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The unvaccinated
By Shahar Smooha
Tags: Vaccines

Even a novice physician could diagnose what was afflicting the 7-month-old baby who was brought to Laniado Hospital in Netanya last month. The infant's body temperature was soaring and he seemed unresponsive to his surroundings, but the clearest sign of the problem was the bulging fontanel (the soft spot in a baby's cranium), a common symptom when excess pressure builds up in an infant's soft skull. "The emergency room doctor immediately saw how much the fontanel was bulging," says Dr. Yaakov Shechter, director of the hospital's pediatric department. "I've been a doctor for 20 years and this was one of the worst cases of meningitis we had ever seen."

The staff, led by Shechter and the hospital's infectious disease expert, Dr. Uri Rubinstein, worked hard to save the baby's life. But it took three weeks - during which the infant was transferred to another hospital - before his condition stabilized and he was finally discharged. It is not yet known whether the severe infection caused any permanent damage to his brain or nervous system.

In any other case where a baby's life was saved, the doctors might just congratulate themselves and the medical team and move on. But the case of this baby, whose parents had not immunized him against the disease, left them with other feelings. Not only because they know it is just a matter of time before another baby with the same sort of infection will show up at the hospital, and not just because of the frustration of knowing that the vaccination the Health Ministry provides for free to every baby would have prevented this particular case of infection. The doctors' gloom stems from their awareness that a steadily growing number of parents are refusing to have their children vaccinated for ideological reasons.
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"You probably think that the people who aren't willing to have their kids vaccinated are primitive folks, but it's not like that at all," says Shechter back in his colorfully decorated office in the pediatric ward. "While there are small groups within the ultra-Orthodox population who refuse to vaccinate their children because some rebbe told them it's forbidden, lately we've been seeing a lot more people I can describe - even though it's a group that transcends different sectors - as readers of the newspaper you write for."

Devora Efrimov, the national director of the well-baby clinics for the Meuhedet HMO, is well acquainted with the trend. "At a clinic that sees 200 babies, there will be about 10 whose parents refuse to give them vaccinations," she says. "In the past, there weren't any parents like that, but since people have had the Internet, I see more and more parents spending a lot of time online and reading about the side effects that some of the vaccinations have. You have to realize - the ones who refuse to vaccinate are very highly educated parents. They have this philosophy of natural immunization, so they refuse. It's very frustrating, but they have the right to choose."

Although the charts provided by the Health Ministry paint a picture of an immunized public with only a minuscule rate of unvaccinated people, doctors and senior health system officials claim that the situation is already quite dangerous. Dr. Emilia Anis, director of the Health Ministry's Department of Infectious Diseases, says that the ministry does not have accurate data about the scope of the phenomenon because there is no mandatory immunization in Israel. Nevertheless, "the feeling is that more parents are seeking an individual immunization program and doing only some of the vaccinations, on a different schedule than what is recommended."

Conversations with doctors, nurses, parents, homeopaths and anti-vaccination activists all indicate that the number of those refusing to vaccinate and of the unvaccinated has risen dramatically in recent years. And the data supporting this assessment is worrying. According to the Health Ministry, in recent years there have been outbreaks of diseases for which vaccinations exist. In addition to reports of a nationwide increase in cases of whooping cough, in 2003 and 2004 outbreaks of measles were reported among the ultra-Orthodox population in the Jerusalem district. In 2005 there were outbreaks of mumps in East Jerusalem, Hadera and Holon; and about two months ago an unvaccinated ultra-Orthodox community in the Jerusalem area suffered an outbreak of measles that affected more than 250 people. Apparently the source of the biggest outbreak of the disease in Israel in decades was a young, unvaccinated yeshiva student who came here on a visit from England.

The cost in human lives is also escalating. In 2002, a 6-week-old baby died from whooping cough; in 2004, a 7-year-old boy died from measles; in 2006, two 6-week-old babies died of whooping cough; and this year alone, the disease claimed the lives of five infants, ranging in age from 3 weeks to 7 months. Not one of them had been vaccinated.

