Vaccines have unquestionably saved many lives and banished some epidemic diseases to the historical archives. Smallpox is believed to be extinct except in laboratory freezers, and the last case of ``wild'' polio in the Western Hemisphere was reported in Peru in 1991.

According to statistics compiled by the CDC, which compared maximum reported annual morbidity in the pre-vaccine era to recent years, cases of diphtheria have fallen from 206,939 in 1921 to 5 in 1997; measles from 894,134 in 1941 to 135 in 1997; mumps from 152,209 in 1968 to 612 in 1997; pertussis from 2,655,269 in 1934 to 5,519 in 1997; congenital rubella syndrome from more than 20,000 in 1964 to 4 in 1997; tetanus from 1,560 in 1948 to 43 in 1997; polio (wild) from 21,269 in 1952 to 0 in 1997 ( http://www.cdc.gov/nip/vacsafe.).

Vaccination is strongly favored by most Americans; a 98% vaccination rate for children entering kindergarten was achieved without a massive government-operated vaccine tracking registry. But opposition by parents is growing as more and more vaccines are required, when they perceive that the risk to their child from the vaccine is greater than the risk of the disease.

The approach to vaccines has changed dramatically. In 1960, A. Wayne Elsten, M.D., explained his views in a letter to his patients (Freeman, August 1960). When patients asked about polio shots, he usually said, ``Yes, I think it is a protection you should have.'' However, he weighed the risk/benefits in every situation. If he thought a particular patient's risk of contracting polio was 1 in 50,000 and would be reduced to 1 in 400,000 by the shot, yet that patient faced a 1 in 1,000 chance of an adverse reaction to the vaccine, he would advise against the shot. Dr. Elsten also considered whether it was polio season and advised some patients to wait to see whether a better vaccine would be released before the next season.

The key point is that one doctor advised one patient according to his own best judgment: ``Under no circumstances can the society practice medicine, nor can it dictate to its members what they shall do professionally.'' Only people, not organizations or corporations, can give advice.

In 1998, physicians consult official ``guidelines'' on immunization schedules, not their own judgment. If they are contracted to a managed-care organization, their charts will be reviewed for ``quality''-and quality means compliance.

Many states now have adopted computerized data bases and laws that require physicians to report all immunizations given to children under the age of 18. Parental consent for reporting is simply assumed, though in some states (including Arizona), parents may refuse to have information sent to the State. ``All Kids Count,'' a project of the Robert Wood Johnson Foundation, has campaigned aggressively for such mandated data bases.

One public health official explained the rationale for State immunization records thus: even responsible parents might lose the records, or they might be buried in an eruption of Mt. Pinatubo or the local volcano. As patients are now constantly shunted from one ``provider'' to another, records may not be readily obtainable from a physician.

The parents' memory is not to be relied upon. Documentation is needed to prove that the ``recommended'' schedule has been followed, or children can be denied food stamps, welfare, insurance, or admission to day care facilities or school. One Illinois mother whispered over the telephone that she was afraid even to have her name on a mailing list of the National Vaccine Information Center (NVIC) lest her partially vaccinated children be taken away from her by the State.

Unlike the hypothetical scares promulgated by environmental extremists, vaccine-related tragedies are real, though uncommon. For example, one 44-year-old mother, who had been immunized against polio in childhood, came down with paralytic polio when her infant received the oral live vaccine. She now uses a wheelchair. Since 1979, all 119 U.S. cases of polio were caused by oral vaccine.

Permanent brain damage occasionally follows pertussis vaccination (incidence estimated by the CDC: 0 - 10.5 cases per million doses). Still most parents would not choose to forego the vaccine because pertussis is quite prevalent and frequently fatal. They would, however, like to be able to choose the much safer acellular vaccine, used in Japan since 1981, at an additional cost of $9 per dose. Allegedly, American vaccine manufacturers decided not to bring the product to market because of lower profit margins (Money, Dec 1996). The CDC explained that a vaccine cannot be approved for use in an age group in which safety and efficacy have not been demonstrated, and that FDA-approved efficacy studies were hard to conduct because a successful vaccine was already in use.

The current push to achieve universal immunization of infants against hepatitis B-which is transmitted by sex or contact with infected blood-demonstrates the shift from patient-based to population-based medicine. Unless its mother is infected, a newborn is at a near-zero risk for hepatitis B. In 1996, only 279 cases of hepatitis B were reported in the U.S. in children under age 14. After that, risk is highly dependent upon behavior. Because high-risk persons are the least likely to seek or accept a vaccine, the public health establishment's solution is to capture everyone at a time when it is easiest and cheapest-even though the vaccine's duration of protection is not known. Public health officials emphasize activities such as piercing or contact sports to minimize parental objections such as ``my twelve year old doesn't have sex.'' Some proponents of universal immunization are infuriated by publicity about as-yet-unproved associations such as severe neurologic diseases (see p. 2), stating that the public health is endangered by those who are sounding alarms (Science 281:630-631, 1998).

Mandatory data bases are for the purpose of tracking compliance, not adverse reactions. There is a nationwide Vaccine Adverse Event Reporting System (VAERS), but it is estimated that only 10% of physicians obey the law and report adverse effects. If so, then about 100,000 such reactions occur annually (www.909shot.com/ihstat.htm ).

``Recommendations'' are developed by the Advisory Committee on Immunization Practices (ACIP). Members may have financial ties to vaccine manufacturers and sometimes meet behind closed doors. Many parents are alarmed that this powerful public-private partnership could pose a grave threat both to civil liberties and to the health of their children.

