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Almost everyone agrees that vaccination has been one of the single most effective public health measures ever undertaken however it still remains one of the most controversial issues facing medicine today. We will take a look at these controversies, attempting to dispel truly fallacious information and focusing on real issues of concern to families. Once the efficacy of vaccines became established, governments rushed to both make vaccines available to the populace and to make vaccination compulsory in many cases. In the twentieth century, as immunizations for childhood diseases were developed, including diphtheria, measles, mumps and rubella, vaccination became required for public school attendance. In 1974, the WHO launched the Expanded Programme on Immunization. Through their efforts the last naturally occurring case of smallpox in the world occurred in Somalia in 1977. Governmental entities strive to immunize as many people as possible in order to reach "herd immunity". Herd immunity takes place when enough people are vaccinated to substantially lower the likelihood that a susceptible person will come into contact with an infected person. Unfortunately, while the discovery of vaccines has probably been one of the single most important steps in eradicating disease (along with sanitation and antibiotics), there have been and continue to be safety issues associated with vaccine administration. In 1955, two batches of polio vaccine contained live virus, which caused an outbreak of polio. In the 1970s a paper was published linking pertussis vaccination to permanent brain damage. The ensuing boycott of vaccinations and slate of lawsuits drove vaccine manufacturers out of the business, creating shortages and a rapid increase in disease incidence. The theory was later disproved but the controversy led to the development of the National Vaccine Information Office, the National Vaccine Injury Act, which provides some liability protection to manufacturers and the National Vaccine Injury Compensation Fund which provides monetary compensation when a vaccine is proven to have had a deleterious effect. In 1976, there was evidence that the swine flu outbreak could create an epidemic as bad as the flu epidemic of 1918, which killed 50,000,000 people worldwide. Swine flu vaccine was rushed to the public without adequate testing, resulting in about 500 cases of Guillain-Barré syndrome before the program was cancelled. Vaccines, like any drug or foreign material that enters the body, can cause allergic reactions, often due to the adjuvant, i.e., materials that the vaccine uses as a vehicle for administration. Side effects such as localized swelling, fever, crying and more are often associated with injections. Beyond the concern about specific vaccine problems as described earlier, there is a strong minority of people who believe that the increasing rates of autism and learning disabilities in the

U.S. are related to its mandatory immunization program. A good deal of research has been cited on both sides of the issue and there's no clear evidence to either support or completely deny these beliefs. Autism is a developmental disorder characterized by impairment of social behaviors and interactions. These behaviors usually become observable at about eighteen months. Most vaccinations are given on a schedule that begins at age 2 months, creating a question about whether the immunizations cause the autism. Historical review shows that the incidence of autism did increase at about the time of the introduction of the MMR vaccine in the U.S. However, awareness of autism as a distinct disease increased at the same time. Autism in the UK did not increase after MMR was introduced there. In the past, thimerosal, organic mercury, was used as a component of vaccines. Fears of a link between mercury and autism caused the Institute of Medicine to request removal of thimerosal from vaccines as a precautionary measure. This move, which was not based on scientific evidence, lent credibility to these fears. The current scientific consensus is that thimerosal causes or worsens autism; by 1999, this ingredient was removed from almost all vaccines. Overall, vaccines have improved the lives of billions of people worldwide, eradicating many diseases or reducing them to small, manageable outbreaks. Proponents in favor of TO VACCINATE cite the following arguments. Getting vaccinated protects the individual and the community; it's an obligation of living in a society to support the public good. While most vaccination proponents recognize that there maybe individual situations where vaccination is not recommended, they point to the fact that if vaccinations weaken the immune system, there should be a higher rate of infections after immunization. A 2001 study of over 800,000 children in Denmark determined that there was no correlation. It is not fair to subject vaccinated children, especially those who have been vaccinated because their medical conditions suggest that the disease would have serious negative effects, to the potential of getting the disease from those who have chosen not to be vaccinated (since vaccinations are not 100% effective in most cases.) Manufacturers are constantly working to reduce chemical agents in vaccines such as thimerosal. Children who are not vaccinated with MMR (Mumps, Measles and Rubella) are 35 times more likely to get the diseases, which can be severe. Varicella (chicken pox) can lead to hospitalization and/or death. Polio vaccination is still important because polio is still present in developing countries. These diseases are rare because of the high degree of immunization. If people choose to stop vaccinating, the diseases will rebound as studies in other countries have shown. There is still no credible evidence of a correlation between autism and vaccination. This position is supported by the World Health Organization, the CDC, The AMA and the American Academy of Pediatrics. However, while vaccines are spectacularly successful in the macro sense, on a person by person,

basis, vaccines can pose mild to severe risks for side effects and/or permanent and debilitating damage. There is a fundamental belief that the government should not be able to force people to submit to unwanted medical interventions. As a result, some people, especially parents of vaccination-age children, are in favor of NOT TO VACCINATE and utilize the following arguments The U.S. vaccination rate is already way above herd immunity thresholds. Each person or family has the right to make their own free choice about invasive medical procedures. Recognizing the macro value of vaccination, each person or family need the liberty to evaluate their own situation, particularly with respect to vulnerabilities, and then choose the best course of action for the individual. Vaccines are actively promoted due to the profit motive of manufacturers. When lawsuits related to immunizations go to trial, pharmaceutical manufacturers can supply "purchased" experts to plead their case. The U.S. Vaccine Compensation Program has paid over 2000 awards (over $1.2 billion) for damages due to vaccines including a recent case where the court found that simultaneous immunizations caused autism symptoms. Children with auto immune diseases are at greater risk for serious side effects from vaccination and should be able to be exempted from participating. The Vaccine Adverse Event Reporting System (VAERS), a government-run program that collects data on adverse events related to vaccines receives over 1,000 reports per month, estimated to be approximately 10% of actual events. Hepatitis B immunization is not worthwhile - the disease does not even affect children (less than 1% of all reported victims are under the age of 15) yet it carries some risk of adverse effects up to and including death. For less dangerous diseases such as measles and chicken pox, natural immunity is preferable because it is 100% effective. Vaccines contain known toxins and carcinogens such as aluminum and thimerosal. Side effects of the MMR vaccination are similar to the disease and can be severe. Varicella side effects are similar to the disease; naturally acquired disease provides lifetime immunity, vaccination requires boosters. Polio vaccination is unnecessary because there hasn't been a case of wild polio in the Untied States in 20 years. These diseases are so rare that it's highly unlikely that anyone would contract them anymore. While the correlation between the increase in autism and the increase in vaccinations may not be causal, it may yet be proved to be causal. Consequently, vaccinations should not be mandatory. It's not surprising that there are strong feelings on both sides of this issue, fueled by an enormous amount of misinformation on the Internet. In the meantime, is there middle ground or any solutions to this controversy? The solution is more and better research on several fronts. People need answers to the question

of autism and vaccines. Equally important is research on new and better ways to engineer vaccines so that they can be more targeted and less likely to create adverse events in specific individuals. The middle ground is probably represented by the United States and Canada which enjoy an extremely high level of vaccination and low levels of preventable diseases but at the same time provides the opportunity for individuals in most cases to be exempted from the need for vaccination based on religious or medical grounds. This balance allows the majority of the population to be well protected while still giving individuals the right to exercise the freedom to choose.

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To Vaccinate Or Not to Vaccinate