The medical establishment is growing increasingly uneasy about the situation. In the last few years, a concerted effort has been made to stem the tide of parents who are convinced that the potential harm of vaccines outweighs their benefits. "It's not a major trend, but it's definitely on the rise," says Dr. Rubinstein. "My impression is that every week we get three or four parents who don't vaccinate against Hepatitis B, the only vaccine we give in the hospital. It sounds like a small number, but it's not. The unofficial estimate is that about 5 percent of all children in Israel are not vaccinated. It's scary, because the numbers are always growing and when we talk with colleagues at conferences we see that the trend is continuing."

Who's the fanatic?

Every parent who chooses not to immunize his child has his or her own reasons. But it seems there is a direct connection between this trend and the growing feeling that the Western world is grievously harming itself with all kinds of toxins; so there is a desire to return to nature and the simple life. Both sides in the debate agree that the trend is also an expression of the process of individualization that is taking place in Israeli society, and reflects the lack of public trust in the authorities - in this case, the medical establishment.

Dr. Shechter's words take on a more urgent tone as he tries to illustrate just how serious he feels the situation is: "As a pediatrician living in this generation, I've been privileged to deal with children who were vaccinated. To us, infectious diseases are history. But it wasn't so long ago, just 50 or 60 years ago, that smallpox was still around," he says, pulling a thick medical encyclopedia off the shelf and quickly leafing through it to find that entry. "It no longer exists in the world because of vaccination. Children are no longer vaccinated against it because it was eradicated by means of vaccination," he adds with emphasis. "Just look at the pictures. A picture is worth more than a thousand words."

He points to a horrifying black-and-white photograph of a patient with a face covered with oozing sores. He calls parents who refuse to vaccinate their children "pseudo-intellectuals. These are the most dangerous people. You can't reason with them because they're convinced of their rightness and aren't cognizant of the whole historical process, and just say flat out: 'Our child is not going to be vaccinated.'

"I have no problem dealing with patients who read up on the Internet and are intelligent but are willing to listen," continues Dr. Shechter. "But when someone comes to me with a fixed prejudice and searches the Internet from the outset only for what serves his line of thinking, then there's nothing I can do with him. It's fanaticism! It's Khomeini-ism! You can try explaining to them until you're blue in the face and they won't hear what you're saying."

Fanaticism and Khomeini-ism are precisely the epithets that Amir and Milena Shalom of Tel Aviv would apply to Shechter and his colleagues. "Would you buy a car from a Palestinian car salesman? That's what I think of the medical establishment and of vaccinations," declares Shalom, a 39-year-old book distributor, right at the start of the conversation. "The ignorance is so deeply rooted because the medical establishment doesn't give the public a chance to delve into the subject."

His daughter, Naomi, a lovely, energetic 17-month-old toddler playing in the living room, is living and breathing proof to her parents of the quality of life of a child whose body has not received vaccinations. In addition to their total distrust of the medical establishment, the Shaloms are certain that vaccinations are a harmful conspiracy concocted by parties with vast financial interests in the drug industry and the medical establishment. As devout vegetarians, both are highly apprehensive about the possible side effects of the vaccinations.

They made up their minds three years ago that their child would not be vaccinated, long before Naomi was born. "After I was exposed to the subject in a series of seminars on alternative medicine, in which one of the participants was the Hasson Organization that opposes the official vaccination policy, I dug a lot deeper into the issue and became 100 percent certain that if I had a child, he would not be immunized, because of all the information that is concealed by the medical establishment," says Shalom. "How many parents who trust doctors with their eyes closed know, for instance, that until a few years ago, mercury was used as a preservative in vaccines?"

Just as people once thought the earth was flat, until they were finally proved wrong, Shalom is confident that the day will come when "the whole business of vaccinations will be refuted and revealed as one of the greatest hoaxes in the history of the world."

Aren't you exaggerating a bit?

"Medicine is going in an undesirable direction. They think that the body can't take care of itself and say they'll see to it that the body heals. The medical establishment has a lack of trust in this brilliant machine. Every child's body is supposed to go through standard childhood disease. It's like a Passover cleaning for the body."