Although a correlation does not prove the existence of a cause-effect relationship, it can suggest fruitful research. Certainly, an increased incidence of disease calls for investigation. If one of the Usual Suspects is implicated by correlation, industries can be shut down, towns can be evacuated, and multi-million dollar lawsuits will probably be filed. In South Tucson, a slight excess in incidence of an autoimmune disorder (lupus), plus a minuscule excess of a naturally occurring substance (trichloroethylene) in well water in the 1980s, is still generating anxiety, legal fees, and salaries for federal bureaucrats.

But while ``pollution'' is decreasing, there is a steadily increasing exposure to materials deliberately designed to stimulate the immune system: vaccines.

And by the way, a number of serious chronic ailments are increasing in prevalence, including asthma and diabetes. Since 1958, there has reportedly been a sixfold increase in the number of Americans afflicted with diabetes.

As early as 1949, there were reports that children sometimes had trouble maintaining normal blood glucose after receiving pertussis vaccine. Laboratory tests have confirmed that pertussis vaccine can induce diabetes in mice.

In 1996, J. Bartholomew Classen, M.D., former N.I.H. researcher, reported a 60% increase in the incidence of Type I (insulin-dependent) diabetes following a massive campaign to inoculate babies 6 weeks of age or older with hepatitis B vaccine (New Zealand Med J 109(1022):195, 1996). Classen also reported an increase in Type I diabetes in Finland, with the amount of increase correlated with the number of new vaccines that were introduced, with a latency of 1 to 4 years (Inf Dis in Clin Pract 10/22/97).

A team of British scientists published a series of case reports in which 12 previously normal children (5 of whom had had previous vaccine reactions) developed severe intestinal disorders and autism after receiving measles-mumps-rubella (MMR) vaccine (Wakefield et al, Lancet 2/27/98). In the same issue, federal health officials Robert Chen and Frank DeStefano charged that ``vaccine safety concerns such as that reported by Wakefield and colleagues may snowball'' when the public and the media ``confuse association with causality and shun immunization.'' Neal Halsey, vaccine policymaker for the American Academy of Pediatrics and a leading proponent of mandatory measles vaccination, stated in a Reuter's newswire story that it was ``highly inappropriate'' for scientists to suggest a connection between vaccines and children's health problems.

The CDC states that ``to date, there is no reliable evidence that supports the belief that vaccines cause these chronic diseases [such as autism, diabetes, Crohn's disease, and cancer].''

However, none of the $1 billion annually appropriated to develop, purchase, and promote vaccines for mass use is devoted to funding independent researchers to investigate vaccine-associated problems. NVIC maintains that there is ``an inherent conflict of interest in allowing the same health officials in federal agencies responsible for ... promoting vaccines to also be in control of monitoring vaccine reactions.''

Faced with some decisions concerning his own daughter, a mathematician compiled a set of frequently asked questions, with links to many other web sites, including that of the CDC ( www.mindspring.com/~schlafly/vaccfaq.htm#recommend ). Testimony prepared by Texas parents concerned about possible misuse of data in the immunization tracking registries, unlawful actions by the Texas Department of Health, coercive ``outreach'' efforts, and federal financial rewards based on the number of children entered into the data base, is available at http://www.aapsonline.org/ .

Hepatitis B (HB) is a serious disease that is endemic in many underdeveloped nations and certain American subpopulations, such as Eskimos and recent Asian immigrants. However, American parents do not necessarily want to have their newborns enlisted in the comprehensive ACIP vaccination strategy, outlined in the MMWR of 11/2/91. Because of the small prospective benefit, a fully informed parent might consider even a slight risk of serious complication to be unacceptable.

There are anecdotal reports of sudden infant death syndrome; central demyelinating diseases such as transverse myelitis, optic neuritis, and multiple sclerosis; chronic autoimmune diseases such as arthritis; sudden hearing loss; thrombotic thrombocytopenic purpura; hair loss; and occlusion of the central retinal vein. The evidence was considered by the Vaccine Safety Committee of the Institute of Medicine to be inadequate to either accept or reject a causal relationship (JAMA 277:1124, 1997). Of course, it is nearly impossible to rule out causation of events that are exceedingly rare (as shown in studies of radiation exposure, for example).

Four years after the introduction of mandatory HB immunization of newborn children and adolescents in Italy, average morbidity rates for hepatitis B fell from 6.7 to 5.3 cases per 100,000. In the same period, during which 12 million doses of vaccine were administered, 408 reactions and 28 serious reactions, mostly neurologic, were reported (Lancet 350:114, 1997). Thus, to prevent six cases of illness, one person suffered serious neurologic effects (if these were truly vaccine reactions and not coincidental). According to a WHO report, the incidence of demyelinating diseases in association with HB vaccine in France was about the same as the spontaneous incidence. However, the report noted that the sensitivity of passive reporting of adverse events is low and that population-based studies were planned (Weekly Epidemiol Rec 5/23/97).

Biacabe et al: Auris Nasus Larynx 24:357-360, 1997.

Bracci & Zoppini: Br J Rheumatol 36:300-301, 1997.

Hong-Ki Song et al: J Korean Med Sci 12:249-251, 1997.

Kaplanski et al: J Neurol Neurosurg Psychiatry 58:758-9, 1995.

Pirohamed & Winstanley: Br Med J 73(861):462-3, 1997.

Saywell et al: Australasian J Dermatol 38:152-154, 1997.

Barbara Loe Fisher, President of NVIC, stated in March 26 testimony before the Illinois Board of Health that she believed American infants were being used for an experiment on HB vaccines without proper consent. Quoting ethicist Jay Katz on the Nuremberg Code, she said: ``[T]he advancement of science [must] bow to a higher principle: protection of individual inviolability.'' In her opinion, the Dept of Public Health also violated the First Amendment to the Constitution by denying religious exemptions to vaccinations to parents who did not belong to a church with a tenet opposing vaccination.