JOHN DONVAN Over the past year, just what message have we all been receiving about the safety of childhood vaccinations? In the winter we heard on ABC:

Unidentified Woman #1 Ronny’s doctor thinks the vaccination could have triggered his illness.

DONVAN In the summer on NBC:

Unidentified Man #1: These cases are extraordinarily rare. And oftentimes, it’s impossible to clearly identify that the vaccine is the culprit.

DONVAN This fall, CBS:

Unidentified Woman #2 Mary Elizabeth Haggerty suffered a 45-minute-long seizure shortly after receiving a DTP shot when she was 17 months old. She never recovered.

DONVAN And also this fall, CNN:

Dr. JON ABRAMSON (American Academy of Pediatrics) We can’t let down our guard as far as making sure that all our children are vaccinated.

DONVAN In short, it is a conflicting message. Vaccines, say the experts, are why diseases like polio, small pox, and diphtheria no longer scare Americans. There is no evidence, says the medical establishment, that they’re causing any harm. But welling up from the public, from parents, spreading by word of mouth and passed along of course on the Internet are those frightening anecdotes of vaccinations that do harm.

Unidentified Woman #3 He was growing up really fine until he got that shot.

Unidentified Man #2 There’s just an incredible sense of frustration in the family. You know, autism faces you 24 hours a day.

Unidentified Woman #4 There’s three of us walking distance with autistic children.

Unidentified Woman #5 It scares me.

DONVAN Right now, word of mouth says one vaccination may actually be causing autism. The suspect is MMR, the vaccination against measles, mumps, and rubella. The fear just will not die, even though the one study that looked into it, published in the respected journal The Lancet last June, says there is no evidence that autism rates are increasing because of MMR. But it’s as though nobody read the report. Six weeks after The Lancet study, Congress held hearings into the safety of MMR. And the news media kept raising the question of whether there is a link.

We’ve seen this happen before, a refusal by nonexperts, parents or patients, to trust the word of people who are supposed to be the experts. Gulf War syndrome, silicone breast implants, these were cases where the doctors and researchers tried and failed to establish cause and effect. And when that happened, the public suspected the experts just hadn’t tried hard enough. It is the power of the anecdote, the old cliche, when you see the faces of the kids who have become sick after a vaccination, that a picture is worth 1,000 words.

But do not dismiss what an anecdote may be trying to tell you, says Barbara Fisher, who believes her son suffered brain damage from a vaccination in 1982.

Ms. BARBARA FISHER You know, the corner stone of medicine has always been anecdotal evidence. That is the first warning sign that something — that there may be a cause-and-effect relationship between something that a physician does and something adverse that happens.

Unidentified Woman #6 National Vaccine Information Center.

DONVAN Fisher heads a Virginia-based movement that has challenged the safety of vaccines and publishes a consumer’s guide for parents. The operation has a bit of a David and Goliath complex. Fisher feels that her work has been distorted, ridiculed, and demonized by certain members of the medical establishment who, she says, try to dismiss her as an overemotional mom. But Fisher is not above a little demonizing either. She believes there are people with bad intentions.

Ms. FISHER Because I think those who have a vested interest …

DONVAN Who are they?

Ms. FISHER … in maintaining the status quo.

DONVAN Who would — who would want to maintain the status quo if kids are at risk?

Ms. FISHER I think that certainly the vaccine manufacturers who are in the business of making and selling vaccines, and whose obligations to their stockholders, frankly, is the bottom line.

DONVAN All that aside, Fisher’s organization is an example of lay people who have made themselves experts on complicated medical issues. They have also proved their point in a significant way. Thanks in part to their well-informed lobbying, Congress, in 1986, passed a law providing compensation for kids harmed by vaccines. The fact that in recent years, the DTP vaccine for diphtheria, tetanus, and pertussis was changed because there were concerns it could lead to brain damage, the fact that the CDC has suspended this year the rotavirus vaccine, which appeared to cause severe intestinal problems in infants.

Unidentified Woman #7 You are good. Honey, you’re a good girl.

