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SECTION l. MIRACLE IN THE MAKING: REALITY OR DELUSION?

Introduction
EPI--Field Evaluation Experience
UNICEF's General EPI Strategy and Stated Achievements
Field Observations
Contra-Indications Screening
A Case History
Vaccine Scheduling
Immunization's Impact in the Declension of Infectious Diseases
Incomplete Statistical Reporting
The Developmental Implications of UCL/EPI
Is Immunization Effectiveness a Certainty?
Early Theoretical Foundations Re-Examined
Artificially Induced Immunity--Reality or Delusion?
An Historic Overview of the Bacterial/Viral Theory of Disease Causation
The Bacterial/Viral Versus the Cellular/Ecological Theory of Infectious Disease
Infectious Disease Tables I--XVIII
Immunization Effectiveness Data
  Data on Diphtheria
  Data on Measles
  Data on Polio
  Data on Pertussis (Whooping Cough)
  Data on Tetanus Toxoid and Immune Globulin
WHO Smallpox Eradication Success Reconsidered
Vaccine Associated Dangers--General Observations
Of What Do Vaccine Products Consist?
Some Observed and Potential Adverse Effects of Spacific Vaccines and Toxoids--Diagnosable in the Short Term
Extent and Nature of Observable Vaccine Damage
Long Term (Delayed) Potential Adverse Effects of Immunization
Evidences for Immunization Induced Immune Malfimction
The Ethics of Universal Childhood Immunization
Bane or Boon? Selective Medicine in Primary Health Care

INTRODUCTION

Universal Childhood Immunization (UCI)--in its more localized context referred to as Expanded Program of Immunization (EPI)--stands worldwide as a top health programming priority among various multilateral, bilateral, and nongovernmental (NGO) international development agencies. This appears to be the case because immunization programs are widely accepted and actively promoted as offering recipient beneficiaries more substantive disease prevention benefits than any other modality in the arsenal of modern medicine, coupled to its unique capacity to offer the surest and "quickest" results. When compared to the more basic intersectoral and developmental requisites for public health sustenance and disease prevention, UCI/EPI is generally considered to be the easiest to implement programmatically, promote publicly, and defend politically. The World Health Organization (WHO) has gone on record to affirm that, "Immunization is one of the most powerful and cost-effective weapons of modern medicine. Immunization services, however, remain tragically under-utilized in the world today."¹

Despite the Canadian govemment's confirmed support of the comprehensive primary health care approach--as defined in the Alma Ata Declaration--the majority of increases in the Canadian International Development Agency (CIDA) Health Sector disbursements, in the last half of the 1980s, have been for the selective and vertical modality of UCI/EPI. In fact, according to observations made in the 1989, Evaluation Assessment of CIDA Investments in the Health Sector, immunization has become the dominant health activity supported by CIDA. "Annual disbursements over the past three years have risen from $3 to $22, to $49 million."² The lion's share of this increase stemmed from the launching of Canada's International Immunization Programme (CIIP), covering the period of 1986-1991. (An October 10, 1991 Fact Sheet on Canada's Role in Immunization, states that of the $43 million expended by CIIP in the period 1985-1990, involved the execution--by more than 30 nongovernmental organizations--of over 100 projects in more than 50 countries. When we include the government-to-government [bilateral] program, total CIDA funds committed to UCI/EPI in the 1986/1987-1990/1991 fiscal year periods equal some $143 million. At the end of 1991/1992 it was the intention of the government to expend roughly another $50 million on UCI/EPI over the next five years, with about $30 million for CIIP II.) According to a Mid-Term CIIP Operational Review completed November 20, 1989, UNICEF took almost $27 million from the Program for 37 EPI projects, amounting to 67% of CIIP funds. Additional CIIP funding passed indirectly to UMCEF, via Rotary for vaccine purchases, and via Canadian partners who purchased project equipment from UNICEF stockpiles.³

Speaking of this major shift in priorities, wherein by the end of the 1980s immunization support accounted for one half of all health sector disbursements, the CIDA Health Sector Evaluation Assessment recommended that "this situation merits examination on the grounds of both the heavy focus by CIDA on this one type of health program and the nature of immunization efforts . . . Primary Health Care is more complex and multifaceted then the provision of this one . . . technology."⁴ This need to re-examine immunization support was further affirmed when the Assessment identified certain "important am that merit further review," including: case studies of the health impact of projects involving or crossing varied sectors; the level of sustainability achieved in completed CIDA health projects; and areas of large spending or of controversy, i.e., immunization."⁵

Although the Assessment did not go on to define the nature of the controversies surrounding immunization, mass immunization programs have been seriously questioned on both developmental and scientific grounds. It will be the purpose of this report to proceed with a detailed examination of the issues of controversy, draw some conclusions, and make appropriate recommendations. The critique of these issues stems from a careful review and evaluation of wide ranging biomedical literature sources of relevance to the subject. This work has been carried out in the spirit of honest inquiry, thus affording a fresh and critical analyses of the fundamental issues.

Although the conclusions as reached visibly sustain "one side" of what is largely a hidden and professionalist dominated debate on immunization, the reader should note that this is done in order to provide a long neglected and constructive counterbalance to the predominating supportive declarations of the establishment, and in turn the parroted promotion of the same view by the popular media.

It must further be appreciated that past and ongoing investments in the drive for universal immunization extend well beyond the mere allocation of substantial government and publicly donated funds (which translates into biennial expenditures of a billion US dollars, 63 percent of which comes from Developing World countries themselves)⁶ to include:

• extensive public and private sector commitment to meeting the infrastructural, service, product and marketing requirements of the world-wide medico-industrial complex which employs tens of thousands of people in drug companies, private laboratories, universities, governmental health departments, hospitals etc. (furthermore it is estimated that there are 25,000 professional national and international staff who directly oversee hundreds of thousands of field workers involved in the annual vaccination of 60 million children);⁷
• related domestic and international legislation and politics; and
• massive public educational indoctrination initiatives that are largely predicated on promoting the unquestioned effectiveness and relative safety of immunization, and which by design engender an impelling fear in those "unprotected."

UNICEF's Executive Director has gone on record in many fora to herald the substantive value and potency of immunization. In advance of the inception of Canada's current and greatly expanded International Immunization program he gave a full and unqualified assurance that "Expanded immunization--using newly improved vaccines" will "prevent the six main immunizable diseases from killing an estimated 5 million children a year and disabling 5 million more."⁸

The front page of the January/February, 1988, issue of Development Forum, published by the U.N. Department of Public Information, unequivocally affirms that "immunization is the success story of the decade. In the Developing World immunization has reached 50 percent for DPT vaccine and 40 percent for measles, and is now saving over 1.3 million lives annually." Everyone is encouraged--bordering on religious fervor--to get on the bandwagon.

UNICEF.. calls for a 'Grand Alliance' of all possible resources teachers, and religious leaders, mass media and government agencies, voluntary organizations and people's movements, business leaders and labour unions, women's groups and health services to create an informed public demand for. . . the methods which could now bring about 'a revolution' in child survival and development. In Turkey, for example, 200,000 school teachers and 54,000 imams have helped to treble the nation's immunization coverage. In Syria and Egypt, television has succeeded in getting the immunization message into every home . . . UNICEF argues that 'there is no greater cause in which to march.' ⁹

Indeed, immunization has of late gained the distinction of being considered the "leading edge" in primary health care, and is extolled by its advocates as "the single most successful component of the child survival program." Its high acceptance and apparent success relate to a number of factors:

A technological package that is easily understood and readily available . . . the fact that vaccination does not require substantial behaviourial change; the relative ease of measuring coverage and its offer of an opportunity for political leadership at all levels to be visibly involved. Finally, it is the single component of PHC that provides the greatest opportunity for the private sector to participate through the supply or production of vaccine and cold chain equipment.¹⁰

It is accepted wisdom among medical professionals and in turn the public, that millions of children now enjoy improved health and freedom from various life-threatening diseases because of safe and effective vaccines. In the words of Fulginiti, "morbidity and deaths secondary to the contagious diseases have either been eradicated, measles greatly reduced in occurrence, and rubella, mumps, pertussis, and other diseases significantly lessened in terms of their impact."¹¹


EPI--FIELD EVALUATION EXPERIENCE

This general examination of Immunization as a central modality in the prevention of common infectious diseases in the Developing World will begin with some salient extracts taken from the writer's findings in a field evaluation he carried out on a UNICEF--Expanded Program of Immunization and Primary Health Care initiative in Northeast Thailand, in March of 1990. The data derived from evaluating the EPI component is being provided as basic background information because it provides some useful insights on comparable UNICEF-EPI initiatives that are now occurring throughout the Developing World, and points to some critical issues meriting further investigation. (EPI was one of eight components in the Integrated Services Project for Children, extending over a five year period, at a cost exceeding $8,500,000.(Cdn). This funding was primarily provided by the Canadian Government, and supplemented with public contributions. The Project was executed by UNICEF Thailand, in cooperation with the Royal Thai Government.)

The EPI in Northeast Thailand proved to be a considerable undertaking. It included: the execution of a cluster survey on immunization coverage in all 59 districts (in which there are over 900 villages); provision of EPI training for 600 Village Health Volunteers, Village Health Communicators, and religious leaders; similar training for 200 health care providers, and 40 multiple WHO staff, EPI information strengthening and finally social mobilization to vaccinate, viz. provide BCG/OPV/DPT and measles coverage for all 59 districts. It further involved the equipping of 373 tambon (subdistrict) health centres with sufficient numbers of. refrigerators; vaccine carriers with four icepacks; BCG vaccine kits; thermometers; cold chain monitoring cards; and steam sterilizers.
The EPI initiative placed its strategic concentration on the following areas:

1. EPI training of village and religious leaders
2. emphasis on reaching progressively higher annual vaccination targets
3. provision of cold chain equipment and support to targeted Tambons
4. information campaigns in primary and elementary schools
5. public education campaigns in targeted villages
6. increased vaccine production; and
7. strengthening the EPI information system at the district and provincial level.

In reviewing figures for the project covering the first three years (1985-1987), the priority emphasis on immunization is evident. Project expenditures for this component reached 126 percent of the original target for immunization, compared to only 28 percent for primary health care. Food and nutrition fared somewhat better at 60 percent of the target, a little under the project average of 61 percent. A budget analysis conducted on the project for this period states that "Implementation of the community action component is . . . low. However, the savings obtained here will be passed on to the EPI and pre-school components . . ." The reason given for exceeding the original budget projections for EPI, was "because of the demands and opportunities for support presented."¹²

Recognizing the central importance of "health care outcomes," both the evaluation exercise and this broader examination of the issues have purposely focused on concerns surrounding the qualitative issue of EPI health care outcomes and effectiveness. However, it became readily apparent in the evaluation of the Program that--due to the absence of base line data on any sample of the recipients, let alone the additional need for a comparable control group, and the control or monitoring of intervening variables it was not really possible to proceed with any accurate or verifiable determination of health care outcomes (i.e., to establish a cause and effect relationship) for EPI.

This need to provide verifiable measurement of a program's health care outcomes appears to be pervasively deficient throughout most health programming directed to the Developing World. The implications of this general deficiency to the specific measurement or determination of EPI effectiveness, remains a serious one, and will be addressed more thoroughly at later points in this report.

UNICEF'S GENERAL EPI STRATEGY AND STATED ACHIEVEMENTS

In a UNICEF sponsored research study on immunization coverage conducted in Thailand in the mid 80's, the following general observation is made:

[The] immunization programme has been proven to be an efficient, and relatively inexpensive method of disease prevention in both developing and developed countries. In the last decade, we have seen an increase in immunization usage, public acceptance, improved delivery techniques and more stable vaccines. The more extensive use of vaccines has resulted in a dramatic decrease of many leading communicable diseases in all parts of the world. However, this condition is by no means true in developing countries where most of the vaccine preventable diseases like diphtheria, pertussis, neonatal tetanus, poliomyelitis and measles remain to be a serious health menace among infants and children in these countries."¹³

The view as expressed here--during the early stages of this project--provides a fair representation of the rationale behind UNICEF'S resolve to proceed with its universal disease eradication drive, via vaccine induced immunization. (It is of no passing interest that WHO and UNICEF sponsored literature, such as above, now embody a new nomenclature, in which one does not refer to preventable diseases, but more precisely "vaccine preventable diseases" thus tending to convey the unsubstantiated conclusion that such diseases are only preventable through the use of vaccines.)

In UNICEF's Fourth Progress Report on this project issued in 1989, it was affirmed that, "Impressive progress has been made towards the achievement of Universal Child Immunization (UCI). Immunization coverage has been increased and the incidence of immunization diseases reported has reduced." This achievement was reported as taking place despite such persistent obstacles as: insufficient "awareness and knowledge among health officials and community leaders;" inadequate "availability of vaccines and cold chain in remote areas;" and the problem of "drop-out due to ignorance, distance, and fear of side effects."

FIELD OBSERVATIONS

On the basis of structured and semi-structured interviews in five provinces, five districts, and nine villages visited, the following facts came to light:

• The EPI component objectives were comprehensively and successfully implemented, exceeding the original numerical targets
• EPI was reported as the "only activity that is implemented and recorded entirely by government (health) officials"
• All parents had been informed that: immunization was an effective, and essential life-guarding measure, and although it could result in fever or a minor rash for their infants, this should be expected as normal (a small price to pay for the benefits received); and that otherwise the procedure was very safe and should pose no cause for fear or alarm
• The most commonly reported side effect of infant vaccinations was fever, with village reports ranging from a low of 6% of infants immunized to "99%." (Rashes were the second most commonly reported side effect)
• Fever reducing drugs are either routinely administered to vaccinated infants, or administered on request of parents (however, one village did report the effective use of water instead of drugs to reduce fever), and
• Sisaket province reported that "rare" cases of post-vaccination shock have occurred, attributing this to vaccinal "overdose." Surin province reported that there were cases of post-vaccination shock in various other provinces, but not in Surin. Such cases were attributed to the vaccine vial not being "sufficiently shaken."

CONTRA-INDICATIONS SCREENING

Evidence indicated that the EPI program did not incorporate adequate measures for contraindications pre-screening and post-monitoring.

1. All infants received the vaccines regardless of their weight or nutritional status (only one village indicated that vaccines were not given to infants severely underweight, and only one province reported post-vaccination monitoring of infants under 3 kg).
2. Actual nutritional status assessment does not appear to be conducted on infants (excepting the body weight factor) before administering vaccination.
3. There did not appear to be any procedural requirements for checking family histories to determine whether there existed any history of neurological disorders before administering vaccination.

