $2 billion to petitioners since 1989 for other claims, primarily in cases where the evidence wasn’t clear. For thimerosal, the evidence was abundantly clear. But what was most striking about Estepp’s comments was that virtually every major news organization, including the New York Times, carried them unchallenged.

Conspiracy theories proliferate because of one shared characteristic between vaccine makers and the government: lack of a definable face. Companies are portrayed as caring only about money to be made, not lives to be saved. The media never tell, and the public never hears, stories of people at pharmaceutical companies who are directly involved in vaccine research and development.

Penny Heaton is a pediatrician who trained in infectious diseases at the University of Louisville. Then she joined the Epidemiology Intelligence Service at the CDC investigating diarrheal diseases in Africa. Between 1997 and 1999, Heaton, working in Africa, saw children die from overwhelming dehydration, mostly caused by ro-tavirus. In 1999, she decided to do something about it, joining Merck to lead its rotavirus vaccine program. It was a daunting task. At the end of a pre-licensure study that took four years to complete, involved eleven countries, included seventy thousand children, and cost $350 million, Heaton called together two hundred people at her company. She began by showing a map of the world. “This is what the world looks like now,” she said, pointing to hundreds of small black dots concentrated in Asia, Africa, and Latin America. “Each of these dots represents a thousand deaths a year from rotavirus.” Then Heaton showed a map without any black dots. “Now,” she said, pointing to the clean map, “we have the technology in hand to eliminate deaths from this disease.” Then she wept. She stood in front of two hundred people with her head down and her shoulders shaking, thinking of those children in Africa. This isn’t an image that anyone has of a pharmaceutical company. And it’s unlikely that anyone ever will. Because no matter how much companies make people like Penny Heaton available to the press and the public, no matter how much they try to provide a compassionate face to their industry, one belief will remain: vaccine manufacture is an enterprise that makes money and makes money only. Heaton later helped to provide Merck’s vaccine to several African countries.

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Drs. Penny Heaton (center of photo), Kathy Neuzil, and Abraham Victor Obeng Hodgson in Northern Ghana during rotavirus vaccine field trials. (Courtesy of Penny Heaton.)

If we are to get past the constant barrage of misinformation based on mistrust, we have to set aside our cynicism about those who test, license, recommend, produce, and promote vaccines. Only then will we survive this detour—a detour that has caused far too many children to suffer needlessly.