Asked how he would explain the rising incidence of sickness and death among unvaccinated children in recent years, Shalom quickly pages through the book "Hisunim Hasifa" ("Vaccines - An Expose") published by the Hasson Organization. The cover of the book, which has sold more than 2,000 copies, features an illustration of an infant and a hand holding a large syringe approaching him. "A professional inquiry into the parents' lifestyle would turn up a lot of things," he replies. "Maybe they used synthetic, toxic and carcinogenic products and the doctor didn't know about it? Maybe there was exposure to cellular radiation? The doctor certainly didn't check whether the mother is a heavy smoker or maybe ate fruits and vegetables that were sprayed with pesticides. There could be dozens of reason for an outbreak of disease."

You don't accept the success of vaccinations in preventing diseases among children as a proven fact?

"Maybe instead of the doctors asking questions, we ought to ask them questions about all the cases of death among the population that was vaccinated and about all the side effects? I want them to give answers to all the graphs and studies that show that vaccinations caused irreversible damage to the population. People don't know that vaccinations are manufactured using cell cultures of rotten monkey kidneys that are brought from Africa and that afterward their genetic load enters the human body via the vaccination. Any reasonable person would find that unnatural and irrational."

The couple attributes the last century's marked rise in life expectancy and decline in infant mortality solely to improvements in hygiene. "There's no reason that diseases like polio, meningitis or viral hepatitis should erupt among children in the Western world if their living conditions are decent and they have proper nutrition," says Shalom.

Not ready to risk it

The Hasson Organization, which is spearheading the fight against vaccinations in Israel, operates a very comprehensive Web site. The organization was founded in 1999 by pharmacologist Keith Alexander (a new immigrant to Israel who has since returned to England). Despite its declaration of neutrality, the Web site (www.hisunim.com) offers a tremendous amount of material: articles, statistical charts, diagrams and personal testimonies all representing just one side of the debate. It documents the supposed dangers entailed in receiving vaccinations, exposes the financial interests of the drug companies and the medical establishment, highlights a possible connection between the measles vaccine and autism, and ostensibly refutes the axiom that widespread vaccination has contributed decisively to eliminating disease, improving public health and extending life expectancy. In addition to its book, the organization sponsors lectures, and its representatives have appeared in Knesset debates.

Hasson spokeswoman Lisa Trudler says there has been growing interest in the subject in recent years. "In the early years, we'd maybe get one phone call a week, but lately not a day goes by without my getting at least one phone call from people who want more information about the vaccines and the damage they can cause. Yesterday, for example, I got five such calls."

She herself used to think that people who didn't vaccinate were fanatics. She changed her mind after her eldest son, now 16, received the "triple vaccine" (also known as DPT - for diphtheria, pertussis and tetanus). She waited with her baby son at the clinic, as instructed, for 20 minutes after he was given the vaccine. But as soon as they got home, the baby burst into a terrible wailing that went on for six hours straight. "From that moment, I began seriously investigating the subject. I read books and newspaper articles about it and only later did I read about it on the Internet."

Her second son received the measles vaccine after her was 2 (the Health Ministry recommends that it be given at the age of one year). She decided to forgo the rest of the standard series of vaccinations against hepatitis (A and B), polio, diphtheria, pertussis (whooping cough), meningitis, measles, mumps and rubella. Her youngest child, a 6-year-old girl, was not vaccinated at all.

Trudler is not worried that her unvaccinated children will contract serious illnesses. "I really believe that the vaccines are harmful. If I were convinced they were beneficial, perhaps I'd be ready to risk it. These vaccines contain mercury and formalin, and even though I understand why these things are put in a vaccine, I don't understand why they should be put into the body."

All in the same boat

Prof. Yona Amitai, head of the Health Ministry's Department of Mother, Child and Adolescent Health, is familiar with the anti-vaccination arguments. Back in 2004, he was so troubled by the growing trend that he created a Power Point presentation rebutting the arguments of vaccination opponents one by one.

