Once, it was simple. You took your baby to the pediatrician and he got his shots. But for some years now, a growing number of moms and dads have been struggling with the decision to inoculate or not. They may waver because of the clamor of news reports about possible links between vaccines and terrifying side effects. Or they're put off by the number of shots recommended -- up to 20 before age 2.
Emotions run high for other reasons too. Often, parents who choose not to have their children vaccinated are enraged that public-health policy makes it so difficult to avoid what they see as a dangerous practice. At the same time, those who do get their children inoculated can be just as angry that exposure to unvaccinated kids may raise the risk of disease for their own kids -- indeed, for everyone.
Once, it was simple, but no longer, and many parents are grappling with what they feel is a life-and-death decision.
Margaret Renkl is a contributing editor to Parenting.
Is This Shot Needed Now?
Ten years ago, Lisa of Gulfport, Mississippi, brought her first baby, Helen, home from the hospital. That night, the baby spiked a fever of 102°F. Her pediatrician sent them straight to the emergency room. Tiny Helen was subjected to a spinal tap to rule out meningitis, then hospitalized for three days of intravenous antibiotics in case of blood poisoning.
But Helen had neither meningitis nor sepsis; doctors concluded that she was reacting to the hepatitis B vaccine she'd received in the hospital the day she was born. Though Helen hasn't suffered any long-term ill effects, Everleigh is still angry. "What my baby went through was horrible and completely unnecessary. An infant's chances of contracting hepatitis are nil unless the mother has the disease, and it was highly unlikely I would be a carrier," she says. "So I was kicking myself for not questioning the vaccine. And I was mad at the medical community for recommending it in the first place. My child suffered because of a blanket policy designed to protect a population she doesn't even belong to." With Helen's younger siblings -- Katherine, 6, and Michael, 10 months -- Everleigh was cautious: She let both have the hepatitis B vaccine, but not until they were 2 months old, when a high fever wouldn't be such a medical emergency (they've gotten all their other shots on schedule). Since 1991, the Centers for Disease Control and Prevention (CDC) has recommended that children get a shot right after birth, since tests for a mom's exposure aren't foolproof.
Jill Scobie of Asheville, North Carolina, avoids nearly all vaccines for her three children except when she believes the risk of serious illness is greater than the risk posed by the vaccine -- as when her 11-year-old daughter visited Latin America with an aunt. Scobie knows several families whose children are suffering from debilitating autoimmune disorders that their parents think were caused by vaccines. Although medical research has shown no connection, she's not convinced. "Infectious-disease experts aren't discussing the risks of long-term effects like arthritis and lupus. They don't treat those diseases, so they're not even on their radar."
Public-health policy in the U.S. doesn't make it easy for moms like Scobie to decide against vaccinations for their kids, says San Diego lawyer Karin Schumacher, a national advocate for the right of parents to refuse vaccines. Requiring vaccinations for enrollment in daycare or grade school effectively eliminates most parents' right to opt out. "It's an insult to parents because it says that the medical community doesn't trust us to make good decisions about our children's health," Schumacher says.
After her own daughter, now 12, suffered a frightening reaction to the DTP (diphtheria-tetanus-pertussis) vaccine when she was 2 months old -- a high fever, inconsolable crying, a painful knot at the injection site that lasted for weeks -- Schumacher refused any shots once her daughter turned 1. (DTP has since been replaced by DTaP, which causes far fewer reactions.) "I don't believe the medical community is telling people about the real dangers, and I don't believe society has the right to make me take risks with my child's health for the sake of a perceived benefit to the common good," she says. "I'm obligated to take care of my own child first."
Weighing Risks, Taking Responsibility
Shellie Michael of Nashville didn't give much thought to the question of vaccines when her son, Alec, now 6, was born. A worrier during pregnancy, she was still luxuriating in the relief of her healthy baby's birth when a friend challenged her decision to vaccinate him. The questions the other mom raised threw Michael into a tailspin: "I was tormented by the idea of holding down my baby while the nurse injected him with something that might damage him. But I also worried that if Alec wasn't vaccinated, he might catch a horrible disease. I was terrified by the possibility of making a wrong decision."
