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The Vaccine War is a documentary (2010) produced by Jon Palfreman and Kate McMahon. The documentary displays medical minds versus those against vaccination. Vaccines are seen as one of the greatest achievements of modern medicine, but for regular Americans, vaccines have become controversial. Young parents are concerned at the sheer number of shots — roughly 26 shots to combat 14 diseases by 6 years old — and follow alternative vaccination schedules. Other parents go further. In communities like Ashland, Oregon, up to one-third of parents are choosing not to vaccinate their kids at all. This is the vaccine war: one side supports scientific medicine and the public health establishments that advocate for vaccines while the latter is a coalition of parents, celebrities, politicians, and activists that are anti-vaccinators.

Synopsis

The Vaccine War begins with a newborn baby girl, Rachel Murphy, immediately receiving her first shot against hepatitis B already being less than one hour old. This would be the first of 35 shots she will receive within the first six years of her life to battle 14 diseases. Vaccines are held as one of modern medicine's greatest achievements by public health doctor's as vaccines have raised life expectancy by about 30 years. Vaccination benefits are as seen clearly in the eyes of medical minds like Melinda Wharton who works for the Centers for Disease Control and Prevention. However, vaccination has been losing ground as parents across America have decided to either alter the vaccination schedule or not fully vaccinate their children. In December 2014, America experienced a major measles outbreak, a disease that had been eliminated 14 years ago at that time. The efforts to track down the individuals those the infected came in contact with is a tedious and expensive process. Similar to the 2014 measles outbreak, in 2008, there was a measles outbreak in San Diego where the disease entered from abroad. The origin of this outbreak comes from a 7 year old who returned home from a vacation in Switzerland. The 7 year old spread the disease to siblings and classmates, thus leading to a further spread of the disease. The choice of not immunizing individuals was determined to be what allowed measles to re-enter communities of non-immunized children.

The Personal Belief Exemption

In states like California, parents were able to find a loophole to not vaccinate their children through a personal belief exemption. Personal beliefs would bypass the "requirement" of vaccination to enlist a child in school, whether the belief be due to religion, customs, etc.

The Centers for Disease Control and Prevention has found communities where parents do not vaccinate their child or alter the vaccination schedule. A prime area the CDC found was Ashland,Oregon. Jennifer Margulis, a parent living in Ashland, is against vaccination. Margulis has a Ph.D. in English; with her platform, Margulis began to write about vaccines where she published an article in Mothering magazine, a magazine that promotes natural lifestyle. Margulis began to question why children are given so many vaccines, comparing times in the 1970s to current times. Margulis, like many other parents in Ashland, has decided to not fully vaccinate her child, as she sees getting sick as a natural occurrence. Ashland has an exemption rate of 25.4% as of March, 2016, which is much higher than the state average. As a result of low vaccination rates in Ashland, the community is at risk to contract serious diseases. In contrast to parents in Ashland who disagree with vaccination, there are parents, like Lorie Anderson, who enforce vaccination. Anderson expresses that avoiding immunization is "an outbreak waiting to happen."

Emilio Emini, the head of Pfizer inc.'s vaccine operation supports the standpoint of vaccination, as he believes that those who choose not to vaccinate have become too smug and have put their children and themselves in danger of disease. Again, the viewpoint on vaccination differs greatly depending on each person. Dr. Paul Offit, a pediatrician and co-creator of the vaccine for rotavirus, states that vaccination has become more so a matter of faith, but as time goes on, faith within parents is diminishing. Arthur Caplan, a professor of bioethics at New York University Langone Medical Center adds that the diminishing faith may be due to the invisibility of the diseases being vaccinated. The risk of not vaccinating is not thought of because parents are not seeing children being devastatingly affected by mumps or polio for example. The diseases that are preventable via vaccine have become quite rare within America.

the child displayed has whooping cough

The documentary then proceeds to a video of an infant with pertussis, also known as whooping cough, which is a vaccine preventable disease; the video of the child with pertussis is being shown to an audience of paramedic students. Pertussis is a highly contagious respiratory tract infection that is induces a severe cough that sounds like a "whoop"(see pertussis for more). Dr.Cynthia Cristofani, the professor instructing the paramedic audience, then begins going into depth about life-threatening diseases, those specifically that are preventable by vaccines such as chicken pox, rotavirus, and haemophilus influenza type B meningitis; Cristofani mentions that eradicated diseases may come back if people stop vaccinating.

However, Jennifer Margulis still questions why children have to receive so many vaccines, as diseases like polio have been eradicated from America. Margulis begins to inquire as to why polio has not been taken off the vaccine schedule since the polio epidemic is nonexistent. Health officials have struggled to convince parents that the benefits of vaccines greatly outweighs their risks. The risks of vaccination may be swelling, slight pain, fever, etc. However, there is always chance of a much more serious risk outcome, although that chance is infinitesimally small.