"They claim, for example, that it's better to let the child have the illness because that way he ends up stronger and develops immunity and natural antibodies. This is dangerous and incorrect advice," he says. "The vaccines that are given treat just 10 to 12 infectious diseases. There are dozens, if not hundreds, more disease-causing factors for which there is no vaccine, so children have plenty of opportunities to get other illnesses. The illnesses for which there is a vaccine were selected because of how dangerous they are. The Spartan attitude of "what doesn't kill me makes me stronger" isn't fair and could be quite dangerous. How brave can a person be at their baby's expense?"

He completely dismisses the argument about "rotten monkey kidneys brought from Africa." "Has any one of these people ever been on an actual production line? The use of adjectives like 'rotten' is part of the slander campaign. I don't know what the source of this claim is, but it's totally absurd. The vaccines are manufactured by the world's leading drug companies under the highest quality-control standards. Billions of doses are given every year. Their safety profile is extremely high." Amitai, an expert on toxicology, confirms that some vaccines do contain small concentrations of mercury, but he emphasizes that these amounts are even smaller than the amounts of mercury found in fish approved for consumption, and are not at all damaging.

Amitai is especially keen to address the popular claim that arose from a controversial study published in the prestigious British medical journal The Lancet in 1998, which indicated a connection between the MMR (mumps, measles, rubella) vaccine and a significant increase in the rate of autism. "It's very loaded and emotional to say 'a vaccine causes autism.' It's not scientific, it's not true and it's misleading the public. The data that was collected later in larger studies in England and Denmark showed that while there was no change in the vaccination routine during the period in question, there was an increase in the number of autistic children. Which essentially refutes the connection between vaccines and autism."

Amitai is right: Studies in Britain, Denmark and Canada ruled out any connection between the MMR vaccine and an increase in the rate of autism. In addition, 10 out of the 13 researchers listed as authors of the article in The Lancet subsequently disavowed the article's conclusions, and the journal's editor issued an apology for its publication.

Amitai also dismisses the assertion that the medical establishment is seeking sole credit for the decline in infectious diseases, ascribing it to vaccines and not to improvements in hygiene and sanitation. "There is unassailable evidence to refute this argument. Take for example the vaccine against meningitis of the haemophilis influenza type B (Hib), which was introduced into partial use in Israel in 1992 and into full use in 1994. Before then, this disease caused about 100 cases a year of severe infection, including meningitis and several cases of death and permanent disability. Right after the vaccine was introduced, the number of patients went down to fewer than five a year. During this time there was no change in the state of hygiene in the country. Another example is the hepatitis A vaccine. It was introduced in 1999, and since then the incidence of this virus has decreased by about 90 percent, within just a few years.

"The feeling of 'it won't happen to me' is very common among generally healthy populations, but as the circles of the unvaccinated expand, the risk of falling ill increases," he warns. "In a society where 95 percent of parents vaccinate, the small minority that doesn't vaccinate also has relative protection, just because they're surrounded by vaccinated children. This is known as 'herd immunization.' However, when there is a significant decrease in the rate of vaccinated children, the risk goes up. In the State of North Rhine-Westphalia in Germany, where only 75 percent of the children were vaccinated against measles, there was an outbreak in 2005, with more than 1,000 cases in a short time."

Dr. Rubinstein echoes Prof. Amitai's sentiments. In his view, even failing to adhere to the recommended vaccination schedule is dangerous. "These parents who don't vaccinate are not only egoists toward their own children but toward their environment. In the case of whooping cough, for example, if a child who hasn't yet received all three doses of the vaccine against the disease is exposed to an unvaccinated child, the 'vaccinated' child could still contract the illness this way."

Dr. Yechiel Schlesinger, director of the Infectious Diseases Unit in the Pediatrics Department at Shaare Zedek Hospital in Jerusalem, treated some of the measles patients affected by the recent outbreak in the ultra-Orthodox community. "I'm familiar with this attitude. They [secular parents who don't vaccinate their children - S. S.] say, 'Let the masses vaccinate,' but they don't understand that they're behaving like a passenger on a ship who drills a hole in the wall of his private cabin. His action endangers everyone on the ship. Secular people should take the recent measles outbreak in Jerusalem as a model of what happens when a pocket of the population is not immunized. In such a situation, the disease spreads like wildfire and eventually seeps into other populations."

