Today, U.S. vaccine policy is set by a 12-member Advisory Committee on Immunization Practices (ACIP) appointed by the secretary of health and human services. Once ACIP recommends universal vaccination for a disease, state officials routinely add it to the list of mandatory immunizations. Many states don't even allow for public debate on the risks and benefits of new vaccines. Some bypass the legislative process altogether, giving public health officials the authority to enforce ACIP's recommendations. Thus, 12 people have the power to determine which vaccines will be forced on millions of American children.
The lack of debate is especially troubling when you consider that more than 200 new vaccines are in the research pipeline, including vaccines for HIV, herpes, chlamydia--even cocaine addiction. In 1996 Peter Cohen, a researcher at the National Institute on Drug Abuse, presented a paper explaining that cocaine addiction could be viewed as an infectious disease. "A cocaine vaccine, currently under investigation by several laboratories, would be an innovative and exciting means of treating and preventing cocaine addiction," he wrote. "I propose to analogize cocaine addiction to an infectious disease which poses a major public health problem. This approach can provide an ethical and legal foundation on which we may begin to formulate a societal approach to the use of the cocaine vaccine." Given the emerging policy regarding hepatitis B, it is not hard to imagine public health officials arguing that all children should be vaccinated against cocaine addiction to protect the small minority who might one day have a problem with the drug.
People who rebel against this trend are increasingly looking for a way out. In all 50 states, children and adults with suppressed immune systems or other documented contraindications can obtain a medical exemption that allows them to enter day care, public school, or college without the usual vaccinations. All but two states (Mississippi and West Virginia) have a religious exemption, and 17 states have a philosophical exemption. The demand for "conscientious belief" exemptions is growing, with bills being considered in Texas, Illinois, and other states. But even when such exemptions are available, parents are rarely told that they can turn down vaccinations for their children without repercussions.
Some public health officials argue that parents who refuse to vaccinate their children should be held legally accountable for child neglect. The justification for mandatory vaccination, which used to be protecting the general public from disease carriers, has thus shifted to protecting children from parents who fail to take precautions recommended by the government's experts. But when it comes to guarding against diseases that children almost certainly will not get, parents should be allowed to weigh the risks and benefits.
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