DONVAN These changes suggest that parents and doctors who question the safety of vaccines are not just being paranoid. But the greater fear of most doctors is that parents will panic and stop getting their children vaccinated; and that, they say, could be a nightmarish step backward. You don’t see whooping cough, pertussis very much anymore. It used to kill 9,000 a year, before there was a vaccine. And polio, it’s been all but eradicated from our hemisphere since 1991, because of a vaccine.

Dr. ABRAMSON There were hospitals full of children and adults on iron lungs, which was the only way these children and adults could breathe because of polio. When you see the real disease, and it’s in front of you, that’s when it becomes real. We have done such a good job with vaccines and eliminating diseases that people forget what happens when you stop vaccinating.

DONVAN Let me be clear about one thing. You’re coming nowhere near calling for a banning of vaccines or a boycott of vaccines by parents.

Ms. FISHER No. Absolutely not. We’re simply saying you’ve got to take a look at this. You’ve got to achieve a balance. And you’ve got to make the policies more humane. And you’ve got to always try to make the vaccines safer.

DONVAN Which any doctor will tell you is their concern, too.

Dr. ABRAMSON Safety is extremely important to me. I have three children. I have immunized them. I want to make sure these vaccines are safe.

DONVAN But the truth is, even living as we do in the most medically advanced society in history, 100 percent safety in anything still eludes us. Medicine tries all the time to achieve that mark. But, when medicine fails, when science cannot explain everything, that’s when we start listening to tragic anecdotes, especially if you’re the mother or the father of the child the anecdote is about. I’m John Donvan for NIGHTLINE in Washington.

KOPPEL So, what’s a parent to do, vaccinate or not? A variety of views when we come back.

(Commerical Break)

KOPPEL Joining me now here in Washington, Dr. Samuel Katz, one of the co-creators of the measles vaccine. He co-chairs the National Immunization Information Network. In Coeur D’Alene, Idaho, Dr. Jane Orient, an internist, who’s also executive director of the Association of American Physicians and Surgeons. And in our Boston bureau, my old friend ABC News medical editor Dr. Timothy Johnson.
     But I’d like to begin, Dr. Orient, with you, and have you make the case for — how would you put it, caution on vaccinating?

Dr. JANE ORIENT (Association of American Physicians & Surgeons) I think we should be cautious. All vaccines just like all drugs have side effects. I think we need to consider whether we should force parents to have vaccines that they believe are not in their child’s best interest, particularly against diseases such as hepatitis B at which the child is at minimal risk, at least if his mother is not infected. We have sent a letter several months ago to the CDC asking for the answer to a few simple questions. When before you licensed hepatitis B vaccine for newborns, how many newborns were tested, how old were they, what ethnic groups did they belong to, what did you look for and how long did you follow them for? We have yet to get an answer to those questions.

KOPPEL Let me …

Dr. ORIENT There’s a lot of questions about the safety of vaccines that have not been answered.

KOPPEL Let me just rewind the tape a little bit here and ask you whether, in fact, it is just a few vaccines that you are concerned about, or are you concerned in principle about the notion of mandatory vaccines of any kind?

Dr. ORIENT We are concerned in principle about violating the Nuremberg code which forbids subjecting patients to medical treatment without their informed consent. I think that for many vaccines the physician would certainly advise the parents to have the child vaccinated. For others there are serious questions. In every case it’s the physician’s responsibility to weigh the risk and the benefit to the individual patient.

KOPPEL What do you think would happen, Dr. Katz, if in fact we left it up to each individual parent? I mean, there is something rather appealing about the notion that a parent should in the final analysis have the right to determine whether his or her child gets a vaccination.

Dr. SAMUEL KATZ (National Immunization Information Network) Indeed, that is the way it is done, Mr. Koppel. Physicians, pediatricians, in particular, and parents discuss vaccine programs and arrive at informed decisions about what has been determined to be the most lifesaving protective event and discovery of the 21st and 20th century. The vaccines that you already spoke of have prevented many of the infectious diseases that formally made children ill, killed some children, and left some children disabled for life.

