Deadly Choices: How the Anti-Vaccine Movement Threatens Us All

by Paul A. Offit M. D.

  Sabin’s polio vaccine wasn’t the only problem.

  Ten years before Jonas Salk made his polio vaccine, his former mentor, Thomas Francis, made an influenza vaccine. Francis took influenza virus, injected it into eggs, grew the virus, purified it, and inactivated it with formaldehyde. (Salk’s idea of inactivating poliovirus with formaldehyde came from working in Francis’s laboratory.) The influenza vaccine is made the same way today. Unfortunately, some people can’t get it because they’re severely allergic to eggs. (In the United States about a million are.) Reactions can be frightening, and can include hives, low blood pressure, difficulty breathing, and shock—all of which could be avoided; companies could grow influenza viruses in mammalian cells rather than avian ones. Although this procedure wouldn’t be easy, it’s doable. But, absent a public outcry, pharmaceutical companies have had little incentive to make the change and public health agencies haven’t insisted they do it. Again, it’s a perfect situation for an advocate.

  Egg proteins aren’t the only vaccine component that causes severe allergic reactions, or even the most common cause of them; gelatin is. Made by extracting collagen from the bones and hides of pigs, gelatin is used as a stabilizing agent, allowing small quantities of live viral vaccines to be evenly distributed throughout a vial. (For decades, the MMR vaccine contained gelatin as a stabilizer; today only the chickenpox and nasal-spray influenza vaccines have it.) Most people don’t have a problem with gelatin, but some develop severe allergic reactions. Also, certain religious groups are hesitant to receive a vaccine made with pig products. Again, for those wanting to make vaccines safer, gelatin would be a great place to start. Other stabilizing agents are available.

  Barbara Loe Fisher founded America’s modern-day anti-vaccine movement. (Courtesy of Dayna Smith.)

  All of these problems were worthy targets for a consumer advocate. But Barbara Loe Fisher chose to take vaccine safety activism in a dramatically different direction.

  Beginning in the early 1980s, and for the next three decades, every time a new vaccine was recommended, the media sought out Barbara Loe Fisher for her opinion. The first vaccine licensed under Fisher’s watch prevented Hib.

  Older American pediatricians have witnessed the horror of Hib disease. Before the vaccine, Hib was the most common cause of meningitis, often leaving children deaf, blind, or severely mentally disabled. And it was a common cause of bloodstream infections (sepsis) and pneumonia. But one disease caused by Hib is even more frightening—a disease that most parents have never heard of and most young doctors have never seen: epiglottitis.

  The epiglottis is a thumb-like wedge of tissue at the back of the throat; when people swallow, it flops down over the windpipe, preventing food and water from entering the lungs. Hib is unique among bacteria in its capacity to infect the epiglottis. Once infected, the epiglottis can block the windpipe—no different, in a sense, than being smothered by a pillow. Before 1990, every big city hospital had an “epiglottitis team,” designed to usher children quickly and quietly into the operating room for a lifesaving tracheostomy (a surgical hole in the windpipe). The quietly part was particularly important. Once agitated, children with epiglottitis were much more likely to suffocate on the spot. No disease was more nerve-wracking.

  In 1987, the Food and Drug Administration licensed the first Hib vaccine. To doctors across the country, the vaccine was a godsend. At last, they could prevent the severe, permanently disabling, and fatal cases of Hib that occurred every year. Barbara Loe Fisher didn’t share their enthusiasm. On World News Tonight with Peter Jennings, she cautioned, “We have to do more independent vaccine risk studies to find out whether or not vaccinations are causing chronic diseases, like diabetes.” Fisher’s response was predictable. Years before, in her book A Shot in the Dark, she had written, “With the increasing number of vaccinations American babies have been required to use has come increasing numbers of reports of chronic immune and neurological disorders being suffered by older children and young adults including asthma, chronic ear infections, autism, learning disabilities, attention deficit disorder, diabetes, rheumatoid arthritis, multiple sclerosis, chronic fatigue syndrome, lupus, and cancer. The unanswered question is whether multiple vaccinations, which are suppressing many diseases, especially in childhood, are playing a leading role in the rise of chronic illnesses later in life.” By simply replacing infectious diseases with chronic diseases, vaccines, according to Fisher, were responsible for many of mankind’s ills. For every new vaccine, Fisher would find at least one doctor to support her view. In the case of the Hib vaccine, it was Bart Classen.