The official view historically held and still articulated by the World Health Organization (WHO) is that both the provision of screening for contraindications, and post operation monitoring for adverse reactions are uncalled for in the context of Developing World EPI campaigns. The underlying rationale has been that the life saving benefits of EPI so far outweigh any risks, that attention to potential risk factors and the potential for vaccine induced damage in vaccinates remains impracticable, and thus a non-issue.¹⁴

Despite this unqualified optimism, according to information provided by CIDA's Health and Population Directorate sector, the WHO effective October, 1990, instituted a policy for "adverse event monitoring" in Developing World Immunization activities. A definitive policy statement on this issue titled Monitoring of Adverse Events Following Immunization, has been available since April 1991. (The implications of WHO's recognition of the significance of this issue in setting UCI/EPI research, monitoring and evaluation priorities should be apparent.)

It is thus important to point out that there is by no means a consensus on this issue within the Bio-science community (including the inconsistencies exhibited in the public pronouncements, and policies of the WHO). In one of the most recent scholastic manuals available on immunization practice, noted authority, George Dick--Professor Emeritus of Pathology, London University--provides the following cautions relative to the traditional assumptions of the WHO:

• Before considering immunization it must be determined that the disease in question is of sufficient severity, frequency or other importance to justify immunization against it. Furthermore, "if the infection is readily treatable, there is seldom justification for immunization."
• "immunization is indicated only when the classic methods of control are [demonstrably] impracticable or unsuccessful."
• Before any vaccine is introduced "there must be good evidence that the vaccine is effective and relatively safe . . . Sufficient time has not yet elapsed to predict with any certainty the durability of immunity with the live virus vaccines, which are now in common use, such as poliomyelitis, measles . . . [etc.]"
• "The best type of active immunization follows a clinical or subclinical natural infection. With many diseases this often gives lifelong protection at little or no cost to the individual or to the community."
• The pre-immunization era declines in infectious diseases "should make one careful in attributing changes in the epidemiology of some diseases to the result of a specific treatment or immunization."¹⁵

He further confirms that in the following conditions, the EPI vaccine as noted should not be administered. (Obviously pre-vaccine screening measures must be in place in order to ensure that these guidelines are met.) Dick's recommendations follow on Table A.

Preliminary PHC and EPI research conducted for CIDA's Evaluation Division indicates as well that vaccines should not be administered to children who are suffering from malnutrition due to associated immunodeficiency problems (of which--inter alia--chronic infections are symptomatic). However, the official WHO position on this point is that "Fever, respiratory tract infections, diarrhea, and malnutrition should not be considered as contraindications to immunization." This is based on the relationship between immunodeficiency status and increased risk of natural infection.^{16, 17, 18} (For a cross-sampling of other reference sources which support a counter-view to the WHO stance on immunodeficiency and contraindications to vaccines, please see ref.¹⁸)

The Project's failure to address this issue--in a responsible manner--has undoubtedly caused some very real harm, when only good was meant, as the following shows.


A CASE HISTORY

Upon completing the briefing session with a large contingent of Surin provincial and Northeast regional health officials--at which the chief provincial spokesperson confirmed that although post-vaccination shock was a problem in other provinces, there were no known cases being reported in his province evaluation team members departed for their respective village destinations. Upon entering the village of Kanjarong, in the Chom Phra district (only 35 miles distant from the provincial capital) in company with the UNICEF Integrated Services Project Monitor, we encountered and met with the village Head Man and the Deputy Head Man.

In the course of the interview, the Deputy Head Man, with some intensity explained that his own son had experienced what he considered as very serious damage as a result of immunization. The Project Monitor and I returned the following day, at which time we both interviewed the mother and observed the affected child during the interview. As a result of this more careful and thorough interview, the following facts of the case were ascertained:

• Up to the age of 3 months the infant had been breastfed. Breastfeeding was terminated by the mother due to a diagnosed thyroid deficiency, per the "doctor's" request. She subsequently began feeding him powdered milk, supplemented by egg, meat, and white rice. The use of fresh fruit and vegetables in the infants diet remained very marginal.
  
  
• At the age of 8 months the infant was taken in for his final DPT (triple antigen) vaccine. He almost immediately went into what was diagnosed and described as a state of "shock," for which he was duly treated by a physician. As well, a whole series of serious problems began:
  1. chronic sleeplessness
  2. high fever
  3. unbroken colds and runny nose continuing over several months
  4. unbroken crying (except when held) for a period exceeding 2 months
  5. in the eleven months following the vaccine (the child at time of inter-view was I year 7 months) there appeared to be severely impaired weight and growth developments.

     Although cognizant that this case history could be construed (and in turn dismissed) as a rare anecdotal occurrence that was only coincidental to the administration of the triple antigen vaccine, after careful thought I've decided to included it in some detail for three basic reasons:

     I. evidence suggest that for multiple reasons--as noted throughout this document--such adverse reactions are likely to be taking place at a significantly greater level than is popularly believed;

     II. a calm, intelligent and caring mother's direct experiential observations and hindsight about her child represent a fully valid and trustworthy source of information; and

     III. overall, the clarity and force of the evidence was such that the child's reaction was clearly more than a mere coincidence, and thus not attributable to other direct causes. (As well there is clear evidence suggesting that the occurrence and severity of adverse reactions to vaccines--among infants--correlate proportionally to both lack of breasffeeding, and Vitamin C deficiency (e.g., see refs. 17 & 18).

The following comments should be made with respect to points (a)-(e) above:

• The evidence of unabated infections suggests general impairment of the child's immune system, i.e., vaccine induced immune malfunction.
• The unbroken crying (its unfortunate that children under the age of one can't verbally explain the nature and extent of their distress) suggest the possibility of permanent nervous system damage. (In observing the child walk about, it was visibly evident that his general motor functions and coordination were impaired.)

The reported growth stunting effect was also visibly obvious, as the child appeared to be at most the size of a one year old. (In that impaired growth is generally not identified in the literature as a vaccine related or induced hazard, this condition may well have been principally related to other factors bearing on the child's nutritional intake and or assimilative capacities.) The mother reported that his weight at birth was 4 kilos (a very heavy baby by Thai standards) and at 5 months, 9 kilos. At the time we visited--though now I year and 2 months older--his weight was unchanged, still at 9 kilos.

It is also worth noting that the mothers three month old grandson, who was present during the interview, had been experiencing high fever, and continuous colds since having received recent inoculations. Given that I visited only 9 out of over 900 participating villages, and then only raised this issue with a fraction of respondents, poses serious concern as to just how widespread and serious the problem of adverse side effects is.

It is known for instance that when mass immunization programs were enforced in Australia's Northern Territory among what was a generally malnourished Aboriginal population (the most notable concern being Vitamin C deficiency) death rates doubled, in some areas approaching 50 percent i.e., "Every Second Child." According to the author of a book by that title and veteran physician to the Aboriginals A. Kalokerinos:

A health team would sweep into an area, line up all the Aboriginal babies and infants and immunize them. There would be no examination no taking of case histories, no checking on dietary deficiencies. Most infants would have colds. No wonder they died Some would die within hours . . . Others would suffer immunological insults and die later from pneumonia, 'gastroenteritis'or 'malnutrition'.¹⁹

In Northeastern Thailand, in the villages visited practically all mothers were breastfeeding, and were to some extent including fresh garden vegetables and fruit in their diets. This in turn provided a fair degree of protection from the kind of severe reactions and mortality just noted among Australian Aboriginals. Nonetheless, it is apparent that there still remains a sizable number of malnourished. To quote C. Guthrie:

Malnutrition seems to be declining in the Northeast... Still, malnutrition is widely prevalent. One does not need to go looking for it. In one school . . . in Don Luang, 50 percent of the children were suffering from one level of malnutrition or another. I found it somewhat disturbing to find that the objective expressed by most officials was restricted to the eradication of 3rd degree malnutrition, in spite of the wide prevalence of 1st and 2nd degree malnutrition.²⁰

It appears that the mass coverage obsession common to UCI and EPI, have run roughshod over the repeated qualifications, and warnings that have been issued against administering vaccines to inimunodeficient infants and children, of which malnutrition is a prime indicator. The fact that a March 1988 Annual Report on this Project (p. 5) indicated that a WHO/UNICEF review team found that EPI "drop out rates were high, because of the fear of side effects as expressed by mothers," suggests that the prevalence of vaccine induced complications and morbidity in Northeast Thailand, may well be more significant than heretofore thought. (The broader question and implications of vaccine induced morbidity and mortality will be examined in more detail, later in the report.)

VACCINE SCHEDULING

The rationale behind administering multiple vaccines and toxoids throughout the first 14 week period of an infant's life (excepting measles) is that in the first year of life--when the immune system is still relatively immature--a child is considered more susceptible to most infectious diseases. However, this view fails to admit the corollary that the immune and nervous systems of infants, are immature thus making them potentially more vulnerable to the toxic effects of vaccines and toxoids.

Nonetheless, the argument is commonly raised that vaccines must be administered in accord with the recommended schedule," (particularly in the Developing World), as the risk of dangers is so marginal, and the dangers of widespread and unchecked infectious diseases so great that the infant must have the vaccines--or else. Of course this view is acceptable only insofar as the multiple beliefs surrounding UCI/EPI are valid, i.e., that there are no better disease preventative measures; that the presence of such infections cannot be safely handled or treated; and that vaccines are both highly effective and very safe.

It is instructive to consider the experience of Japan in this regard. Delay of DPT immunization until 2 years of age in Japan has resulted in a dramatic decline in adverse side effects. In the period of 1970-1974, when DPT vaccination was begun at 3 to 5 months of age, the Japanese national compensation system paid out claims for 57 permanent severe damage vaccine cases, and 37 deaths. During the ensuing six year period 1975-1980, when DPT injections were delayed to 24 months of age, severe reactions from the vaccine were reduced to a total of eight with three deaths. This represents an 85 to 90 percent reduction in severe cases of damage and death. ²¹

Although it is obvious that conditions in Japan remain distinctive from that of most Developing World countries, it must be noted that insofar as susceptibility to infectious disease remains greater in lesser developed countries, it clearly follows that susceptibility to vaccine damage will also be proportionally greater. Thus the lesson from Japan carries a valid message relative to the prevention of vaccine damage in Developing World EPI campaigns.

IMMUNIZATION'S IMPACT IN THE DECLENSION OF INFECTIOUS DISEASES

Statistics indicate that over the life of this project, Thailand (and presumably the Northeast region, for which direct figures were not available) has exhibited some degree of declension in childhood infectious diseases (excepting measles) for which immunization has--in recent years--been made generally available. However, it must be borne in mind that prima facie improvement in morbidity levels--in end of itself--falls far short of proving any actual interventional cause and effect relationship for EPI.

Direct discussions with the International Development Research Centre's Health Sciences Division confirms that in selective primary health care activities, such as EPI, there exists "no good base line data from which to measure health care outcomes. SPHC (Selective Primary Health Care) programs in the implementation of EPI appear to ignore this whole issue," Due to the strong and widely maintained assumption that interventions such as EPI serve inextricably and directly as the basis for health improvement outcomes, there has been a general failure since the inception of the first vaccine programs to establish genuinely verifiable evidence for their long term effectiveness, and safety. ²²

The general nature of this problem in Selective Primary Health Care activities is well expressed by prominent Medical Sociologist J. Williamson, when he says there has been a failure to "assess explicitly the degree of validity and sufficiency of the evidence linking care structures (facilities, personnel), and processes (what providers do, e.g., EPI) to outcomes of care in general and to health outcomes in particular."²³

Epidemiological science is largely predicated on the reality that changes in morbidity and mortality in populations are necessarily linked to a whole series of contributive factors." (Noted authority George Dick states that: "Many infectious diseases can be prevented without immunization, because once the natural history of the disease is understood, the source may be eliminated or transmission prevented [e.g.,] . . . . When it was discovered that cholera and typhoid epidemics were regularly transmitted by faecal contamination of water, the provision of clean water supplies nearly eradicated these diseases from many countries without recourse to immunization.")²⁴ It is widely acknowledged that factors such as: nutrition, sanitation, potable water; the natural and social environments (e.g., agricultural practices, food supply, education and income), all play vital roles in determining the onset, severity, and eradication of both infectious and degenerative diseases. Diseases such as cholera and typhoid, have been strongly linked to water and sanitation, whereas evidence continues to accumulate that nutrition remains likely the most critical determinant factor in the full range of infectious and degenerative human diseases.²⁵

The very fact that in this UNICEF project--as in many others--EPI is implemented over a period of years in the midst of a whole series of other natural and basal socioeconomic improvement measures, each having their own critical impact on any population's health status (including epidemicity levels) suggests that EPI could actually be playing a negligible or even a negative role, and no one would really know the difference.

According to the recently completed comprehensive Program Evaluation of the Canadian International Immunization Program--Phase 1, this poses a situation in which the relative impact of expanded immunization programs on mortality levels in the Developing World remain largely unsubstantiated. To quote: "at present it appears that there is no conclusive evidence on the impact of immunization on child mortality from all causes . . . It may be that EPI's effect is merely to bring about "replacement mortality," whereby children . . . succumb to other diseases instead. The uncertainty over the impacts of EPI remain a major question in PHC programming."²⁶

In a similar vein, Debabar Banerji, Chairman of the Centre of Social Medicine and Community Health at Jawaharlal Nehru University raises serious concerns with the UNICEF sponsored Universal Childhood Immunization program in his own nation. He suggests that:

If we turn to the epidemiological analysis of UCI-90 in India, we are astonished to learn that such a gigantic program has been launched without having even the most basic data on infectious diseases . . . Then how will it be possible to determine the cost-effectiveness of the program? Actually, there ought to have been much more detailed analysis. . . .

For example, with regard to disease levels and factors, he urges that very basic questions should have been addressed before implementing UCI, such as: . . . how different are the rates in different parts of the country and what are the ecological, cultural, social and other factors which affect the rates--through influencing the balance between the host, the parasite [i.e., virus or microbe] and the environment. Information should have been provided on what are the trends in the epidemiological behaviour of the different diseases over a time period, what should be the epidemiological strategy for intervention in the natural histories of the diseases, and so on. Paying scant attention to such critical epidemiological considerations, the crusaders of UCI-90 have opted in favor of saturation spraying with "silver bullets " [vaccines]. Over and above this, there are also the important questions of efficacy of the vaccines. . .