Barbara Loe Fisher, the president and founder of the National Vaccine Information Center, explains that her son experienced physical, mental, and emotional regression after receiving his fourth DPT shot, rendering him a completely different child. Fisher also states that he was later diagnosed with ADD and multiple learning disabilities. Soon after the occurrence of Fisher's son's vaccine side effect, DPT vaccine was replaced with a much safer vaccine, the DTaP. The documentary then cuts to a vaccination protest rally where one of the protesters are Jenny McCarthy; McCarthy uses her celebrity platform to promote anti-vaccination. McCarthy claims her son, Evan, who received a series of vaccines, including the MMR vaccine, developed seizures and autism a couple of weeks later. Devastated by the event, McCarthy came upon Generation Rescue, a nonprofit organization that supports the idea of vaccines causing autism and regression. The founder, J.B. Handley, has a similar story to Jenny McCarthy; Handley's son was diagnosed with autism after a series of shots he received. Handley claims that his son was a different person after receiving his shots. Handley goes on to claim that "tens of thousands of parents" reported their children being different after receiving vaccines. He then claims that the federal government pays money to children who had a negative side effect from vaccines to keep quiet; Handley states that "it does not take a rocket scientist to draw a possible correlation between the vaccines being given and the brain injury that our children are suffering, because autism is brain injury." With Handley and McCarthy having similar viewpoints, the two teamed up to organize a movement of concerned parents.

The Original Impetus for Vaccines Causing Autism

Andrew Wakefield, a British ex-gastroenterologist, wrote an article in the journal The Lancet where he wrote of 12 children with gastrointestinal issues, and 8 of those children developed symptoms of autism after receiving the MMR vaccine. Wakefield's article spread fear across the world, as he put out reason to believe that the MMR vaccine may cause autism which fueled the fire of anti-vaccination.

Due to the publication of Wakefield's article claiming that there is a link between the MMR vaccine and autism, the MMR vaccine rate began to decline. However, the events of receiving the MMR vaccine then developing symptoms of autism may be coincidence, as vaccines are given at the same age where autism symptoms begin to emerge. Vaccine critics then began to not only question the amount of vaccines given, but also the ingredients within vaccines, primarily mercury components of vaccines, specifically thimerosal. Robert F. Kennedy Jr., an environmental lawyer with great influential platform power began to question the usage of mercury components, as it will cause neurological damage to children. Dr. Eric Fombonne stated that the claim of mercury being a toxicant did not have enough evidence to conclude that vaccines led to autism. The infinitesimally small chance of mercury components having to do anything with neurological damage frightened public health agencies and thus led to calling for the deletion of mercury components, like thimerosal in vaccines.

Scientists around the world began studying the possible link between vaccines and autism. Anders Hviid, a senior investigator in the department of Epidemiology Research at Statens Serum Institut, and his colleagues at Statens Serum Institut "conducted a retrospective cohort study of all children born in Denmark from January 1991 through December 1998."Within the study, two groups were observed, those with the MMR vaccine and those without. The autism cases for each group was counted and the autism rate was calculated. The experiment concluded that "the relative risk of autistic disorder in the group of vaccinated children, as compared with the unvaccinated group, was 0.92, and the relative risk of another autistic-spectrum disorder was 0.83." From this study, it was concluded that there was no association with vaccines and autism development. Similar studies were done in Sweden, Britain, Finland, and America, but the result was the same: no association between vaccines and autism. Hviid also decided to test the effect of thimerosal in vaccines, to gather further information on a link between vaccines and autism. Hviid stated that in Denmark, the only vaccine that had thimerosal in it was the pertussis vaccine; thimerosal was discontinued from the pertussis vaccine in Denmark in May or June of 1992. Hviid compared the autism rates between all children born in Denmark from January 1, 1990, until December 31, 1996, slightly before thimerosal was taken out of vaccines and a bit after it was taken out. Hviid found that the rates of autism in children who received the pertussis vaccine including thimerosal had no significant difference in autism rates when compared with children who received a thimerosal free pertussis vaccine.There were also several other studies done that conclude there are no links to autism in vaccines.

The Andrew Wakefield Controversy

On February 2, 2010, The Lancet withdrew Andrew Wakefield's 1998 article, as they stated it was scientifically flawed, and the findings could not be replicated; the article more so contained an opinion rather than fact. A few months later, Wakefield was stripped of his medical license.

Generation Rescue's Support of Wakefield

As a result of Wakefield's license being stripped away for his scientifically inaccurate article, Generation Rescue continued to believe and support Wakefield's science.

After Generation Rescues intense support towards Wakefield, parents of autistic children began to file lawsuits based on theories about the MMR vaccine and thimerosal having a link to their child's autism. The lawsuit was quickly shut down, as the court ruled there is no scientific or legal merit. J.B. Handley, however, continues to disregard science, as he claims his child regressed due to vaccines.

Ethical Testing Issues

In order to further test vaccines and their effects, a study must be done on a set of individuals who have received vaccines and those who have not. The issue with a study of similar format is ethics. Vaccines have been proven to prevent diseases. To not give a study group vaccines would put them in danger, thus posing an ethical issue in the study.