  Classen was the president and chief executive officer of Classen Immunotherapies, a company that held patents on alternative vaccine schedules and alternative methods to identify vaccine side effects. To establish that Hib vaccine caused diabetes, Classen showed that children in Finland who had received three doses of vaccine in infancy were more likely to have diabetes than those who had received only one dose in the second year of life. Appearing with Barbara Loe Fisher on World News Tonight, he said, “In fact, the scheduling has a major impact on the development of diabetes. We’re saying that when you look at the big picture, looking at five, ten years down the road, that this isn’t the ideal schedule.”

  This was big news. The Hib vaccine, thought to be one of medicine’s greatest lifesavers, was, according to Classen, actually causing children to suffer a lifelong, debilitating, often fatal disease. Other researchers rushed to confirm Classen’s findings. One group examined the risk of diabetes in twenty-one thousand American children who had received the Hib vaccine and compared it with twenty-one thousand children who hadn’t. The risk of diabetes was the same in both groups. Other investigators examined two hundred and fifty American children with diabetes to see if they were more likely to have been vaccinated than other children. Again, Hib vaccine didn’t increase the risk of diabetes. Indeed, no vaccine has ever been shown to increase the risk of diabetes. The inability of researchers to reproduce Classen’s findings caused them to take a closer look at his original study. They found severe flaws in his analytical methods, further substantiated when, ten years after vaccination, Finnish children who had received Hib vaccine in infancy weren’t more likely to have diabetes—exactly the opposite of what Classen had said on World News Tonight.

  Barbara Loe Fisher’s appearance on national television with Bart Classen wasn’t her only public comment on the Hib vaccine. One ironic twist remained.

  Heather Whitestone was born in 1973 in the tiny town of Dothan, Alabama. After high school Whitestone attended Jacksonville State University and started competing in beauty pageants. On September 17, 1994, at the age of twenty-one, she was crowned Miss America—the first with a severe disability. “I lost my hearing when I was eighteen months old,” she said. After Whitestone accepted her crown, her mother told a local news reporter what she thought had caused her daughter’s deafness: DTP vaccine. Whitestone’s prominence, combined with her mother’s revelation, was chilling for any parent deciding whether to vaccinate their child. Barbara Loe Fisher quickly weighed in: “It’s so often that the parent who is with the child and witnesses the high fever, witnesses the convulsions, the shock or whatever; it comes down to whether the doctor agrees it was due to the vaccination just given. [The medical community] continues to try to sweep these children under the rug.”

  Heather Whitestone, the first Miss America with a disability, was a controversial figure in the anti-vaccine movement. (Courtesy of Donna Connor/Sygma/Corbis.)

  Heather’s mother had omitted one critical part of the story. Ted Williams, the Dothan, Alabama, pediatrician who had taken care of Heather, had followed her rise to fame with pride. But when Heather’s mother claimed that DTP had caused her daughter’s illness, Williams stepped forward. He knew that Heather wasn’t deaf because of DTP; she was deaf because of a near-fatal case of Hib meningitis. Fisher responded to Williams’s revelations angrily, seeing conspiracy. “Within hours after the Mis
s America pageant, a horrified medical establishment moved quickly to publicly dispute any connection between Heather’s deafness and the DPT vaccine and instead blame her deafness on a bacterial infection,” said Fisher. “The American medical establishment went to extraordinary lengths to publicly challenge Heather and her mother in order to avoid having to acknowledge DPT vaccine risks.”