Administratively, the exponents of UCI-90 seem to indulge in collective amnesia to wish the bitter experiences of major vertical [top down] programs like the mass BCG Campaign, the National Malaria Eradication Program, and the three [national] efforts at eradication of smallpox . . . Also actively shunned are the many lessons from the failures of vertical programs for trachoma, leprosy, filariasis, cholera, and sexually transmitted diseases." ²⁷

INCOMPLETE STATISTICAL REPORTING

Selectively slanted and incomplete reporting of the true statistical picture is not an infrequent problem in the promotive oriented reporting on EPI impact data. For example, the following Tables B and C, were based on data presented in Section 4.3 "Expanded Programme of Immunization," in UNICEF's Fourth Progress Report CUC/CIDA Development of Basic Services for Children in Thailand, covering the period January--December, 1988.

The following comment is made with respect to the expansion of the measles vaccination program, ". . . the immunization coverage for measles has increased from 6 percent in 1984 to 63 percent in 1988, leading to a reduction in measles prevalence from 93.7/100,000 in 1984 to 37.1/100,000 in 1986."

What the report fails to indicate though is that although the 1986 inununization coverage of 44% had increased by 1987 to 60%, the measles infection rate in the same period actually more than doubled, with an increase from 37.1 to 87.1 per 100,000. It is also noteworthy that the culminating maximum immunization coverage of 63% achieved in 1988, correlates with a 1988 infection report rate of 59.1 /100,000--which in fact poses higher level of measles infection than the 1982 reported infection rate of 57.1 /100,000, which was a time when measles immunization was not being provided in Thailand. (The higher per capita infection rate--after five years of expanding coverage--obviously reflects very negatively on the assumed efficacy of the vaccine, and may have been deliberately obfuscated in the reporting. No evidence was seen to suggest that the post-immunization increases in disease rates were attributable to case reporting improvements.)

THE DEVELOPMENTAL IMPLICATIONS OF UCI/EPI

Clearly, Universal Childhood Immunization stands in contradiction to the strategically development based primary health care principles as embodied in the Alma Ata Declaration. (The issue of intersectoral primary health care versus selective medicine remains an area of major controversy. It will be examined in considerable detail later in this paper). In fact, Developing World analysts such as D. Banerji, forcefully contend that short term, "top down" approaches to health care--such as EPI threaten to reverse Alma Ata's historic gains for more self-directed and sustainable health care. In his view the shifting emphasis toward selective medicine including UCI/EPI:

• Negates the principle of community participation and control as exemplified in "bottom up" development
• Accords resource allocations only to certain target groups, ignoring the needs of the total family and community
• Reinforces elitist authoritarian attitudes, thus increasing oppression.
• Has a fragile basis in science
• Displays questionable moral and ethical values, in which a questionable commodity of foreign and elite interests, is promoted to and imposed on the majority of the people.²⁸

In his own words, the Universal Childhood Immunization initiative, constitutes the efforts of ruling interests in Donor nations:

. . . to hit out at the very core of the philosophy of primary health care by imposing technocentric vertical programs against a few diseases in the name of saving children . . .This movement not only tends to fragment a health care system and take it away from a wider ecological, intersectoral, and integrated approach, but it also actively hinders community self-reliance and seriously erodes the democratic rights of the people to participate in decisions which so vitally concern them. This is perhaps the most malignant facet of the present efforts to impose specialized . . . programs from outside, using social marketing techniques to sell them." ²⁹

Researchers like Rifkin and Walt maintain that interventions such as EPI, are essentially based on the (now fading) view that human health is dependent upon and arises from a force of elite professionals who hold privileged knowledge--coupled with corresponding power and control--to effect their disbursal of technocentrically contrived benefits, to relatively ignorant and passive recipients.³⁰ It goes without saying that any programmed encouragement of this mind set--despite the very best of intentions--constitutes an inimical force to those principles and processes whereby intelligent self-development, and informed self-care can prevail.

In reference to the developmental implications of UCI/EPI, medical sociologist L.J. Chetelat notes that:

Health professionals, by taking and promoting easily executed interventions, such as immunization, create a demand for these programs and raise expectations which are seldom realized.. SPHC by identifying specific techniques (such as EPI) and strongly supporting them, diverts attention and resources from the process of development, to highlighting specific programs with exaggerated and often unpredictable outcomes. In reality, technocratic and "instant" successes, put into danger the long slow process that leads to sustained improvements. They are creating a climate of short-term expediency, rather than long term change.³¹

IS IMMUNIZATION EFFECTIVENESS A CERTAINTY?

It can well be said that real "ignorance is not knowing, but knowing what isn't so." The question of whether vaccines in fact protect recipients from the diseases for which they are given, might seem absurd on the face of it. As already noted, when we closer examine the question of statistical evidence for immunization's effectiveness, there remain significant epidemiological uncertainties. The literature further reveals some critical problems in data gathering, interpretation and reporting practices. These basic concerns are succinctly summarized by Professor Gordon Stewart, recent head of the Department of Community Medicine at Glasgow University:

What kind of immunization is this for which success is being claimed?... What kind of epidemiology is this which advocates immunization b excluding, consideration of factors other than immunization? . . . "at kind of editorial policy is this which publishes incomplete data and promotes far reaching claims about the efficacy of immunization, but refuses to publish collateral data questioning this efficacy? ³²

We are thus confronted with an unenviable situation where in the general absence of verifiable multifactored and controlled studies, EPI remains today--scientifically speaking--as a basically unproven program intervention. In fact, there is a substantive and growing body of data that call into serious question the soundness and effectiveness of mass immunization programs. This data not only calls into question EPI effectiveness, but further details adverse side effects and potential long term dangers of this widely implemented medical intervention.

EARLY THEORETICAL FOUNDATIONS RE-EXAMINED

In order to better grasp the issue of vaccine effectiveness, it would prove helpful for us to go back to the early theoretical foundation upon which current vaccination and disease theories originated. In simplest terms, the theory of artificial immunization postulates that by giving a person a mild form of a disease, via the use of specific foreign proteins, attenuated viruses, etc., the body will react by producing a lasting protective response e.g., antibodies, to protect the body if or when the real disease comes along.

This primal theory of disease prevention originated by Paul Ehrlich--from the time of its inception--has been subject to increasing abandonment by scientists of no small stature. For example not long after the Ehrlich theory came into vogue, W.H. Manwaring, then Professor of Bacteriology and Experimental Pathology at Leland Stanford University observed:

I believe that there is hardly an element of truth in a single one of the basic hypothesis embodied in this theory. My conviction that there was something radically wrong with it arose from a consideration of the almost universal failure of therapeutic methods based on it . . . Twelve years of study with immuno-physical tests have yielded a mass of experimental evidence contrary to, and irreconcilable with the Ehrlich theory, and have convinced me that his conception of the origin, nature, and physiological role of the specific 'antibodies' is erroneous.³³

To afford us with a continuing historical perspective of events since Manwaring's time, we can next turn to the classic work on auto-immunity and disease by Sir MacFarlane Burnett, which indicates that since the middle of this century the place of antibodies at the centre stage of immunity to disease has undergone "a striking demotion." For example, it had become well known that children with agammaglobulinaemia--who consequently have no capacity to produce antibody--after contracting measles, (or other zymotic diseases) nonetheless recover with long-lasting immunity. In his view it was clear "that a variety of other immunological mechanisms are functioning effectively without benefit of actively produced antibody."³⁴

The kind of research which led to this a broader perspective on the body's immunological mechanisms included a mid-century British investigation on the relationship of the incidence of diphtheria to the presence of antibodies. The study concluded that there was no observable correlation between the antibody count and the incidence of the disease." "The researchers found people who were highly resistant with extremely low antibody count, and people who developed the disease who had high antibody counts.³⁵ (According to Don de Savingy of IDRC, the significance of the role of multiple immunological factors and mechanisms has gained wide recognition in scientific thinking. [For example, it is now generally held that vaccines operate by stimulating non-humeral mechanisms, with antibody serving only as an indicator that a vaccine was given, or that a person was exposed to a particular infectious agent.])

In the early 70's we find an article in the Australian Journal of Medical Technology by medical virologist B. Allen (of the Australian Laboratory of Microbiology and Pathology, Brisbane) which reported that although a group of recruits were immunized for Rubella, and uniformly demonstrated antibodies, 80 percent of the recruits contracted the disease when later exposed to it. Similar results were demonstrated in a consecutive study conducted at an institution for the mentally disabled. Allen--in commenting on her research at a University of Melbourne seminar--stated that "one must wonder whether the . . . decision to rely on herd immunity might not have to be rethought.³⁶

As we proceed to the early 80s, we find that upon investigating unexpected and unexplainable outbreaks of acute infection among "immunized" persons, mainstream scientists have begun to seriously question whether their understanding of what constitutes reliable immunity is in fact valid. For example, a team of scientist writing in the New England Journal of Medicine provide evidence for the position that immunity to disease is a broader bio-ecological question then the factors of artificial immunization or serology. They summarily concluded: "It is important to stress that immunity (or its absence) cannot be determined reliable on the basis of history of the disease, history of immunization, or even history of prior serologic determination.³⁷

Despite these significant shifts in scientific thinking, there has unfortunately been little actual progress made in terms of undertaking systematically broad research on the multiple factors which undergird human immunity to disease, and in turn building a system of prevention that is squarely based upon such findings. It seems ironic that as late as 1988 James must still raise the following basic questions. "Why doesn't medical research focus on what factors in our environment and in our lives weaken the immune system? Is this too simple? too ordinary? too undramatic? Or does it threaten too many vested interests . . ?" ³⁸
ARTIFICIALLY INDUCED IMMUNITY--REALITY OR DELUSION?

Physiologist, S.K. Claunch raises an reasonable postulate when he suggests that the body's capacity to initiate a "vigorous reaction" (i.e., the acute processes of elimination associated with viral and infectious diseases) hinges essentially on its level of vitality, and thus such reactions are most commonly found in children. In contrast, it is generally acknowledged that the very feeble and or chronically diseased--who have significantly lower vital energy levels--tend to remain relatively free from such acute reactions. This observation in turn lead him to express the concept that:

If any child has its vitality lowered and its health impaired to the degree that it is no longer strong enough to develop an acute disease, it is, for the time being, at least "immune." This is the exact clinical picture one observes when serums, vaccines and "biologicals" are shot into a child . . . its vitality is so lowered that it is no longer healthy enough to protest or react against them. So long as its vitality stays down, it will be "immune." ³⁹

A number of detractors have legitimately raised the question of how the injection of foreign disease matter into the human system can constitute a legitimate approach to the sustenance of human health. After all, we don't seek warmth of icebergs, is there thus any more logic in seeking health from substances which are intimately associated with disease and death? The articulate view of physiologist H.M. Shelton is that:

To interfere with the all-important composition of the blood in the haphazard manner serologists do, results in incalculable disturbance of its physiological equilibrium . . . health depends, not upon killing bacteria [& viruses] but upon building up the soundness . . . integrity [and] functional vigor . . . of our own tissues and organs. . . . Normal resistance can be achieved only by use of the same means by which it was originally built and maintained.

Nature makes no mistakes and violates no laws. She is uniformly governed by fixed principles and all her actions harmonize with ... [nature's governing] laws . . . The best, indeed the only method ofpromoting public health is to teach people the laws of nature and.. how to preserve health. Immunization programs are futile, and are based on the delusion that the law of cause and effect can be annulled Vaccines and serums are employed as substitutesfor right living; they are intended to supplant obedience to the laws of life. Such programs are slaps in the face of law and order." ⁴⁰

AN HISTORIC OVERVIEW OF THE BACTERIAL/VIRALTHEORY OF DISEASE CAUSATION

In order to provide some further background to the reader, this section will briefly recount some of the most significant observations of earlier scientists on the broader question of what is the actual role bacteria and viruses play in human infectious disease. The debate on this issue--although an old one remains highly relevant and timely in that the whole edifice of Western selective medicine, both preventive and therapeutic, hinges upon a correct perspective on and resolution of the question.

Indeed, it remains remarkable that whether we go to recent or more distant history, we find that fundamentally critical scientific discoveries and observations which serve to clarify these issues, and point in a more appropriate direction, continue--at least in practice--to be largely unknown and or ignored. (Some researchers would suggest that this failure arises because such discoveries--if genuinely applied--would significantly curb what amounts to annual income totaling multiple billions of dollars in the exploitation of human disease.) However, it is apparent that the factors underlying this failure are in reality much broader and more complex.

Due to the need for brevity, only two cases of historic significance will be considered. Earlier in this century, C.E. Rosenow of the Mayo Biological Laboratories began a series of experiments in which he took distinctive bacterial strains from a number of different disease sources and placed them in one culture of uniform media. In time the distinctive strains all became one class. By repeatedly changing cultures, he could individually modify bacterial strains making them some harmless or "pathogenic" and in turn reverse the process. He concluded that the critical factor allowing demonstration of the polymorphic nature of bacteria was their environment and the food they lived upon. These discoveries were first published in the year 1914 in the Journal of Infectious Disease." ⁴¹

Rosenow's work was corroborated and expanded upon about two decades later by R.R. Rife, developer of the Universal Microscope which was developed concurrent with RCA's initial marketing of the electron microscope. Rife's alternative was a 5,682 component, 150,000 power (60,000 diameters of magnification) instrument which made live bacteria visibly "clear as a cat on your lap." This microscope was a light transmitting instrument with a resolution of 31,000 diameters (traditionally electron microscopes had resolutions of up to 25,000 diameters) which overcame the chief weakness of the electron scope, i.e., the inability to view living cells structures and bacterial and viral organisms in their unaltered living state.(An alternative was required, as living matter when viewed under the electron scope, becomes altered and distorted due to bombardment by a virtual hailstorm of electrons, with such distortions increasing proportionally with the intensity of magnification. Consequently, the extremely high magnification levels found in the latest electron microscopes actually serve to exacerbate this major flaw.)