A policy of denial

The medical establishment is generally united in its support for vaccinations, although there are a few exceptions. Most vocal among them is Dr. Haim Rosenthal, a physician who came out of the establishment and later founded the Israeli School of Homeopathy. He is now the director of the Medirose homeopathic clinic. Rosenthal, author of the book "Vaccines - Everything You Wanted to Know and They Didn't Dare Tell You" (in Hebrew), lectures on the dangers of vaccinations and encourages parents who come to him to consider alternatives. "There are people who claim that vaccinations are completely ineffective and completely unnecessary. I say that even though vaccinations are effective and have helped to eradicate diseases, they can also cause serious damage, which the establishment denies," he explains.

For example, he is convinced that there is a close connection between vaccines and the rise in the number of autistic children and those with attention deficit disorders. "As you know, the percentage of normal children is going down, because from a young age, when the immune system isn't ready, they inject them with these substances whose effects are really unknown. We know that there have been cases of substances that were included in vaccines and later removed, but until that happened, millions of children received these vaccines and we don't know what harm it did them. The ease with which this is given to everyone reeks of negligence."

Are there studies that back up your suspicion?

"I'm sure that within 10 years a study will come out that proves the connection between vaccines and damage. If only 1 percent of newborns in Israel are harmed, that's about 14,000 children a year, and if it's one tenth of 1 percent, that's still 1,400 children a year. Those are big numbers. But there's a policy of denial in the medical establishment and they also really believe what they say. I come across a lot of healthy children who come to me sick two days after a vaccination, and the doctors always tell them that there's no connection between the two. Granted, on the scientific-research level, there is difficulty in proving that harmful symptoms two days after a vaccination are a direct result of the vaccination, but I remind you of the incident of the Navy divers in the Kishon River. There, too, they said there was no way to prove that these people - the healthiest in the country - were harmed as a result of the dives they performed."

In any event, the Health Ministry does not claim that vaccination is a perfect solution for everyone.

"Vaccinations contain foreign proteins, stabilizers and toxins. This stimulates something, but it's different for everyone. Sometimes it's meningitis, sometimes it's an allergy, depending on the person's particular weakness. It's not intelligent to think that a vaccine is not liable to cause damage. I'm saying that we need to check who comprises the 10 percent of the population that is sensitive. Damage from vaccines could be dramatically reduced if we recognized their harmful potential. I'm not saying that vaccinations should not be given, but it should be done more cautiously."

Does this mean that you are also opposed to the approach of the Hasson Organization?

"Their approach is too extreme. If we all stopped getting vaccinated it would be a problem. Diseases would immediately erupt because the population is addicted to vaccines. It's like getting weaned from drugs."

The state does recognize that vaccines can cause damage on rare occasions. In 1987, after Jawhar al-Turi, a 4-month-old baby girl, became ill following the DPT vaccine and suffered brain damage, her family sued the Health Ministry, accusing it of negligence. During the legal proceedings, no causal connection was proven between the administration of the vaccine and the appearance of the illness, and the Supreme Court, which heard the case, ruled that the administration of the vaccine did not constitute negligent conduct, since the dangers to public health from not giving the vaccine far outweigh the tiny risk inherent in vaccination.

In its ruling, the Supreme Court said that a doctor's duty to inform a patient about the risks entailed in receiving a particular medicine does not apply in the case of vaccination: Here it is a not a personal decision that's involved, but the mass vaccination of all healthy children. In such a case, said the court, the parents are not fit, and not required, to make a private decision about whether it is appropriate to vaccinate their children. The risk is so remote that the benefits and need for the vaccine for the child's health is not in doubt.

Following this case, legislation was enacted in 1989 setting maximum compensation at $100,000 for harm resulting from a vaccination. So far, the number of plaintiffs who have resorted to this law has been quite small.