  American children have used Hib vaccine for more than twenty years. During that time the number with Hib meningitis, bloodstream infections, pneumonia, and epiglottitis has decreased from twenty thousand every year to fewer than fifty. Sadly, some parents watching World News Tonight, frightened by Barbara Loe Fisher’s and Bart Classen’s warning that Hib vaccine could cause diabetes, might have chosen not to vaccinate their children: a choice that would have put them at unnecessary risk of a highly disabling, often fatal infection.

  The next vaccine recommended for infants protected against hepatitis B virus. It was immediately controversial. Although most parents had probably never heard of Hib, they had all heard of and feared meningitis. So the Hib vaccine was an easy sell. But while most parents know what hepatitis is, they had never considered it a disease of children. Actually, it’s more common than people realize.

  Before the vaccine, hepatitis B virus infected about two hundred thousand people in the United States every year, mostly teenagers and young adults. The infection isn’t trivial, causing fever, vomiting, nausea, food intolerance, abdominal pain, headache, muscle pain, joint pain, rash, and dark urine followed a few days later by jaundice (yellowing of the skin and eyes) and an enlargement and tenderness of the liver. Some patients become disoriented, extremely sleepy, semi-conscious, or comatose: all symptoms of severe liver damage. Four of ten people in the United States with symptomatic hepatitis B infection will be hospitalized and five thousand killed by the virus every year. For those who survive, the virus may cause a long-lived infection, resulting in permanent scarring of the liver (cirrhosis) or liver cancer. Worse: people chronically infected with hepatitis B virus often don’t know it—problematic, given that many are highly contagious to others. For this reason, hepatitis B infections are known as the “silent epidemic.” Prior to the development of hepatitis B vaccine, about a million people in the United States were chronically infected.

  In 1981, the year before Barbara Loe Fisher watched Vaccine Roulette, the first hepatitis B vaccine was licensed. It wasn’t recommended for routine use in children. Public health officials reasoned that the best way to eliminate the disease was to recommend the vaccine for those most likely to become infected—specifically, people who have sex with an infected person, especially men who have sex with men; healthcare providers unknowingly exposed to contagious patients; intravenous drug users; prisoners; and people who get tattoos from places that don’t adequately sterilize equipment between customers. Between 1981 and 1991, the vaccine was recommended only for those at highest risk. Unfortunately, the strategy failed, miserably; and the incidence of hepatitis B virus infections remained unchanged. So, government officials embarked on the second stage of their plan, recommending three doses of the hepatitis B vaccine for all babies, the first to be given soon after birth.

  The new hepatitis B vaccine policy was a public relations nightmare. Because the vaccine had initially been recommended for prisoners, intravenous drug users, and men who had sex with men, it was viewed as “dirty”: a vaccine that had no place in the infant vaccine schedule. Fisher leveraged this perception to promote her premise that vaccines caused chronic diseases. The doctor who supported her this time was Bonnie Dunbar.

  On January 22, 1999, ABC’s 20/20 aired a program that deeply scared the American public. (Fisher, who provided information to the show’s producer, can be seen briefly pointing to a computer screen.) Sylvia Chase was the correspondent. The program began with a teaser: “Next, an important medical controversy. Serious new questions about a vaccine most school children are forced to get: one given to millions of babies every year.” “We just thought it was like all the immunization shots,” said one mother. “We were doing it to protect our child.” “It’s the hepatitis B vaccine,” warned the announcer. “These parents thought it would protect their child. No one told them that there might be risks.” “Within three weeks of the third shot, I lost my vision,” said one woman. The announcer then revealed the show’s premise: “Is it smart preventive medicine, or an unnecessary risk? Sylvia Chase asks: When it comes to hepatitis B, who’s calling the shots?”

  The 20/20 program told the stories of several healthcare providers who had developed multiple sclerosis after getting the hepatitis B vaccine.

  CHASE: These medical workers say they were healthy. Then they were vaccinated.

  WORKER #1: Within two months I was very ill. I was ill in bed.

  WORKER #2: I can’t even feed myself.

  DUNBAR: These people were completely healthy.

  CHASE: Dr. Bonnie Dunbar, a cellular biologist at Baylor College of Medicine, believes that in certain people a genetic component sets off an explosive chain of events.