KOPPEL What about some of the public school programs which, indeed, require that before a child can come to school that child has to have, as I mentioned at the top of the program, in some cases our kids have 12, 14, 15 different inoculations and vaccinations before they are six years old.

Dr. KATZ In the first two years of life, children get a dozen immunizations, and then several more by the time they are four or five years of age. The school entry requirements and day-care requirements are established to protect these children. It’s not just an individual but a community protection and responsibility.

KOPPEL But that does undermine the—the suggestion you made a moment ago that indeed it is voluntary. It’s not voluntary if I can’t send my children to school if I don’t do it.

Dr. KATZ You can refuse to have your child immunized. But, by and large, less than 1 percent of the US population, about .4 percent in the studies that have been done, choose not to have their children immunized. You may pay a penalty in the sense that if a disease breaks out in the school, which is one for which your child has not been immunized, she or he will be discharged from the school until the disease epidemic or outbreak has ended.

The other thing that people forget is that though we don’t see these diseases in the continental US today, there were over 100,000 cases of diphtheria in Russia in the last several years. There are measles outbreaks in Brazil and even in Canada. These diseases have not disappeared. They are less than a jet plane ride away from us. And, in fact, last year, of all the measles cases that occurred in this country, they were all imported from other countries. And, indeed, it was determined by studies that if you were unimmunized you had a 35 times greater likelihood of acquiring measles than did any of the immunized children.

KOPPEL Tim Johnson, let me — let me bring you in. You’ve made a career here at ABC out of reassuring people all over the country. So, do a little bit of reassuring here. When — when there is concern, for example, by some of these parents that their autistic children, that the autism seems to manifest itself shortly after or in concert with the giving of a certain vaccination, you can understand that they — that they may jump to certain conclusions here. How justified are those conclusions?

Dr. TIM JOHNSON (ABC News Medical Editor) The issue is, and the problem is that you are talking about two things that are very common in early childhood. That is certain disease conditions. You’re talking about autism in this case and the fact that most children get vaccinated. So you have side by side two very commonly occurring events in early childhood. When it occurs in a child, that is a child that gets vaccinated and then develops autism, it’s very natural that a parent would put the two together. That’s an association. But the job of science is to pr — prove that it’s true cause and effect. And the way we do that traditionally, in this case the way it’s been done already, is to take a look at a group of autistic children and see if there’s any difference in the rate of autism among those children who were vaccinated and those who were not. And when they did that in the study referred to in the piece earlier, printed in The Lancet last June, there was no difference. That suggests that while there may be a causation — that is, a coincidence in time, there is no true scientific cause and effect. That’s what we have to do for all of these kinds of problems when they arise. And every time we’ve tried to look at them with vaccines, we can not prove cause and effect.

KOPPEL All right, we’ve set the table. We’ll continue the discussion in just moment. Back with our guests in a moment.

(Commerical Break)

KOPPEL Three guests, three doctors, Samuel Katz, Jane Orient, and ABC’s Tim Johnson.
     Dr. Orient, you raised before that sort of dramatic analogy to the Nuremberg laws in which people were required to undergo medical procedures against their will. It’s a horrible analogy, and I’m sure you are aware of just how horrible it is. Do you really think it’s an appropriate one?

Dr. ORIENT Yes, I do, because I think that the CDC is not being completely honest with people. They are saying these vaccines are safe and to save the world from hepatitis B your baby has to be vaccinated. If parents want to refuse consent, they may be threatened with having their children taken away from them. They may be treated quite — quite callously when they ask, ‘Well, why did my baby bleed to death and have liver damage at autopsy 12 hours after receiving an injection hepatitis B vaccine?’

KOPPEL Let me — let me — let me — let me stop you, because what you’ve said is—is so outrageous if true, that it does require an immediate response. And Dr. Katz, I know you’re an adviser to the CDC. So, would you respond, please?