Ultimately, Michael decided that her son would be far safer vaccinated than not. She also realized that it wasn't a purely personal decision. "I think that parents have a responsibility to help keep immunization rates high, that the decision can't be only about your own kid. And now, having taken the risk myself, I get upset with parents who don't vaccinate because I feel like they're free riding off me. They can get away without vaccinating because other families are accepting the risks. I'm very bothered by that."
Not surprisingly, parents whose children have gotten sick from unvaccinated playmates feel even more strongly. Thirteen years ago, Mary-Clayton Enderlein, a mom of three in Seattle, contracted whooping cough (pertussis) from the seemingly healthy, unvaccinated baby sister of a friend her son was playing with. She was 38 weeks pregnant. The next week, she came down with a cough so violent, it caused her water to break. But tests came back saying -- falsely, as it turned out -- that she didn't have whooping cough. "Two hours later, my healthy nine-and-a half-pound baby, Colin, was born. The second I kissed him, I gave him whooping cough."
Healthy adults can fight the disease fairly well, but it's life-threatening for infants under 4 months. "It was horrible," Enderlein recalls. "Colin would cough until he turned blue and threw up." He spent ten days in intensive care and was on monitors for a month; for most of his first year, he was frequently sick with respiratory infections.
Even now, Enderlein doesn't believe that parents should be compelled to vaccinate their children, but she does think they should be educated about the risks if they choose not to. "They have to realize the social consequences if they don't vaccinate," she says. "They're making a choice, but the kids they expose their children to don't have that choice. It almost cost Colin his life."
When Mary Catherine Walther, the third of five children in Herndon, Kentucky, was 11 months old, she contracted bacterial meningitis and was hospitalized in critical condition. Her two older siblings had been fully vaccinated, but her mom, Suzanne, had refused the shots for her after a friend warned her about safety concerns. "I found a bunch of homegrown websites that said, 'Look at these beautiful babies. They all died of SIDS because they got their vaccines,'" says Walther. So she decided to postpone Mary Catherine's shots until she was safely past the 12-month mark, when the risk of SIDS ends. But just before her first birthday, Mary Catherine became desperately ill.
For more than a week, Walther didn't know whether her daughter would survive. "At night I walked the halls of the intensive care unit, and I was furious," she says. "I was angry at my friend for suggesting there was a problem with vaccines, at my husband for letting me go along with her, at myself for being arrogant enough to think I knew better than my pediatrician. My baby was suffering from a disease that could have been prevented so easily." Mary Catherine's now a healthy 4-year-old, and both of her younger siblings got all their vaccinations on time.
Living With an Avoidable Tragedy
Two years ago, Shannon Duffy Peterson of Sleepy Eye, Minnesota, lost her first child, Abigale, to an infection that might have been prevented. Her pediatrician assured her that her child didn't need a varicella (chicken pox) vaccine or a pneumococcal vaccine, Peterson has testified before the Minnesota state legislature. (While both of these immunizations are recommended by health experts, not all states legally require them.)
When Abigale was almost 6, she caught a severe case of chicken pox. The disease so weakened her that several months later, she picked up a second infection, a form of pneumonia that the pneumococcal vaccine protects against. She died in her parents' arms on the way to the hospital. Last year, Peterson -- now an advocate for vaccination -- pushed for a law that requires varicella and pneumococcal immunizations for enrollment in daycare or grade school. (It was passed and goes into effect this September.) "No parent should have to go through what we went through," she says. "Our hearts broke the day we lost our daughter."
It's rare that a middle-class family in America faces the loss of a child to an infectious disease. Thanks in part to the CDC's "Vaccines for Children" program, which has been effective in immunizing un- and underinsured kids, the average vaccination rate by the time a child enters kindergarten in this country is 97 percent.
Many parents understand that connection. "I do acknowledge the risks of vaccines," says Barb Waugh, a mom of two fully vaccinated children, ages 6 and 4, in Houston, "but they're minimal compared with the risk of the diseases themselves to public health, and with the risk of my own kids getting sick." Whichever choice a parent makes, she's only doing what all good moms do: trying to protect her child. But in this case, private actions can have public consequences. There's no doubt that a high vaccination rate is one crucial way to keep the nation's kids healthy. In a sense, each decision we make for our own children is a decision for all children.