The hypotheses of vaccines causing regression continued to shift, as the MMR vaccine had no link to autism and vaccines including thimerosal versus vaccines excluding thimerosal had no difference in autism rates; vaccination critics began to blame vaccines in general. The CDC then got involved in a study called SEED (Study to Explore Early Development), where the possibilities of what might put children at risk for autism disorders or other disabilities are analyzed. The CDC's participation in this study does not put an end to the vaccine war, on the contrary, it raised skepticism.

Dr. Paul Offit visited a high school where he asked an audience of about 200 how many of them received the influenza vaccine. Only about half raised their hands. Those who voted no to receiving the vaccine based their belief on a YouTube video about Desiree Jennings, a redskins cheerleader that claimed she lost the ability to walk after receiving a vaccine. Jennings's disability consisted of being only able to walk backwards; Jennings's ability to walked forward was hindered by spasms. Dr.Offit stated that "the students who refused the vaccine were more likely to believe a YouTube video rather than what the CDC and doctors have to say."

The documentary then proceeds to Dr. Jim Shames, Ashland's public health officer, meeting with a couple of parents against vaccination to speak about public health. Dr.Shames meets with Gretchen, a mother of a 2 and a half year old, and Augustine, a midwife. Dr. Shames questions whether Augustine and Gretchen feel like they are putting others at risk with the decision to decline vaccination to which they reply no, as mothers are looking for the best option for their child rather than the public. Dr. Shames indicates that not all children may have the immune capacity to receive a vaccine, but Augustine feels that it is the responsibility of the parent to quarantine the unvaccinated child should they contract a transmittable disease.

Herd Immunity

Herd immunity is "the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination." In lament terms, herd immunity is immunity towards diseases that the general population is protected against, thus making the likelihood of vaccinated diseases unlikely. When a significant amount of people remain unvaccinated, there is a drop in herd immunity, thus leading to viruses being able to spread; the drop in herd immunity renders children who are not vaccinated and children who are unable to be vaccinated to be at risk. Vanessa, a 40 day old child who was just a week away from receiving the pertussis vaccine, was diagnosed with pertussis; children like Vanessa depend on herd immunity to protect them from diseases they cannot yet defend against.

Reed Elementary School and Rhett Krawitt

Reed Elementary School is a school in Marin County where the ability to exempt a child from vaccination is quite simple. Rhett Krawitt, a 7-year-old student enrolled in Reed Elementary, has lived with leukemia for most of his young life. The treatments Rhett has received have helped him recover, but they typically wipe put his immune system. Rhett is a child who depends on herd immunity to stay healthy and alive. The rate of exemption for vaccines at Rhett's school being so low put children like Rhett at risk. A school board meeting was then held to address the personal belief exemption where Rhett Krawitt featured as a speaker. Rhett displayed his opinions about vaccinations and why it should be a requirement.

The Vaccine War

The Vaccine War is the debate about freedom and parental choice versus safety of children and the public, a battle between doing good in public health and doing good in children. Both sides of The Vaccine War can agree that there is a lot at stake; one side fears the exposure to disease, while the other wants to do what is best for their child.

What are the Benefits of Vaccines? How do They Work?

Vaccines are classified as "a preparation of killed microorganisms, living attenuated organisms, or living fully virulent organisms that is administered to produce or artificially increase immunity to a particular disease." Vaccines are designed with a set of antigens, the same antigens, or parts of antigens, that cause disease. The antigens injected through the vaccine is just the right amount where they are killed or so weak that they do not cause disease. The antigens within the vaccine are weak enough to not cause disease, but at the same time they are strong to make the immune system produce antibodies to provide protection from the injected antigens. Some benefits of vaccines are listed below (For more, see vaccine).

• Vaccines ensure child health and prevent disease.
• Diseases such as mumps, measles, and pertussis are still a threat , however, vaccines prevent these diseases from being contracted and spread.
• Vaccines have led to a dramatic decrease in infectious diseases that are common in other countries and brought to the U.S. by foreigners. Vaccination reduces the risk of disease spreading.
• Vaccination is safe and effective, as vaccines are reviewed by the federal government, doctors, and scientists.
• Vaccinations serve as a protection for children unable to get immunized, as they depend on those around them to be safe from contracting disease.

Impact of Vaccination/Anti-Vaccination on Communities

Vaccination serves as a protection to individuals from diseases such as mumps, measles, rubella, influenza, etc., thus serving as a safeguard to communities to prevent disease transmittance. In summary, vaccination affects communities in a beneficial way, as people remain safe from preventable disease, those who cannot be immunized are protected via herd immunity, outbreaks are less likely, and the elimination of disease is more plausible.

Anti-vaccination on the other hand may serve as a threat to communities. The choice to not vaccinate a child poses as a threat to achieved herd immunity. Also, due to communities being connected, there may be a higher transmission rate of pathogens, which may lead to outbreak of a disease. The outbreak of disease would lead to several unvaccinated people becoming sick, eliminated diseases coming back into the U.S., potential death of those infected, and high risk towards those unable to be vaccinated.