  DUNBAR: The only thing that happened is they took this vaccine and within a month most of these people had completely debilitating life-style changes.

  The implication was clear; hepatitis B vaccine caused multiple sclerosis. Chase then described the same problem that Lea Thompson had described for DTP:

  CHASE: Three-day-old Ben Converse’s seizures began less than twenty-four hours after his first shot. Now Ben is developmentally disabled. Thirty-three hours after his vaccination, thirteen-day-old Nicky Sexton’s heart stopped. The coroner said it was Sudden Infant Death Syndrome, or SIDS. Lyla Belkin’s death was also attributed to SIDS. She had received her first shot at six days old: the second one, a month later.

  MR. BELKIN: How is a baby possibly going to get hepatitis B? It’s ridiculous to give this vaccine to a child. I wish we’d known that before receiving this vaccine.

  CHASE: You did what the doctor told you to do.

  MRS. BELKIN: I did what the doctor told me to do. Yes, of course.

  CHASE: And they didn’t say that there were any cases of deaths or serious reactions?

  MRS. BELKIN: No, nothing.

  CHASE: On September 16, 1998, Mrs. Belkin nursed Lyla at 5:30 a.m., not long after, she found her pale and cold.

  MRS. BELKIN: (fighting back tears) She died early in the morning about sixteen hours after vaccination.

  The scene shifted back to the show’s hosts, Hugh Downs and Barbara Walters. Walters looked into the camera, incredulous. “What a choice for parents to have to make,” she declared. “There is so much conflicting information!” Unfortunately, the problem with the program wasn’t that there was so much conflicting information; it was that there was so much wrong information, such as the false notion that babies aren’t at risk of getting infected. “How’s a baby possibly going to catch hepatitis B virus?” Michael Belkin had asked. Fisher echoed Belkin’s disbelief. “There are only four hundred cases a year of hepatitis B in children under fourteen [years of age],” she said. “It’s not a disease your average, healthy child is likely to contract.” Although it is true that most disease and death caused by hepatitis B virus occur in adults, every year before the hepatitis B vaccine about sixteen thousand children less than ten years of age were infected by nonsexual, person-to-person contact. (Hepatitis B virus can spread fairly casually, such as by sharing toothbrushes.) Worst of all, infants infected with hepatitis B virus are at the highest risk of long-term problems; many develop cirrhosis or liver cancer later in life. Although childhood infections accounted for fewer than 10 percent of all infections in the United States, they accounted for 20 percent of all cases of chronic liver disease. This is the reason public health officials had recommended the vaccine for newborns.

  Another misleading message from the 20/20 broadcast was that hepatitis B vaccine caused SIDS. The most compelling story was that of Lyla Belkin, who died of SIDS following her second dose. Fisher asked Michael Belk
in to head the Hepatitis B Vaccine Project at her National Vaccine Information Center. Soon Belkin, a Wall Street financial advisor, was everywhere. In February 1999, at a meeting of a federal vaccine advisory group at the CDC, he said, “I hold each one of you who participated in the promulgation or perpetuation of that mandated newborn vaccination policy personally responsible for the death of my daughter.” Several months later, Belkin told a congressional committee, “Almost every newborn U.S. baby is now greeted on its entry into the world by a vaccine injection against a sexually transmitted disease for which the baby is not at risk—because they [health officials] couldn’t get the junkies, prostitutes, homosexuals, and promiscuous heterosexuals to take the vaccine. Parents need to understand that the system providing the vaccines injected into their children’s veins is corrupt and scientifically flawed.”

  Despite Belkin’s certainty that hepatitis B vaccine had caused his daughter’s SIDS, study after study failed to support him. Indeed, during the 1990s, when the vaccine was given to more and more babies, fewer and fewer died of SIDS. This wasn’t because of the vaccine; it was because of an aggressive program called “Back to Sleep.” Investigators had found that children who died of SIDS were more likely to have been lying on their faces than on their backs at the time of death. Encouraging parents to lay their children on their backs dramatically reduced the incidence of SIDS.