Modern microscopy texts suggest that with light microscopes it is impossible to obtain extremely high magnifications of objects and still retain visual clarity. For example Novikoff and Holtzman affirm that in such instruments a point is reached after which the image is "increasingly blurred and nothing is gained by further magnification. Thus, light microscopes are rarely used at magnifications greater than . . . 1500 X." ⁴²

However, Rife's invention with its 14 separate crystal quartz lenses and prisms, was able to bend and to polarize light in such a way that a specimen could be illuminated by extremely narrow portions of the spectra, and even by a single light frequency. This combined with the shortening of projection distance between prisms, and other innovative technical features permitted high resolutions without distortion at extremely high magnifications, never before or since attained in light microscopy.⁴³

Rife showed that by altering the environment and food supply, friendly bacteria such as colon bacillus could be converted into varied "pathogenic" bacteria. For example, Rife also observed that bacillus coli could in time be modified into the bacterial agent associated with typhus, and the process actually reversed. In Rife's words:

In reality, it is not the bacteria themselves that produce the disease, but we believe it is . . . the unbalanced cell metabolism of the human body that in actuality produce the of disease. We also believe if the metabolism of the human body is perfectly balanced . . . it is susceptible to no disease.⁴⁴

This observation closely parallels Alexis Carrel's earlier research at the Rockefeller Institute where he was able to control the rates and levels of infectious disease mortality among mice. Beginning with the standard diet he observed a corresponding death rate of 52 percent. By making specific dietary improvements he was able to reduce mortality rates downward to 32 percent, then 14 percent, and finally to a rate of 0.⁴⁵

Not too long after Rife's and Carrel's reported observations, scientist Rene Dubos (also at the Rockefeller Institute) reaffirmed their open and direct challenge to the conventional thinking and practice of the scientific community at large. He suggested that the presumed relationship between microbes and the onset of human disease has been "so oversimplified that it rarely fits the facts of disease. Indeed it corresponds almost to a cult . . . undisturbed by inconsistencies and not too exacting about evidence." He expanded upon this view in suggesting that we need to objectively account for the fact that extremely virulent:

. . . pathogenic agents [i.e., bacterial and viral micro-organisms] sometimes can persist in the tissues without causing disease, and at other times can cause disease even in the presence of specific antibodies. We need also to explain why microbes supposed to be non-pathogenic often start proliferating in an unrestrained manner if the body's normal physiology is upset. . . .

During the first phase of the germ theory the property was regarded as lying solely within the microbes themselves. Now virulence is coming to be thought of as ecological . . . This ecological concept is not merely an intellectual game; it is essential to a proper formulation of the problem of microbial diseases and even to their control " ⁴⁶

Indeed, Dubos--in time--came to voice the conclusion that "Viruses and bacteria are not the cause of disease, there is something else." In his classic work Mirage of Health, he states "The world is obsessed by the fact that poliomyelitis can kill and maim . . . unfortunate victims every year. But more extraordinary is the fact that millions upon millions of young children become infected by polio virus, yet suffer no harm from the infection."⁴⁷ This view closely corresponds to the oft quoted conclusion arrived at in later life by R. Virchow (popularly reputed as father of the "germ theory") when he stated, "If I could live my life over again, I would devote it to proving that germs seek their natural habitat, diseased tissues, rather than being the cause of disease."

Since Dubos' time, researchers have estimated that the quantity of symptom free exposure to viruses out number clinical illnesses by at least one hundred-fold.⁴⁸ This conclusion is based on the "high proportion of adults who have virus-neutralizing substances in their serum and the number who, during an epidemic, excrete virus without becoming ill.⁴⁹

Further corroborative conclusions have been recently reached by some prominent scientists in their critical examination of the popular view that Human Immuno-deficiency Virus (HIV) is the key, if not the singular cause of the Acquired Immuno-deficiency Syndrome (AIDS). Evidence is in that the popularized view that HIV causes AIDS is far more a political necessity, than a genuine scientific conclusion. (Although the observed action and effects of viruses, and retroviruses--such as HIV--do in fact significantly differ, what is being called into question is the validity of labeling microbes--of whatever form--as the key and or sole "cause" for disease, or as in this case of acquired immunodeficiency.)

Peter Duesberg (Professor of Molecular Biology at the University of Calif.- Berkeley; considered by many to be the world's leading expert on retroviruses; and Nobel Prize candidate for his work in discovering oncogenes in viruses) provides compelling evidence that lifestyle based factors serve as the primal determinants in the evolution of the 20 plus neoplastic and degenerative diseases that are now associated with AIDS. Employing his own research--complemented by 196 cited references--an article entitled "HIV and AlDs: Correlation but not causation," was published in 1989 in the Proceedings of the National Academy of Sciences USA. This article indicates that "Free" HIV virus (Free meaning that the retrovirus is already part of the genome) is not detectable in most cases of AIDS;" "Pure HIV does not cause AIDS upon experimental infection of chimpanzees or accidental infection of healthy humans;" and "Epidemiological surveys indicate that the annual incidence of AIDS [to be understood as a condition symptomized by various secondary infections for which natural immunity has been lost] depends critically on non-viral [related] risk factors . . . defined by lifestyle, health, and country of residence."

In an interview published nearly five years later Dr. Duesberg is more convinced than ever that the HIV retrovirus is not the cause of AIDS, or of the mortality associated with AIDS. Some of the key points he makes in this important interview follow:

1. There are roughly seven and a half million people world wide who are known carriers of HIV, and who continue to remain free of the immune deficiency symptoms associated with AIDS, and there's not one authenticated case "where you get infected today and get a disease. . . years later . . . infectious agents work immediately or never."
2. HIV has been found to be totally absent in the system of over 4,600 persons diagnosed with AIDS, so to save political face the US Centers for Disease Control have been forced of late to give such cases a new name i.e., "idiopathic CD 4 Iymphocytopenia."
3. There are a million Americans with HIV and their T cells are normal, indeed, "HIV is one of the most harmless viruses you could possibly have. It never claims more than one in 1,000 cells every other day" during which time your body replaces "at least 30 out of 1,000" cells.
4. AIDS is not an infectious disease, but rather arises from "party swinger lifestyles" that includes: the widespread and abundant use of various immune- depleting drugs both legal and illegal such as cocaine, alcohol, marijuana, amphetamines, aphrodisiacs, amyl or butyl nitrites (poppers), combined with correlated conditions of malnutrition, inadequate sleep, and poor hygiene.
5. Another key cause of AIDS and the mortality arising from it is medical treatment in itself, viz. AZT has become "AIDS by prescription" and design. In other words in the US alone 200,000 persons (most of whom have normal health) who've tested positive for HIV antibodies, are given 250 mg of AZT every six hours. This highly toxic drug destroys bone marrow, as well as red blood cells thus precipitating cellular oxygen starvation destroys white blood cells; causes anemia, weight loss, muscle loss, nausea, and worsening immune system deficiency coupled with the ensuing infectious diseases commonly associated with AIDS, and finally death. (The very same sequence of rapid physiological deterioration, immune deficiency and infections has been documented in healthy persons who were tested positive for HIV, and quickly submitted to medical treatment, but were later confirmed as false positives.)⁵⁰

Bio medical scientist and AIDS researcher Joseph Sonnabend speaks of ". . . the failure of our scientific and medical institutions to have provided an even rudimentary understanding of the pathogenesis of this disease in the eight years since its first description, let alone to have developed interventions...that might significantly alter its course." His well researched conclusions include the view that "The association of HIV seropositivity with AIDS could . . . derive from the possibility that the expression of HIV (and consequent seroconversion) is an effect, rather than a cause of AIDS. . ."⁵¹

In summary, if we retum to Robert Koch's 19th century postulates of the "Germ Theory," viz. in order to cause disease particular "bacterium:" a) must be found in every case of the disease; b) must never be found apart from the disease; and c) must consistently produce the same disease as that manifested by the body from which the disease related germs were taken; we find that in reality each postulate has been disproved time and again by varied experience and experimental data.⁵²

Nonetheless, it appears that to this day there remains only a marginal acknowledgment or practical recognition that it is the condition of the body-mind complex and its internal and external environments, which are the principal determinants of the nature, prevalence and role of bacteria, viruses, and even retroviruses.

THE BACTERIAL/VIRALVERSUS THE CELLULAR/ECOLOGICALTHEORY OF INFECTIOUS DISEASE

As a result of the re discovery of many of these earlier scientific investigations, as well as more recent observations in molecular biology, there has arisen among more independent scientists and primary health practitioners a new concept that has been coined as the cellular theory of infectious disease. This seemingly more logical and updated view, poses a serious challenge to the present unquestioned emphasis on supporting mass selective medicine approaches (including artificial immunization) in the Developing World.

The traditional Bacterial--Viral and the emerging Cellular--Ecological theories of disease are contrasted in the table which follows. The practical acceptance of the cellular theory as delineated would entail a substantive shift away from both preventive and therapeutic interventions which are heavily predicated on Western selective medicine, i.e., vaccines and drugs, and toward fundamental health improvement measures such as sound nutrition, potable water, sanitation and overall enhancement of the human physical and social environments.⁵³

Considerable experimental, historical and epidemiological evidence supports the cellular ecological theory, as outlined in Table D.

In that major declines in infectious disease took place before the advent of specific vaccines and antibiotics, scientists and or physicians such as Dubos, Dettman, Illich, McCormick, Taylor, Buttram, and Hoffman agree that the overall eradication of varied infectious diseases were due to basic improvements in nutrition, sanitation, housing, education and related socioeconomic conditions. For example, Canadian physician W.J. McCormick was able to make this telling observation at midpoint in the present century.

The usual explanation offered for this changed trend in infectious diseases has been the forward March of medicine in prophylaxis and therapy; but, from a study of the literature, it is evident that these changes in incidence and mortality have been neither synchronous with nor proportionate to such measures . . .

. . . . the decline in diphtheria, whooping cough and typhoid fever began fully fifty years prior to the inception of artificial immunization and followed an almost even grade before and after the adoption of these control measures. In the case of scarlet fever, mumps, measles and rheumatic fever there has been no specific innovation in control measures, yet these also have followed the same general pattern in incidence decline.⁵⁴

INFECTIOUS DISEASE TABLES

Tables I--X

Span several decades--with some going back to the mid-nineteenth century--and reveal the evidence upon which McCormack's observation is based.


Tables XI & XII

Provide more recent data which suggest the apparent failure of Expanded Programs of Immunization in the reversal and prevention of whooping cough (pertussis) and diphtheria in Nigeria, with notable increases in these diseases occurring soon after implementation of widespread immunization (tables in the source article for measles, polio and tetanus, although not included, each suggest that the impact of EPI was negligible).


Tables XIll--XVIII

Represents the period of a decade in the Dominican Republic (a visually parallel micro-cosm to the longer decline periods exhibited in the Western world) where there occurred a general pattern of significant multiple infectious disease declines--prior to the advent of expanded immunization--with a general pattern of moderate increases in various disease levels occurring soon after full implementation of specific immunization interventions, followed by a return to the earlier decline pattern.


FURTHER BACKGROUND NOTES ON TABLES

1. It is a rarely excepted rule that when increases and or decreases in disease specific mortality occur, there will be corresponding changes in morbidity, (e.g., see parallel death, and case bar lines on tetanus and tuberculosis in Canadian Immunization Guide, 3^rd Edition, 1989).
2. The only tables which are not essentially visual reproductions of tables found in the documented "Source References," are Tables XIII- XVIII. The reason follows: In reviewing a series of 6 UNICEF evaluation studies (Evaluation Pub. No's 1-6) on EPI efforts throughout the 1980's in Nigeria, Burkino Faso, Turkey, Cameroon, Senegal, and the Dominican Republic, only Pub. No. 6 on the Dominican Republic provided sufficient epidemiological data to permit the drawing of any definite conclusions on EPI impacts. Because EPI intervention data was not included in the evaluation report's morbidity tables, original tables were prepared.
3. The designation "natural decline," simply indicates infectious disease declines free from adventitious immuno-prophylaxes. As in the West, significant and enduring non-artificial immunization factored declines have occurred in the Developing World. This has occurred despite what are considered to be normal cyclical down and up-swings in infectious disease levels.

Table 1: Deaths of Children Under 15 Years (England & Wales)

Table I--shows that in England and Wales there was a 90 percent decline in child mortality from the combined infectious diseases of scarlet fever, diptheria, whooping cough, and measles in the period of 1850 to 1940. The first vaccine made available was for Diptheria in the early 40's, whereas the pertussis (whooping cough) vaccine became available in the early 50's and the measles vaccine in the late 60's (no vaccine was provided for scarlet fever).⁵⁵

Table II: Whooping Cough (England & Wales)

Table II--indicates that in England and Wales the annual death rate of children (under age 15) from whooping cough declined by roughly 98.5 percent in the period covering 1868 to 1953, after which the pertussis vaccine became generally available.⁵⁶

Table III: Measles (England & Wales)

Table III--shows that in England and Wales the annual death rate of children (under age 15) from measles declined from over 1,100 per million in the mid-neneteenth century, to a level of virtually 0, by the mid 1960's.⁵⁷

Table IV: Smallpox (England & Wales)

Table IV--reveals that in England and Wales there was a continuing decline in the annual death rate from smallpox, with a reduction in mortality of roughly 300 per million to virtually 0, taking place in the 60 year period following the middle of the last century. This table further illustrates that the progressive rate of decline was severely disrupted--with a roughly 275 percent increase in mortality from the disease--occurring immediately after smallpox vaccination laws were enforced.⁵⁸

Table V: Infant Mortality Rate (Australia)

Table V--Indicates that in Australia, approximately two thirds of the total decline in infant deaths from all childhood infectious diseases, in the period covering 1881 to 1971, occurred before the introduction of mass immunization offorts.⁵⁹

Table VI: Declining Death Rates (US)

Table VI--reveals that in the United States--without benefit of any vaccine--the tuberculosis mortality rate underwent a drop of roughly 96 percent in the first 60 years of this century; and that in a little short of the same time span (although the effectiveness of the vaccine has been seriously questioned by reputed scientists) mortality from typhoid vanished.⁶⁰

Table Vll: Declining Death Rates (England)

Table VII--shows that in England death rates from respiratory tuberculosis underwent a roughly 87 percent decline in the period beginning 1855 and ending in 1947, when antibiotics first came into wide use; and a further decline approximating 93 percent by 1953, preceedin the introduction of the BCG vaccine.⁶¹

Table Vlll: Number of Countries Reporting Smallpox

Table VIII--reveals, in the 17 year period preceeding the WHO Smallpox Eradication Program, a progressive drop to nearly one half, in the number of countries reporting smallpox morbidity.⁶²

Table IX: Acute Rheumatic Fever Death Rates (Britain)

Table IX--indicates that in Britain, the annual death rate from rheumatic fever underwent a decline approximating 86 percent in the period covering 1850 to 1946, before penicillin had become available.⁶³

Table X: Scarlet Fever Death Rate (England & Wales)

Table X--reveals that in the period of 1865 to 1935, before sulfonamides had become available in England and Wales, the annual death rate from scarlet fever declined by approximately 96 percent.⁶⁴