Dr. KATZ Yes, I think that is an egregious totally unreliable statement. First of all, the Nuremberg code speaks to experimentation, not to prevention and to treatment. Secondly, hepatitis B infection in infants and children leaves an incredibly high risk of chronic liver disease, of cirrhoses, of cancer of the liver. There are four of five thousand individuals a year in our country who die of the complications of hepatitis B.

KOPPEL Address — address, if you would, though, what Dr. Orient said about if parents refuse, that the child would be taken away from them, because I’ve never heard that.

Dr. KATZ That’s fallacious. There’s no such event ever been recorded to my knowledge, or that I’ve ever heard from anyone else. That’s just not true.

KOPPEL Dr. Orient, would you like to be a little more specific there.

Dr. ORIENT I have heard of cases — well, I have heard of cases of parents …

Dr. KATZ I’d like to hear one demonstrated.

Dr. ORIENT … who were threatened in that way.

KOPPEL Well …

Dr. ORIENT Even after the baby had a severe adverse reaction to the first dose, they were told …

KOPPEL I must tell yo u— I must tell you, for a scientist to say I have heard of cases is about as unconvincing as anything I have ever heard to …

Dr. ORIENT Well, I’m a physician. And when a patient tells me something, I don’t assume that the patient is a liar. I assume that what he’s telling me is probably true.

KOPPEL Tim Johnson, have you ever heard anything like this happening? I don’t want to dismiss it because, you know, strange and terrible things happen even in this country. But I also don’t want to leave it hanging out there if, in fact, there’s no evidence to support it.

Dr. JOHNSON No, I have not heard of any such case, nor have I ever had an impetus to look into it. You know, this kind of boils down to individual rights vs. what’s best for society. And from a political point of view, this debate can be appealing. I have to say just flatly from a medical point of view, there should be no debate. That is the benefits of vaccines so clearly outweigh potential risks.

Dr. ORIENT That …

Dr. JOHNSON That from a strictly medical viewpoint there should not be a debate.

KOPPEL Go ahead, Dr. Orient.

Dr. ORIENT … that is not—that is not so.

KOPPEL What is not so?

Dr. ORIENT There has been no proof that the benefits outweigh the risks for the individual patient. And hepatitis B is extremely rare in babies.

Dr. JOHNSON What — what...

Dr. KATZ Let me tell you about meningitis. We had 20,000 cases of meningitis a year in this country due to an organism caused tomof — called Haemophilis influenza B, in children under five years of age. Until the early 1990s, when a new vaccine was introduced, a conjugated protein vaccine against the organism, Haemophilis influenza B. This last year there were less than 200 cases in children under five years of age. That’s a remarkable achievement. But those are the things that people don’t put on the front pages of papers. They put on these bizarre complaints, such as Dr. Orient is raising, which have no basis in fact.

KOPPEL Tim Johnson, we’re — we’re down to our last minute or so, and I think it is appropriate if you would just spend that last minute weighing and comparing the relative importance of individual rights, which of course Dr. Orient is stressing, and the rights of society as a whole, in a case like this, particularly with infectious diseases, to protect itself.

Dr. JOHNSON It’s appealing on the surface to say an individual has the right to do what they want. The problem when it comes to vaccines and infectious disease is that if enough individuals start making that decision, all of a sudden you reach a point where the immunity that has been caused by the vaccine will start to disappear and all of us will be at risk. Ten years ago, when there was concern about the measles vaccine, measles vaccinations dropped by 10 percent. In a relatively short time we had an epidemic of measles. Over 55,000 cases, 120 deaths. So, what an individual does doesn’t just affect that individual, but it can affect all of us. And that’s why we have to be so certain that we vaccinate in our society.

KOPPEL It would have been overly optimistic to expect that we can resolve this issue tonight. But I’m very grateful to the three of you for joining us Dr. Orient, thank you. Dr. Johnson and Dr. Katz.

Dr. KATZ Thank you, Ted.

KOPPEL I’m deeply appreciative that you all came in. I’ll have a word about our NIGHTLINE Friday night special when we come back in a moment.

(Commercial Break)