Table XI: Diphtheria (Nigeria)

Table XI--shows that following a significant increase in the diptheria morbidity rate which Peaked in 1977, the disease underwent two years of rapid natural decline--equivalent to 73.5 percent--in the number of cases, with such decline occurring prior to the immplementation of EPI in 1979. This decline pattern continued during implementation of EPI to 1980, after which--by 1982--the incidence of diptheria exhibited a major increase of nearly 30 fold.⁶⁵

Table XII: Whooping Cough (Nigeria)

Table XII--shows that a significant increase in the whooping cough morbidity rate (1973 to 1974), was followed by a sharp natural decline from 1974 to 1975 equivalent to 91 percent. The very slight incline which followed up to 1979--when EPI was introduced--still posed an 86.5 percent lower morbidity level than in 1974. Post EPI data indicate a short lived slight decline, followed by an increase in morbidity of 34 percent over the ensuring two years.⁶⁶

Table XIII: Poliomyelitis (Dominican Republic)

Table XIII--reveals that in the period of 1980 to mid 1983--before implementation of EPI the poliomyelitis morbidity rate underwent a natural decline equivalent to 98.5 percent to wheat is practically an eradication level of only 1 per million. EPI was followed by a continuing natural decline to zero, however the incidence of poliomyelitis then underwent a minor increase for two years, and gradually returned to a zero level in 1980.⁶⁷

Table XIV: Measles (Dominican Republic)

Table XIV--indicates that in the period of 1980 to late 1985--before implementation of EPI the measles morbidity rate underwent a natural decline equivalent to 88 percent. Upon introduction of EPI in late 1985, the natural decline continued for a brief period, halted and then measles more than doubled from its 1986 and 1987 levels.⁶⁸

Table XV: Diphtheria (Dominican Republic)

Table XV--shows that in the period of 1978 to mid 1985--before implementation of EPI--the diptheria morbidity rate underwent a natural decline equivalent to 81.5 percent. Upon introduction of EPI in mid 1985, the natural decline continued for a brief period, and then by 1987 the diptheria case rate more than doubled from its 1986 level. The disease than returned to its natural rate of decline, proceeding to a very low level in 1989.⁶⁹

Table XVI: Pertussis (Dominican Republic)

Table XVI--reveals that in the period of 1978 to mid 1985--before implementation of EPI the pertussis (whooping cough) morbidity rate underwent a natural decline equivalent to 84.5 percent. Upon introduction of EPI in mid 1985, there was a slight rise and then return to the earlier natural decline pattern reaching its lowest level by 1988. However, by 1989 the pertussis morbidity rate nearly tripled from its 1988 level.⁷⁰

Table XVII: Tetanus (Dominican Republic)

Table XVII--indicates that in the period of 1979 to mid 1985--before implementation of EPI the tetanus morbidity rate underwent a natural decline equivalent to 74 percent. Upon introduction of EPI in mid 1985, the natural rate of decline continued for a brief period to 1986. However, by 1988 the incidence of tetanus had more than tripled from its 1986 level, and then by 1988 returned to its earlier natural decline pattern, reaching a level in 1989 still higher than its 1986 level.⁷¹

Table XVIII: Neonatal Tetanus (Dominican Republic)

Table XVIII--shows that in the period of 1978 to the end of 1985--before the implementation of EPI (tetanus toxoid for expectant mothers)--the neonatal tetanus morbidity rate underwent a natural decline equivalent to 98.5 percent. Upon introduction of EPI in late 1985, the natural rate of decline continued for a brief period to 1987. However by 1988 the incidence of neonatal tetanus had increased by nearly five fold over its 1987 rate, and then by 1989 declined to a level still higher than it was in 1986.⁷²


IMMUNIZATION EFFECTIVENESS DATA

Data on Diphtheria

Ekanem's earlier noted research (Table XI), reveals an increase of 215 percent in the number of diphtheria cases by the end of the three year period following implementation of UNICEF's Expanded Program of Immunization. Robert Mendelsohn (Assoc. Prof. of Preventive Medicine and Community Health, University of Illinois) reports "that children who have been immunized [for diphtheria] fare no better than those who have not." He went on to describe an outbreak of diphtheria in which "fourteen of twenty-three carriers had been fully immunized." This means that just over 60 percent of the carriers who were presumed to be protected by the toxoid, contracted the disease. In his words "Episodes such as these shatter the argument that immunization can be credited with eliminating diphtheria or any of the other . . . childhood diseases."⁷³

The following conclusion is extracted from the Minutes of the 15th Session (November 20-21, 1975) of the Panel of Review of Bacterial Vaccines and Toxoids with Standards and Potency (data presented by the US Bureau of Biologics, and the Food and Drug Administration).

For several reasons, diphtheria toxoid, fluid or absorbed, is not as effective an immunizing agent as might be anticipated. Clinical (symptomatic) diphtheria may occur . . . in immunized individuals--even those whose immunization is reported as complete by recommended regimes . . . the permanence of immunity induced by the toxoid . . . is open to question.⁷⁴

Earlier historical data on protective toxoiding efforts in N. America clearly verify not only the FDA's conclusion, but the fact that the toxoid actually exacerbated the seriousness of the disease. North American data on various diphtheria outbreaks in the early 40's, reveal the following facts.

• In the Halifax Canada epidemic, of the cases admitted for hospital treatment, 66 had previously received one or more doses of diphtheria toxoid or antitoxin, or were found Shick negative. In fact, of this number five cases had been immunized within the preceding two month period.⁷⁵
• In the Ottawa Canada epidemic, of 99 cases (all under the age of 15), 36 were found to have previously received all three doses of the toxoid.⁷⁶
• In the Baltimore USA epidemic, 63 percent of all cases had a record or history of prior immunization with toxoid. Among the fatal and more serious "Bull-neck" cases, 77.8 percent had previously been toxoided.⁷⁷
• During roughly the same historic period, we find in various European countries a gripping picture suggesting that the use of Diphtheria toxoid in fact precipitated epidemics of the disease.⁷⁷
• Throughout 1941 to 1944 "The Ministry and Dept. of Health, Scotland, admitted almost 23,000 cases of diphtheria in immunized children," with 180 fatalities.⁷⁸
• By the year 1941, the majority of children in France had been inoculated for diphtheria, the case rate standing at 13,795 by the end of that year. Mass immunization efforts continued, and "by 1943, the diphtheria cases were more than tripled to 46,750."⁷⁹
• Diphtheria increased by 55 percent in Hungary and tripled in Geneva, Switzerland after the introduction of compulsory immunization laws. In Germany, with compulsory mass immunization "introduced in 1940, the number of cases increased from 40,000 per year to 250,000 by 1945, virtually all among immunized children." Norway, during the same time frame--just noted--remained unvaccinated, and had only 50 recorded cases of diphtheria. ⁸⁰
• "In Sweden, diphtheria virtually disappeared without any immunization."⁸¹
• According to Coumoyer's research, official US Military records show that enlisted men and women who are thoroughly vaccinated--manifest a morbidity and mortality rate from diphtheria four times higher, than that of unvaccinated civilians.⁸²

Data on Measles

As already noted earlier in this report, the national per capita case rate in Thailand for measles in 1982, 2 years before the advent of the Expanded Programme of Immunization, was lower than in the year 1988, i.e., 5 years after implementation of EPI. Per Ekanem's earlier cited research, the national per capita case rate in Nigeria for measles in 1973, 6 years before the advent of UNICEF's Expanded Programme of Immunization, was lower than in the year 1982, i.e., 3 years after implementation of EPI.⁸³

The University of Alberta initiated special research on the question of measles immunity, as a result of a measles epidemic which "swept" the University campus in 1987, despite a "98 percent immunization rate." The research team's head immunologist R. Marusyk (who is also affiliated with the Alberta Provincial Public Health Laboratory) has subsequently confirmed that it is an invalid assumption that vaccination programs for measles--which are normally administered at 9 to 12 months, and a later childhood booster shot--confers lifelong immunity. One of their findings indicated that 93 percent of infants "who were studied" showed no immunity by the age of six months. The mothers of the 120 babies had all been vaccinated. Normally, antibodies that have been transferred at birth from the mother to the child remain present for a year."⁸⁴ (According to D. de Saving at IDRC, this transfer and retention of antibodies apparently occurs when the mother has had an actual measles infection, and not just vaccination.)

Similar to the experience at the University of Alberta, the National Geographic in its January 1991 issue article "The Disease Detectives," refers to a 1988 measles epidemic at Fort Lewis College, Durango, Colorado USA in these words: "Surprisingly most who fell ill had been vaccinated. CDC (US Center for Disease Control) investigators rushed to the campus during the 1988 outbreak to trace what had gone wrong."

There are repeated reports of measles epidemics occurring in fully vaccinated populations. These failures have occurred repeatedly since the vaccines introduction.⁸⁵ Other documented research findings follow:

• A survey conducted in 1978--covering 30 states in the US--revealed that "more than half of the children who contracted measles had been adequately vaccinated;"⁸⁶
• Moskowitz et al. found that in those states with comprehensive (k-grade 12) immunization requirements, between 61 and 90 percent of measles cases occur in persons who received the recommended vaccines;⁸⁷ and
• A review of 1,600 cases of measles in Quebec, Canada in the period of January to May of 1989, revealed that 5 8 percent of school-age cases had been previously vaccinated.⁸⁸

According to an unpublished WHO research study comparing what would be defined as a "measles susceptible" group of children, to a control group that had been immunized for measles, it was observed that the non-immunized group manifested a normal contraction rate of 2.4 percent, whereas the immunized group exhibited a 33.5 percent contraction level. This implies a 15 times greater likelihood of infection by the immunized.⁸⁹ (The researchers responded to these results with the comment that the vaccine must have been mishandled, or perhaps the vaccine used was badly manufactured.)

It is of interest that there is an emerging body of mathematically based epidemiological research which suggests practicable problems with EPI efforts in the control and eradication of measles in the Developing World. For example, P. Kenya observes that:

Horizontal mass immunization campaigns at regular intervals may be impractical in terms of costs and operational logistics. . . . In spite of high measles immunization coverages, measles epidemics are often reported, not only in the less developed regions but also in those developed countries with measles elimination targets.⁹⁰

Data on Polio

An article in a major consumer journal titled "Twentieth-century miraclemaker," in extolling the value of Salk's polio vaccine, indicated that in 1953, there were 15,600 cases of paralytic polio in the United States; by 1957, due to the vaccine, this number dropped to 2,499." Since this popular conception persists to this day as an important demonstration of the effectiveness of vaccination procedures in general, and the polio vaccine in particular, it bears some re-examination.

Bernard Greenberg (late Dean--School of Public Health, University of N. Carolina) who--during the polio epidemics of the 50's--chaired the Committee on Evaluation and Standards for the American Public Health Association, submitted testimony to the Congressional Hearings on polio vaccines (HR0541, 1962). His evidence respecting diagnostic modifications and statistical manipulation, seriously challenged the popularly promoted view that the epidemics subsided as a result of vaccine intervention. In his words "As a result of . . . changes in both diagnosis and diagnostic methods, the rates of paralytic poliomyelitis plummeted from the early 1950's to a low in 1957." This involved:

1. redefinition of what constitutes an epidemic
2. redefinition of the disease; and
3. mislabelling, and later reclassification (prior to 1954 "large numbers" of presumed "paralytic polio" cases were actually "Coxsackie . . . and aseptic meningitis," statistical reclassification of "polio" cases (not leading to permanent paralysis) in the ensuing 4 year period became the norm in virtually all regions of the country.

It is of further interest that Greenberg testified that after the introduction of much more intensive and frequently compulsory immunization programs--beginning in 1957--there was a correspondingly substantial increase in polio cases (which were presumably paralytic, due to the aforenoted reclassification process). In the period of 1957-1958 there was a 50 percent increase, and 1958-1959 an 80 percent increase in such cases. He also indicated that during this period statistics were manipulated and statements made by the US Public Health service, to give an opposite impression.⁹²

A distinguished interdisciplinary medical panel moderated at the 120^th Annual Meeting of the Illinois State Medical Society, confirmed that in the year 1959, roughly 1,000 cases of paralytic polio occurred in persons who had previously received multiple doses of the Salk vaccine. As a panel member,
B. Greenberg contributed the following observation:

One of the most obvious pieces of misinformation . . . is that the 50 percent rise in paralytic poliomyelitis in 1958, and the real accelerated increase in 1959 have been caused by persons failing to be vaccinated This represents . . . an unwillingness to face facts and to evaluate the true effectiveness of the Salk vaccine. . . . A scientific examination of the data and the manner in which the data were manipulated, will reveal that the true effectiveness of the present Salk vaccine is unknown and greatly overrated.⁹³

When pediatrician R. Mendelsohn, was asked whether polio would return if vaccinations were stopped, he replied "Doctors admit that forty percent of our population is not immunized against polio. So where is polio? Diseases are like fashions, they come and go . . ." Later on US National television he referred to epidemiological records which revealed the disappearance of polio in Europe during the 40's and 50's, without benefit of immunizations.⁹⁴

Speaking at an international health convention in 1978, A. Burton reported that statistical data compiled by the University of New South Wales in Australia revealed that polio immunization programs had no measurable impact in reversing what was a recent epidemic in that country. He expressed the view that polio comes in cycles anyway, and when it does subside, it is inadvertently considered "conquered" by vaccines.⁹⁵ This naturally occurring cycle in polio epidemics was well illustrated in Great Britain where polio peaked in 1950, and had declined by 82 percent by the year 1956, at which time the vaccine was first introduced.⁹⁶

Returning to the earlier cited US Congressional Hearings (HR 1054), we find that the nation of Israel experienced a major "type I" polio epidemic in 1958. Mass polio immunization had already been enforced and there was no appreciable difference in contraction levels between the vaccinated and unvaccinated. Additionally, 3 years later in 1961, the state of Massachusetts experienced a "type II" polio outbreak in which "there were more paralytic cases in the triple vaccinates than in the unvaccinated".⁹⁷

It is noteworthy that in one of the few double blind trials that have been conducted on a vaccine, was for the Salk polio vaccine, in which trial over 200 individuals who received the vaccine went on to contract polio, whereas no observed polio cases developed amongst the controls. This trial was reported by Mendelsohn who in the same 1984 article wrote:

The evidence points to mass inoculation against polio as the cause of most remaining cases of the disease . . . there is an ongoing debate among the immunologists regarding the . . . killed virus vs. live virus vaccine. Supporters of the killed virus vaccine maintain that it is the presence of live virus organisms in the other product that is responsible for thepolio cases that . . . appear. Supporters of the live virus type argue that the killed virus vaccine offers inadequate protection and actually increases the susceptibility (to polio) of those vaccinated. . . . I believe that both factions are right, and that use of either of the vaccines will increase not diminish the possibility that your child will contract the disease.⁹⁸

Thirteen scientists recently concluded that: vaccine failures in the major Oman polio epidemic could not be explained by failures in the cold chain, nor on suboptimum vaccine potency; the efficacy of OPV in inducing "humoral immunity" was lower than expected; and primary reliance on routine polio immunization may be "inadequate" to achieve the goal of eradicating polio by the year 2000. (They also noted similar paralytic polio epidemics in other highly vaccinated populations,⁹⁹ e.g., the Gambia, Brazil, and Taiwan.)

Data on Pertussis (Whooping Cough)

V. Fulginiti, Chairman of the American Academy of Paediatrics Committee on Infectious Diseases made this incisive observation:

Despite more than 30 years of experience with pertussis immunization, the reasons for recovery from the acute infection and subsequent immunity, are still uncertain. It is known that second attacks are rare following natural disease. It is also known that 45-95% of recipients of pertussis vaccine are susceptible to pertussis up to 12 years later . . . we do not understand the immunologic mechanisms involved in resistance to infection after natural disease or immunization.

Is pertussis vaccine effective? . . . prior to the widespread use ofpertussis vaccine, both the incidence of pertussis and the case-fatality ratio declined. A 50-fold reduction in incidence and an 84% reduction in case-fatality were recorded in Great Britain in the years between 1947 and 1972. . . . In England, protection provided by vaccines prior to 1968 was meager; no greater than 20% protection was noted. . . . Britain is in the position of advocating use of a vaccine for which there are not hard data.¹⁰⁰

G.T. Stewart's observations as published in the British Medical Journal indicated that "of 8,092 cases of whooping cough, 2,940 (36%) were fully immunized, while only 2,424 (30%) were definitely not immunized."¹⁰¹

A Medical Tribune Report (January 10, 1979) details an outbreak of whooping cough in which 46 out of 85 fully immunized children contracted the disease.¹⁰² (the reason that the other 39 did not contract the disease could have been related to any number of predisposing factors).

Ekanem's earlier noted research (Table IX) , reveals an increase of 21 percent in the number whooping cough cases by the end of the three year period following implementation of an Expanded Program of Immunization in Nigeria.¹⁰³

Data on Tetanus Toxoid and Immune Globulin

Neustaedter indicates that "Tetanus seems to be nearly eliminated from the United States, primarily because of good hygiene and proper wound management." His research suggests that in the period of 1982-1984 in the US, there were a total of nine tetanus cases among both children and adolescents, in which there were no deaths.¹⁰⁴ Whereas Coumoyer's research points to "contaminated umbilical stump infections" as a principal cause of tetanus in the Developing World.¹⁰⁵ Such infections can be effectively rectified through providing appropriate information and training to traditional birth attendants.

Both Cournoyer and Johnson indicate that there have been some reports of lock jaw death in properly inoculated individuals.^{106 & 107} Additionally Cournoyer suggests that "Evidence in support of the (tetanus toxoid) vaccine comes from epidemiologic studies which are by nature controversial, and which do not satisfy the criteria for scientific proof.¹⁰⁸

According to the data contained in Table XVII, in the Dominican Republic the incidence of tetanus among children actually increased in the two year period following administration of tetanus toxoid. Table XVIII indicates that in the same country, the rate of neonatal tetanus--among mothers underwent an increase in the year following administration of tetanus toxoid.¹⁰⁹

WHO SMALLPOX ERADICATION SUCCESS RECONSIDERED

Although smallpox is apparently now accorded to the history books, it will be necessary to re-examine the issue of this disease having been universally eradicated, with particular reference to the WHO eradication campaign. An honest look at this question is of considerable importance, as the current worldwide UCI-EPI program gains much of its legitimacy and inspiration from this widely acclaimed success story.

A strong challenge to this now popular view, is reflected in the post-campaign findings of medical researchers like Buttram and Hoffman:

Most people probably credit the smallpox vaccine with playing the major role in recent eradication of smallpox throughout the world, but let us examine the facts. In the article 'Vaccines a Future in Question,' statistics showed that less than 10 percent of children in developing countries have received vaccines.

They went on to comment that with this level of coverage, the WHO campaign was not a real factor in the eradication. Data obtained in their broad based research also led them to conclude that "mass smallpox vaccination was not necessary for the eradication of smallpox.¹¹⁰

In further examining this question from a longer historical perspective, it became readily apparent that the WHO claim did not at all square with the earlier data, i.e., historical smallpox eradication efforts. If we go back as far as the last century, we discover that Creighton's independent research findings as published in the Ninth Edition of the Encyclopedia Britannica, strongly contradict the effectiveness of mass smallpox immunization programs. A few revealing excerpts follow:

• . . . in Bavaria in 1871 of 30,742 cases 29,429 were in vaccinated persons, or 95.7 percent.
• Notwithstanding the fact that Prussia was the best re-vaccinated country in Europe, its mortality from smallpox in the epidemic of 1871 was higher (69,839) than any other Northern state.
• According to a competent statistician (A. Vogt), the death-rate from smallpox in the German army, in which all recruits are re-vaccinated, was 60 percent more than among the civil population of the same age . . . although re-vaccination is not obligatory among the latter.
• It is often alleged that the unvaccinated are so much inflammable material in the midst of the community, and that smallpox begins among them and gathers force so that it sweeps even the vaccinated before it. Inquiry into the facts has shown that at Cologne in 1870 the first unvaccinated person attacked by smallpox was the 174^th in order of time, at Bonn the same year the 42d, and at Liegnitz in 1871 the 225^th.¹¹¹

As we move on into the earlier part of this century we find the same dismal picture of increased susceptibility correlated with increased vaccination coverage. Dettman and Kalokerinos describe a visit they paid to the Philippines about 15 years ago:

. . . We were fortunate enough to address their own medical (and) health officials where we reminded them of the incidence of smallpox in formerly "immunized" Filipinos. We invited them to consult their own medical records and asked them to correct us if our own facts and figures disagreed. No such correction has been forthcoming, and we can only conclude that between 1918-1919 there were 112,549 cases of smallpox notified, with 60,855 deaths. Systematic (mass) vaccination started in 1905, and since its introduction case mortality increased alarmingly. Their own records comment that "The mortality is hardly explainable." ¹¹²

Speaking at a 1973 environmental conference in Brussels, Professor George Dick admitted that in recent decades, 75 percent of those that have contracted smallpox in Britain, have had prior a history of vaccination. In that "only 40%" of children were vaccinated (and at most 10 percent of adults), such figures clearly indicate that the vaccinated--as in the much earlier historical record--continue to show a higher tendency to contract the disease. Dick also admitted that smallpox had been eradicated in certain tropical countries without mass vaccination.¹¹³ (Table VIII reveals that in the 16 year period preceding the year the WHO eradication campaign was launched--38 additional countries had ceased to report any smallpox cases.)¹¹⁴

A. Hutchison writing in the Journal of the Royal Society in 1974, referred to the smallpox vaccines "lack of potency" and the inadequacies of other measures for containment, in his words, "I have given details of the various outbreaks of smallpox in Britain and where they were diagnosed. These clearly indicate that the (preventive) measures are most ineffective.¹¹⁵

An article in the New Scientist indicates that "The smallpox family of viruses is genetically unstable," and that new viral strains which threaten the "WHO smallpox eradication programme, could emerge anywhere.¹¹⁶ It is thus of interest that in a 1980 article in the Australasian Nurses Journal, Dettman and Kalokerinos pointed out that electron-microscopy cannot distinguish between the various "poxviruses.¹¹⁷ (According to D, de Saving of IDRC, as of 1990 DNA sequencing can make the distinquishingment. What is not known though, is whether this has any beating on the reporting of the various "pox" diseases worldwide.) This fact led them to raise a vitally significant question "as to whether smallpox may be declared conquered, (it's estimated that only 10 percent of the world population actually received the vaccine) with the possibility of it masquerading under the guise of a similar pox." Their line of evidence and reasoning is summarily stated:

. . . we claim that if the evidence is honestly evaluated that smallpox has actually been prolonged and that the so called protective vaccinations actually put the recipient at risk from . . . the disease itself. Authorities now realize this and the 'top world' countries are making vociferous protests about third world countries continuing use of smallpox vaccination because (a) suddenly it has become recognized that it is an extremely dangerous procedure, (To give some idea of the vaccine's dangers, it was reported--in the late sixties--that annually, roughly 3,000 children were experiencing varying degrees of brain damage due to the smallpox vaccine; and according to G. Kiftel in 1967, smallpox vaccination damaged the hearing of 3,296 children in West Germany, of which 71 became totally deaf.¹¹⁷) and (b) it has now been conquered. The ultimate in ingenuity. . . .¹¹⁸

In turning to recognized textbooks on human virology and vertebrate viruses we find that attention has been given since 1970 to a disease called "monkeypox," which is said to be "clinically indistinguishable from smallpox." Cases of this disease have been found in Zaire, Cameroon, Nigeria, Ivory Coast, Liberia, and Sierra Leone (by May 1983, 101 cases have been reported). It is observed that " . . . the existence of a virus that can cause clinical smallpox is disturbing, and the situation is being closely monitored."¹¹⁹ (For a highly detailed account of the history of this disease and efforts to eradicate it, which further corroborates these observations, see, Razzell P., The Conquest of Smallpox, Caliban Books, United Kingdom, 1977.)

VACCINE ASSOCIATED DANGERS--GENERAL OBSERVATIONS

Another basic issue that has never been raised in the programming, or evaluation contexts of Official Development Assistance supported mass immunization, is the requirement for effective monitoring and research on potential vaccinal adverse effects. The issue of vaccine dangers and damage is obviously a rather unpleasant subject that no one really enjoys thinking or talking about. In fact it appears to have been totally ignored in both the planning and execution phases of Canada's International Immunization Programme(CIIP). Furthermore, the recently completed Qperational Review of CIIP 1986--1991, which according to its sub-title was supposed to address inter alia ". . . lessons learned in the first three years," failed to even raise the two very fundamental issues of vaccine effectiveness, and vaccine damage.¹²⁰

In special PHC-EPI research conducted for the CIDA Evaluation Division, the conclusion was reached that the extensive literature written on the subject of immunization, adverse reactions and contra indications, points clearly to the reality that "massive immunization programs carry with them a number of very real risks and hazards.¹²¹

According to information recently provided by CIDA's Health and Population Directorate the World Health Organization as of October, 1990 has instituted a policy for "adverse event monitoring" in Developing World Immunization activities. A definitive policy statement on this issue titled Monitoring
of Adverse Events Following Immunization, is apparently available as of April 1991. The implications of VMO's recognition of the significance of this issue to the setting of public policy priorities for EPI research, monitoring and evaluation should be apparent. In order to provide some background on why the WHO is now taking these measures, a few critical observations follow.

In recognition of potential vaccine dangers, David Karzon of the Vanderbilt University School of Medicine raises important policy considerations with respect to mass immunization programs in the Editorials section of the New England Journal of Medicine.

. . . there are two compelling reasons for reinspection of the process offormulating and implementing our immunization program: the emergence of new societal considerations and responsibilities; and the need for a fuller public disclosure of the costs of disease prevention . . . we as a society have not recognized and accepted all the costs . . . costs measured not only in dollars spent or saved, but also as adverse biologic reactions.

Literally no drug or procedure used in medicine is risk free. Immunizing antigens, originating from complex biological materials or arising as genetically attenuated live agents, have their own peculiar endogenous hazards, Complications . . . are particularly apt to be visible in mass immunization campaigns. . . . The quality of the data base for national decisions is critical because any vaccine recommendation carries such a vast Potentialfor harm or good.¹²²

It is unfortunate that UNICEF EPI field reports tend to dismiss the concerns raised by "targeted" locals to the issue of vaccine damage, as based on misinformation provided by unreliable local health staff, or the ignorance of fearful mothers, both of whom need re-education. For instance a recent UNICEF annual project report in discussing EPI stated, "A WHO-UNICEF team found that drop out rates were high because of the fear of side effects as expressed by mothers, (and) misinformation about contraindications . . . as communicated by health workers. . . . As a result, increased attention is being directed toward health education. . . ."¹²³

To say the least, it seems incongruous that this issue is paternalistically ignored as an insignificant concern raised by the misinformed and the ignorant, when Canadian citizens are being alerted by the media that the Canadian Government is expected to announce "disaster relief" to families "of vaccine damaged children."¹²⁴ This relatively recent report suggests that vaccine damage is likely more pervasive a problem than is generally acknowledged or believed. In fact, it appears that chronic under-reporting of vaccine-induced morbidity, disability, and mortality appears to be the norm. Probably the most erudite scholar who has thoroughly investigated the issue of vaccine hazards, is Sir Graham Wilson. As Honorary Lecturer in the Department of Bacteriology at the London School of Hygiene and Tropical Medicine, the following observations are excerpted from an earlier lecture series delivered at that school.

The risks attendant in use of vaccines and sera are not as well recognized as they should be. Indeed our knowledge of them is still too small, and the incomplete knowledge we have is not widely disseminated.. a very small proportion [of the actual numbers of vaccine accidents] . . . have been described in the medical literature of the world.

. . . a large number of accidents--I suspect the majority--have never been reported in print, either through fear of compensation claims, or of giving a weapon to antivaccinationists . . . I have come to the conclusion that no vaccine or antiserum can be regarded as completely safe . . . no vaccine or antiserum that has yet been used has been free from complications or accidents . . . [with respect to assessing the "degree of possible danger" he indicates that] Unless both the numerator and the denominator are known, quantitative assessments may fall wide of the true mark. Moreover, the risk, even for a single vaccine, is not uniform. It varies, among other things, with the immunological status of the population concerned..

The inherent danger of all vaccination procedures should be a deterrent to their unnecessary or unjustifiable use. Vaccination is far too often employed, especially in the developing countries . . . and should not be used as an [instead] excuse from applying the well tried standard methods for the prevention of infectious disease. Most important is it to realize the potential dangers of mass immunization. In such an operation time does not permit an inquiry into the suitability of each individual subject for vaccination.¹²⁵

A strong echo of Wilson's conclusion that vaccine damage is chronically under reported, is found in the official minutes of the 15^th session of the US Panel of Review of Bacterial Vaccines and Toxoids with Standards and Potency.

Many physicians are not cognizant of the importance of reporting untoward reactions, or may be unaware of their clinical features. Further, both physicians and manufacturers have been held liable for damage suits by patients who may suffer adverse effects from established vaccines. All of these factors undoubtedly discourage reporting; without some other form of surveillance, definition of the rates and significance of untoward reactions to current and future vaccines cannot be ascertained.¹²⁶

H.S. Martland, former Chief Medical Examiner for Essex County New York, describes how the above unawareness actually translates into practice:

Deaths from brain and spinal cord diseases (poliomyelitis, encephalitis, and meningitis) resulting from . . . immunizations sometimes are attributed to other causes, because doctors are not sufficiently alerted to the connection between immunizations and the deaths. . . .¹²⁷

Neustadter maintains that the research on vaccine side effects by the pharmaceutical industry remains seriously marginalized due to a significant number of vaccine reactions going unreported, and the fact that it is often difficult to attribute delayed effects with a vaccine. He further suggests that the reason that the medico-pharmaceutical industry has consistently failed to address the unanswered question of the long term effects of vaccines, stems largely from their overriding interest in the active promotion, and rapid marketing of vaccines. Investigation of their adverse side effects generally remains a non-priority issue, insofar as such efforts may undermine the public's acceptance of their products.¹²⁸ On the other hand, Snead suggests that when laboratories go public to the media and confirm that "no known problems" exist, this does not mean that scientists have researched to the limits of their knowledge and found no side effects, but rather that no research has actually been done.¹²⁹

Although there is compelling evidence that vaccine induced damage remains chronically under-reported, it is of interest that B. Bloom of the Albert Einstein College of Medicine, openly admits that there is today an emerging reluctance on the part of medico-pharrnaceutical industry to further develop vaccines, for both the developed and Developing Worlds. According to Bloom, this reluctance stems from the fact that financial losses due to the "liability" of established vaccines, actually exceed the "profits" derived from them.¹³⁰ In this vein, Mendelsohn indicates that vaccine costs have "skyrocketed" as a consequence of multiple jury awards to damaged children. In his words:

As more and more parents begin to recognize the link between vaccines and their child's condition--epilepsy, convulsions, mental retardation, cerebral palsy, Sudden Infant Death, etc.--lawsuits have become commonplace. As drug companies exit the vaccine field, public health authorities worry about vaccine shortages. ¹³¹

OF WHAT DO VACCINE PRODUCTS CONSIST?

It would be instructive to consider the range of substances--additional to the attenuated virus etc. normally found in vaccine products. Specific viruses and bacteria are grown in the following substances, with their foreign proteins (antigens) including those derived from: pig or horse blood; rabbit brain tissue; dog and monkey kidney tissue; chicken and duck egg; and calf serum. (It is generally acknowledged that any foreign substances including proteins--which have not been filtered through the body's normal digestive assimilative, and excretory processes, can be highly toxic when freely ranging in the lymphatic and blood systems.) Other foreign additives normally found in various vaccines include:

• formaldehyde--(a known carcinogen)
• thimerosal--(an organomercurial antiseptic--49% mercury--although the mercury is "closely bound," it nonetheless is a toxic metal difficult for the system to eliminate)
• aluminum potassium sulphate (toxic)
• aluminum phosphate--(a toxic substance commonly used in deodorants)
• lactalbumin hydrolysate
• phenol (carbolic acid)--(extremely toxic, not permitted in anti-toxins)
• acetone--(volatile, and can easily cross the placental barrier)
• glycerin--(tri-atomic alcohol derived from decomposed fats which can damage kidney, liver, lungs, local tissue; cause dieresis and possible death.)¹³²

Commenting on the inclusion of such substances in vaccine products, R. Moskowitz indicates that "the fact is that we do not know and have never attempted to discover what actually becomes of these foreign substances, once they are inside of the body."¹³³ Although there are "rigid" precautions in licensing the use and quantity of these common stabilizers and preservative, it certainly seems self-evident that there should be further research to better determine what relationship--if any--exists between such poisons, and various adverse reactions.


SOME OBSERVED AND POTENTIAL ADVERSE EFFECTS OF SPACIFIC VACCINES AND TOXOIDS--DIAGNOSABLE IN THE SHORT TERM

By principally focusing on stimulating the production of antibody--which increasing evidence suggests is only one marginal indicative factor among many in immunity to disease--while ignoring the basic multiple determinants of natural immunity (health), viruses, foreign antigens and proteins are placed directly into the body tissues and are in turn carried throughout the circulatory system (without censoring by the liver) giving them direct accessibility to all of the body's vital organs and systems. Furthermore, it is an EPI strategy that this short-circuiting of the body's natural defense system is imposed at an extremely vulnerable time of life.¹³⁴ The stage has thus been set for the advent of a wide range of adverse complications and sequelae.

What follows is a simple listing of observed side effects of specific vaccines, or when noted toxoids. Practically all of the conditions listed are commonly reported in the medical literature as linked to the prior administration of the particular vaccine or toxoid noted. A few conditions listed--such as the sudden infant death syndrome linked to the pertussis vaccine--are not admitted by mainstream medicine as an adverse effect of that particular vaccine, however the research as referenced is reputable and points otherwise. (The vaccines covered in this section have been confined to those prescribed in the Universal Childhood Immunization program.)


MEASLES

• atypical measles (a more serious form of measles)
• encephalopathy (irreversible brain damage)
• subacute sclerosing panencephalitis (progressive brain damage which can lead to death)
• ataxia (incoordination in voluntary muscular movements)
• mental retardation
• aseptic meningitis (inflammation of the membranes of spinal cord or brain)
• seizure disorders
• encephalitis (inflammation of the brain)
• hemiparesis (half-body paralysis)
• retinopathy and blindness
• secondary complications can include:

  juvenile-onset diabetes
  Reye's syndrome
  multiplesclerosis (degeneration of the central nervous system)¹³⁵

PERTUSSIS (WHOOPING COUGH)

• hyperactivity
• anaphylaxis (hyper-reaction which can include convulsions, unconsciousness and or death)
• epileptic type convulsions
• learning disorders (including IQ reduction)
• encephalopathy
• febrile seizures
• invasive bacterial infections
• hay fever
• asthma
• encephalitis
• sudden infant death (SIDS)¹³⁶

DIPHTHERIA

(The following has occurred with combined diphtheria-tetanus vaccination, and could be associated with either.)

• altered electroencephalogram readings
• seizures¹³⁷

TETANUS TOXOID

• brachial plexus neuropathy (disease affecting nerves which serve the arm, forearm and hand)
• anaphylaxis
• encephalitis
• recurrent abscesses (at injection site)
• abdominal pain
• debility ¹³⁸

POLIO (OPV--ORAL LIVE-VIRUS)

• paralytic polio
• congenital brain tumors (transmitted by mothers who received vaccine during pregnancy)¹³⁹

GENERAL (I.E., IN COMBINATION)

• meningitis ¹⁴⁰

EXTENT AND NATURE OF OBSERVABLE VACCINE DAMAGE

There is a considerable range in estimates given as to the frequency of damage being produced by particular vaccines. A case in point is the American manufactured DPT vaccine, for which the claim is made that only 1 in 300,000 vaccinates exhibit permanent neurologic damage,¹⁴¹ whereas other researchers suggest that permanent damage levels can reach as high as 1 in 300.¹⁴² Coumoyer's research findings fall between these two extremes for permanent neurologic or brain damage. Her conclusions indicate that the following varied rate reactions occur in vaccinates, per number of children vaccinated:

• Persistent crying--1 in 20
• High fever--1 in 66
• High pitched screaming--1 in 180
• Convulsions--1 in 350
• Shock like condition or collapse--1 in 350
• Acute brain disorder--1 in 22,000
• Permanent brain damage--1 in 62,000
• Death--1 in 71,600.¹⁴³

Again to illustrate the great variation in estimates, a relatively recent study at UCLA (see Cody et al, ref 136) found that as many as one in every 13 children exhibited persistent high pitched crying after receiving the DPT vaccine. In reference to this specific reaction, physician B. Young states that "This may be indicative of brain damage in the recipient child."¹⁴⁴

According to data researched by Coulter and Fisher, of the 3.3 million children vaccinated yearly in the US: 16,038 have high pitched (encephalitic) screaming (which is considered by many neurologists as indicative of central nervous system irritation); 8,484 have convulsions; and 8,484 undergo collapse; "for an annual total of 33,006 cases of acute neurological reactions within 48 hours of a DPT shot." The authors further suggest that there is a strong basis for concern with respect to the long term reaction to the DPT vaccine.

Severe neurologic sequelae may . . . occur after vaccination in the absence of an acute reaction. When the baby reacts to a DPT shot with "a slight fever and fussiness for a few days" this may be, and often is, a case of encephalitis which is quite capable of causing even quite severe long-term neurologic consequences . . . . They further suggest that any who would dismiss this possibility, must first establish a basis for distinguishing between post-vaccinal encephalitis and encephalitis arising from other causes.¹⁴⁵

As a final observation on the issue of short term vaccine dangers, is the postulated linkage of immunization with the "mysterious" problem of sudden infant death (SIDS) in which infants can die "suddenly and quietly" in their cribs. Australian microbiologist Glen Dettman explains that when large amounts of an antigen are given the body responds by a massive release of adrenal products including: cortisol, adrenalin, and an excessive level of endorphins, actually "as much as a thousand times more than is normally released by the brain." He goes on to observe that:

The endorphins will suppress respiration and cardiac function. Thus if a child with malnutrition, or an immune problem, is given a load of antigen larger than it can handle--and this antigen may be an immunisation--endorphins may result in respiratory or cardiac failure and death.¹⁴⁶

Torch's research indicates that two-thirds of 103 infants who were victims of the sudden death syndrome had been immunized with DPT vaccine within the 3 week period preceding death, with many dying within a day of receiving the vaccine.¹⁴⁷ In a widely debated occurrence of SIDS in Tennessee (USA), in which eleven infant deaths occurred within eight days of a DPT vaccination, (nine from the same lot), and five within 24 hours of vaccination (four from the same lot). Mortimer reported that the probability of this being mere chance or coincidental to be between 2 and 5 in 1,000;¹⁴⁸ whereas Shannon reported a much lower chance association of 4 and 5 in 10,000.¹⁴⁹

LONG TERM (DELAYED) POTENTIAL ADVERSE EFFECTS OF IMMUNIZATION

Leaving the continuing controversies that exist over the extent and nature of observable adverse reactions to vaccines, we go on to the equally serious spectre of delayed reactions and the larger unanswered questions which surround the long term consequences of immunization. (The material in both this and the following section on "Immunization and Immune Malfunction" is afforded not necessarily as definitive and factual conclusions, but rather as preliminary research observations on vital--albeit controversial--issues and questions which undoubtedly merit further examination, research and analyses.) We began the exploration of this issue by reviewing some basic concepts and concerns relative to the strongly suspected linkage between live viral vaccines and the enormous escalation of varied auto-immune disorders.

Joshua Lederberg, a Stanford University School of Medicine geneticist and Nobel Prize winner, was perhaps the first to raise the warning that the use of live virus vaccines in mass immunization campaigns represents "biological engineering on a rather large scale." He goes on to comment:

While these [vaccines] are thought to be of indubitable value for preventing serious diseases, their global impact on the development of human beings of a side range of genotypes is hard to assess at our present stage of wisdom. . . . Live viruses are themselves genetic messages used for the purpose of programming human cells for the synthesis of immunogenic virus antigens.¹⁵⁰

Researchers such as Buttram postulate that the use of live viral vaccines in mass immunization programs introduces foreign genetic material into the human system, which has precipitated an unprecedented escalation of various auto-immune disorders in recent decades. These are disorders wherein antibodies or immune cells indiscriminately attack the tissues of one's own body-mind complex.¹⁵¹

Harvard graduate and physician, R. Moskowitz, explains how the live viruses in vaccines can, in the long term, lead to such auto-immune disease conditions. Vaccinal attenuated viruses attach their own genetic "episome" to the genome (half set of chromosomes and their genes) of the host cell, and are thus capable of surviving or remaining latent within the host cells for years. The presence of this foreign antigenic material within the host cell sets the stage for their unpredictable provocation of various auto-immune phenomena such as herpes, shingles, warts, tumors--both benign and malignant--and diseases of the central nervous system, such as varied forms of paralysis and inflammation of the brain.¹⁵²

Markowitz further poses the caution that vaccines do not act by merely producing pale or mild copies of the original disease, but all of them commonly produce a variety of symptoms of their very own. In some cases "these illnesses may be considerably more serious than the original disease, involving deeper structures, more vital organs, and less of a tendency to resolve spontaneously. Even more worrisome is the fact that they are almost always more difficult to recognize."¹⁵³

A British Medical Journal article by Miller et al, reports that "Various German authors have described the apparent provocation of multiple sclerosis by--vaccination against smallpox, typhoid, tetanus, polio, and tuberculosis."¹⁵⁴ No less disconcerting is the warning raised by Rutgers University Professor R. Simpson when he addressed science writers at a seminar sponsored by the American Cancer Society:

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, including rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus, Parkinson's disease, and perhaps cancer.¹⁵⁵

As if echoing Simpson, Dettman also raises the caution: that "some of the attenuated strains of vaccines that we advocate may be implicated with . . . a number of degenerative diseases including rheumatoid arthritis, leukaemia, diabetes and multiple sclerosis."¹⁵⁶

A study in Science reported a notable similarity between certain diffffent viruses (including measles and influenza) and the protein structure of the brains protective myelin sheaths. This being the case, antibodies induced by live viral vaccines could well be cross reacting and attacking brain cells.¹⁵⁷ Medical historian Harris Coulter has developed a systematic and comprehensive thesis that childhood immunizations frequently result in a demyelinating encephalitis.(As already noted, encephalitis [inflammation of the brain] has been associated with the pertussis, tetanus, and measles vaccines.) This condition prevents the normal development of the protective myelin sheaths of the brain and nerve cells during infancy and early childhood. Such adverse pathologic changes may, on a visible level, lead to a range of leaming disabilities and behaviourial problems, (As many as one in five elementary school children are now considered to have some form of minimal brain damage."¹⁵⁸ It is also estimated that in the US over one million children are medicated with powerful amphetamine drugs.¹⁵⁹) ^{158, 159} which are now being encountered in the West with increasing frequency.¹⁶⁰

Bruce Rabin, a professor of pathology and psychiatry at Western Psychiatric Institute, Pittsburgh has found evidence that approximately one-third of all cases of schizophrenia are auto-immune in nature, with immune bodies attacking the brain cells.¹⁶¹ When we consider the alarming increase in the numbers of schizophrenic cases, and the now credible "viral hypothesis of mental disorders,"¹⁶² childhood vaccine programs can be considered as highly suspect in playing a causative role.

Medical Professor, R. Mendelsohn summarily comments that:

While the myriad short-term hazards of most immunizations are known (but rarely explained), no one knows the long-term consequences of injecting foreign proteins into the body . . . . Even more shocking is the fact that no one is making any structured effort to find out.

There is growing suspicion that immunization against . . . childhood diseases may be responsible for the dramatic increase in auto-immune diseases since mass inoculations were introduced. These are fearful diseases such as cancer, leukaemia, rheumatoid arthritis, multiple sclerosis, Lou Gehrig's disease, lupus erythematosus, and the Guillain-Barré syndrome. . . . Have we traded mumps and measles for cancer and leukaemia? ¹⁶³

Noted Russian specialist in neuro-pathology, A.D. Speransky, concurs with the foregoing premonitory insights when he warns that post-vaccinal diseases might occur long after the operation has been forgotten. He raises the disquieting observation that ". . . it is conceivable that by these methods we may be crippling humanity."¹⁶⁴

Whether considering the short or longer term dangers of immunization programs, it is further unsettling when we consider the evidence that the public cannot really place much confidence in organized medicine to conduct itself in an honest and forthright fashion. For example, in 1982 the Forum of the American Academy of Paediatrics (AAP) rejected a proposed resolution which would have ensured that the:

AAP make available in clear, concise language information which a reasonable parent would want to know about the benefits and risks of routine immunizations, the risks of vaccine preventable diseases and the management of common adverse reactions to immunizations.¹⁶⁵

EVIDENCES FOR IMMUNIZATION INDUCED IMMUNE MALFUNCTION

There is a growing body of evidence that vaccinations damage the immune system itself. For example, during a placebo controlled trial of acellular pertussis vaccines, a cluster of invasive bacterial infections with fatal outcome occurred among vaccinated children, as compared with unvaccinated children of the same birth grouping. A review of the trial data led to the conclusion that "The hypothesis of an immunosuppresive effect of the vaccines, which would explain the deaths . . . could not be refuted by the data."¹⁶⁶

It is the studied conclusion of H. Buttram and J. Hoffman (Harold Buffram M.D., a graduate of Oklahoma Medical School, with a post internship in internal medicine, has over 30 years of medical practice in the State of Pennsylvania. John Hoffman Ph.D., is a Cell Biologist and when interviewed was serving as a biomedical researcher in the Department of Molecular Biology at the University of Wyoming), that early childhood vaccination "cannot help but have adverse effects on the immunologic system of the child, possibly leaving this system crippled in its ability to protect the child throughout life . . . . opening the way for other diseases as a result of immunologic dysfunction."¹⁶⁷

In reviewing their hypothesis of vaccine induced immune malfunction the evidence they present is substantive (citing numerous references, including four recognized textbooks on paediatrics and immunology), and their line of reasoning convincing. The following observations are made:

1. "For many years immunologists have been aware of a state of anergy (immunological unresponsiveness) following certain vaccinations"
2. A US Center for Disease Control examination of 700 Peace Corps volunteers who had undergone a set of multiple vaccine injections in the US before departure, exhibited an extremely weakened immune system response to the vaccine (HDCV) administered after their arrival overseas
3. Vaccination against one disease seems to provoke another (on this point, a physician's report of 15 case histories, over a five year period, where diphtheria-pertussis vaccination lead to paralytic polio is described, and Sir Graham Wilson is quoted [this doc. ref 7], "when a vaccine is injected . . . a latent infection that might have given rise to no illness is converted into a clinical attack.")
4. Vaccines have been implicated by numerous investigators as playing a "causative or contributory role" to various auto-immune and degenerative diseases, and suggests that their role in the onset of allergies or their worsening, and lowered resistance to infections needs to be further investigated
5. Given the one cell--one antibody rule, once an immune body (plasma cell or lymphocyte) becomes committed to a given antigen, it becomes inert and incapable of responding to other antigens or challenges to the immune system. It is estimated that up 7 percent of the body's overall immune capacity is committed in the natural immunological response to the usual childhood diseases, whereas a child who undergoes the course of routine childhood vaccines could be realizing a committal level of up 70 percent
6. The consequences of this significantly higher committal could result in increased susceptibility to other infections, allergies, and auto-immune diseases. (This particular observation is based upon sophisticated research carried out by the Arthur Research Corporation, based in Tucson, Arizona.)
7. Evidence indicates that maternal immunization "may remove (abrogate) immune defense from the level of the mucosa, thus potentially weakening mucosal resistance" (immunologists have long recognized that the mucosal surface serves as a "first line of defense" against infection)
8. Abnormal drops in the ratio of helper-to-suppresser T--lymphocyte cell subpopulations in healthy subjects (a condition now associated with AIDS, and possibly linked to transient hypogammaglobulinemia), observed after tetanus booster immunization
9. Circumstantial evidence indicates that "cross-cultural" mass immunization programs may be predisposing the onset of acquired immune deficiency syndrome in "virgin soil" populations as found in the Developing World, "which have not historically been subjected to the common diseases of Western civilization"
10. There remains a great need to conduct careful studies on the potential "immunosuppressive effects of vaccines," particularly with respect to "cross-cultural immunizations where exaggerated adverse responses would more likely be detected"
11. Where there is already advanced impairment in a child's general immune system, the injection of multiple antigens (vaccination), can weaken it further to the point of precipitating death in the vaccinate
12. Before public endorsement is accorded to the extensive usage of vaccines, certain preconditions should be addressed which include: a comprehensive evaluation of the multiple factors which constitute the etiologic basis of infectious disease; and the full range of factors and influences which determine natural resistance to infection and disease; with a full public disclosure of such research data.¹⁶⁸

Despite the fact that immune malfunction is "often delayed, indirect, and masked, (and) its true nature is seldom recognized," there is now sufficient evidence to suggest that growing disclosure of both the short and longer term dangers of current vaccination programs will serve to precipitate public demand for research to examine danger-free alternative methods for the prevention of infectious diseases.¹⁶⁹

J.E. Craighead, in summarizing the results of a workshop on "Disease Accentuation after Immunization with Inactivated Microbial Vaccines," sponsored by the US National Institutes of Health, indicated that the process of:

. . . immuno-prophylaxis can be carried out safely only when the natural history and pathogenesis of a disease is understood. In each of the conditions considered at the workshop, this detailed knowledge was lacking when vaccine trials were initiated in man. Had the vaccines induced lasting solid immunity, prolonged protection might have resulted, although this conclusion is far from certain. Moreover, production of circulating antibodies or induction of cellular immunity (or both) may be hazardous when local immune mechanisms of the mucosa are not operative.

Accentuation of disease was an unexpected complication of immunization in each of the conditions. Disease was accentuated when the subject (vaccinate) was exposed again, experimentally or under natural circumstances, weeks or even years after completion of the immunization regimen. Prolonged, intensive surveillance of immunization subjects apparently is a requirement. . . . One can only wonder whether or not recipients of currently licensed vaccines . . . that provide variable and transient immunity are being followed adequately . . . . Accumulating evidence strongly suggests that susceptibility to infection and disease is affected by still undefined constitutional influences. ¹⁷⁰

It is evident that Craighead's key question of what constitutes the still undefined "influences" will be effectively resolved only when the focus of selective medicine is able to make a radical shift towards displacing its present adventitious arsenal of vaccines and toxic drugs, with the normal and natural requisites of life and health. This is stated because the historical record, and common sense point to the latter approach as constituting the only sound basis for ensuring--not undermining--immune functionality, thus effectively resolving the actual underlying causes of both infectious and degenerative disease in man.

THE ETHICS OF UNIVERSAL CHILDHOOD IMMUNIZATION

There is indeed more than sufficient evidence to warrant far greater caution and questioning, than is now evident in the public drumbeating, idealism, and unqualified affirmations promoting the safety and effectiveness of Universal Childhood Immunization Programs. In fairness, it can be noted that some cautions have been raised on this issue from within medical circles. In summarizing an article on whether prevention of post-immunization adverse effects is possible, the editor(s) of Postgraduate Medicine recommend that:

Parents must be informed of the rare possibility of serious adverse effects, including seizure and allergic reaction. Every physician who administers vaccine therefore needs to become familiar with the reactions that may occur with each immunologic agent used. The best safeguard against litigation, when and if a serious reaction follows vaccination, is the indication that these considerations were discussed and that an informed choice was made.¹⁷¹

Nonetheless, we find that UCI-EPI as it has been generally conceived and executed represents two major departures from the time honoured ethics and traditions of medicine. These are:

1. that all forms of treatment should be individualized, particularly when prescribing or injecting substances which carry the potential for disease, disablement, and death; and
2. the objectively informed patient (or parent) should always have absolute freedom to accept or reject any given measure or therapy, and have reasonable opportunity to consider alternatives.¹⁷²

Just as environmentalists rightly challenge the appropriateness and right of big business interests to pollute our fragile natural environment with man-made chemicals, there arises the more personal, urgent and serious matter of protecting the precious body-mind complex from foreign and complex biological products that may well be touted as safe today, but condemned as dangerous tomorrow. Indeed scientists and physicians now openly admit that they have only a limited knowledge of the short term, and even less understanding of the long term consequences of challenging the bio-immune systems of children with a myriad of manufactured vaccines and related toxins.

This in turn poses the more basic question of whether medical and political authorities have the actual right--by reason and moral justice--to compel and expose unnumbered children the world over to undertake what are in fact unnecessary and potentially dangerous risks to their life and long term health. It is reprehensible that such actions continue to be enforced by authorities, while parents and local health workers are not accorded any practical knowledge of the known dangers involved, and the extent to which there prevails a general ignorance of the longer term consequences.¹⁷³

It goes without saying that monopolization is just as dangerous in public health as is it is in the field of general business. The human experience has demonstrated time and again that monopoly and compulsion in any field inevitably brings stagnation, whereas freedom of choice and the opportunity to explore alternatives brings genuine progress.¹⁷⁴

BANE OR BOON? SELECTIVE MEDICINE IN PRIMARY HEALTH CARE

Given the fact that UCI stands at the forefront as a centrepiece in the "selective medicine primary health care model" (around which has grown a powerful multi-billion dollar pharmaceutical industry), we must reconsider its overall relevance to human health. In selective medicine the relationship becomes one where the professional alone holds the authorized enlightenment and skills, while the community and its people come to represent the baser qualities of ignorance and subservient faith. This dynamic engenders in the community an unhealthful respect for officially authorized solutions, even when their effectiveness is in fact illusory. The Aboriginal peoples of N. America have now reached the unenviable distinction of being not only the most thoroughly immunized and medically drugged, but also the sickest group on the continent (e.g., by the late 1970s, the Canadian Aboriginal infant mortality rate was double that of the general population, with life expectancy at 36 years compared with 62 years among Canadians generally.)¹⁷⁵

Furthermore, alarming evidence suggests that in many Aboriginal communities there is a continuing escalation in degenerative diseases and social malaise. Both paleopathological and historical data convincingly indicate that when living a way of life closely predicated upon natural law, and free of adventitious medical interventions, North American Aboriginals were distinguished as being one of the healthiest of world peoples.¹⁷⁶

A more recent, albeit equally instructive picture can be fund among the Maori (Polynesian) people, who likewise have been especially earmarked by their national government (New Zealand) to receive the benefits of selective medical intervention. A study covering the period of 1968 to 1971 found that when compared with their racial counterparts who live in the remote island nations of the Pacific, the New Zealand Maoris appeared more inclined to suffer from infectious disease, rheumatic fever, and tuberculosis. They also seemed considerably more prone to develop degenerative conditions such as heart disease and diabetes, afflictions which were then virtually foreign to the remote island peoples. (In fact, among Maori women in the age grouping of 35 to 55, coronary heart disease was four to five times as frequent as among women of the same age group living on the atolls of the central Pacific.)¹⁷⁷

In the final analysis, disquieting evidence--much of which is not cited in this research--suggests the overall irrelevance of selective Western medicine to effecting longevity and ensuring general freedom from a range of infectious and degenerative diseases. Furthermore, as a system, it continues to significantly contribute to human morbidity and mortality"¹⁷⁸ (e.g., it has been shown in the USA, Holland, Israel and other developed nations that when physicians engage in a complete strike, within a week to 10 days death rates actually plummet, in some cases by as much as 60 percent).

It would be appropriate here to quote Illich's unambiguous observation that "Society can have no quantitative standards by which to add up the negative value of illusion, social control, prolonged suffering, loneliness, genetic deterioration and frustration produced by medical treatment."¹⁷⁹ In reference to selective medicine's central focus on absolving mankind from giving due respect to the natural laws of cause and effect, Mahatma Gandhi shares the following perspective.

I was at one time a great lover of the medical profession. . . . I no longer hold that opinion. . . . Doctors have almost unhinged us. . . . I regard the present system as black magic. . . . Hospitals are institutions for propagating sin. Men take less care of their bodies and immorality increases. . . . ignoring the soul, the profession puts men at its mercy and contributes to the diminution of human dignity and self control. . . . I have endeavoured to show that there is no real service of humanity in the profession, and that it is injurious to mankind. . . . I believe that a multiplicity of hospitals is not test of civilization. It is rather a symptom of decay.¹⁸⁰

Evidence suggests that Western medicine's over specialization and singular focus on pathology has literally obfuscated its perception and undermined its faith in the preventive and restorative power of the normal requisites of health. To a great extent it thus remains as an inexact and ever shifting system of trial and error, apparently more interested in maintaining its monopolistic pecuniary interests and professionalist pride, than in opening itself to new avenues of thinking and practice.

With all seriousness then we must raise the question as to whether we can realistically expect the self-same medico-industrial system that has for so long offered humankind little more than palliative and pathological inducing vaccines and drugs, to offer us anything better. (To obtain additional background on the practical impacts which the medico-industrial system of the West is having on the Developing World, please refer to Annex I--Problems With Developing World Medicalization and the Traditional Medicine Alternative.) It is here that we turn to consider the larger issue of what constitutes safer, more effective and sustainable approaches to ensuring the development and maintenance of human health.