Let's consider each

vaccine separately

Dr. Yitzhak Kadman, director of the National Council for the Child, says that the question of what approach to take toward parents who do not vaccinate their children is "a problem we've been deliberating for some time." He would leave the possibility of legal action for the most extreme situations, such as when a community is aware that children are being harmed and still refuses to vaccinate them. "Penal law states that a parent is obligated to look after his child's health, and I think that covers cases like this," says Kadman.

In most countries in the world, he says, including Israel, "vaccination is not mandated by law, because there is a limit to how much the state can intrude in family life." MK Nadia Hilou (Labor), chair of the Knesset Committee for the Rights of the Child, supports the legislation of mandatory vaccination, similar to the law of mandatory education. "Children's health is not open to negotiation, but there seem to be loopholes," she says. "On the one hand, there's a verbal commitment to look after the child's health, and on the other there's an option to make decisions. If it's mandatory, then the central government has the duty to uphold the law and to be responsible for oversight and enforcement."

MK Aryeh Eldad (National Union-National Religious Party), a professor of plastic surgery, recommends a public relations campaign that would present parents who refuse to vaccinate as "completely irresponsible parents who will forever have on their conscience any defect or death caused to their child if he contracts one of the diseases that can be so easily avoided by means of vaccination."

Liat Bundheimer, 30, a resident of the Susiya settlement in Mount Hebron, is one of the parents against whom such a campaign would be directed. Bundheimer decided not to inoculate her son, now 11 months old. "I come from a family in which everyone is vaccinated," she says. "You know, as secular people, we do whatever they tell us to do, but when we became religious we spoke with my husband's mother, who's an organic vegan, and I was exposed to a different way of thinking. It all began when my husband's older sister investigated the subject of vaccines after her daughter became ill with leukemia. She saw that there are things that medicine doesn't really tell you about vaccines. They contain mercury and other things that are very dangerous. Mercury is toxic and doesn't leave the body. When she asked why these things were put in the vaccines, she was told that it's what preserves them and that there was no way to avoid that, because the vaccines are not manufactured in Israel.

"The whole thing started to become a flashing red light and when I was pregnant, we looked at Web sites, including the Hasson Organization site. My husband is also related to the director of the pediatric department at Hadassah Ein Kerem. We didn't talk with him, but from what we heard, he supports vaccination. Even so, from what we found out and after all of our extensive research, we decided that we would consider each vaccine separately."

This decision has so far led Bundheimer and her husband not to vaccinate their young son at all. "The doctors and nurses really pressured us, but I was resolved not to have him stuck with all kinds of needles," she says. "It's horrifying what goes on there in the maternity ward. We wanted him to come into the world in the best and quietest and most civilized way possible."

Bundheimer acknowledges that "there's a reason why they do vaccinations and that it saves lives. I feel that medicine hides a lot of information from us. I'm not saying that one should dismiss anything that has to do with medicine, but that one should ask questions and investigate and develop a greater awareness. When you take something that's from nature, it's a lot better for the body."

She is convinced that the potential harm of vaccines exceeds their benefit and therefore, "we decided that we would go in the direction of not vaccinating. It seemed a lot healthier and more natural and good for the body."

She says that one consequence of the decision she and her husband made is that they are much more attuned to their son's physical condition. "Almost every disease has a process, an incubation period," she explains. "If you identify it at the start, it can be treated."

Five children who weren't vaccinated have died from whooping cough this year. Would you feel guilty if your child died under similar circumstances?

"I would feel very, very bad. And how would I feel if I'd given him a vaccine and then he got sick because of it? But no, I wouldn't feel guilty. When you take your child to the playground and he climbs on the equipment and falls down and gets hurt, do you feel guilty for having taken him to the playground? We, as parents, must pay careful attention. But things happen. You can't act out of guilt. Look, a few weeks ago a friend of ours was murdered in the West Bank by a Muslim, so does that mean that his parents should feel guilty for living there?"W
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  1.   Vaccinations 23:28  |  Madeleine 04/01/08
  2.   Freedom of choice, sometimes the wrong choices made 23:53  |  Sara 04/01/08
  3.   Vaccination 00:26  |  Pat 05/01/08
  4.   Typical Chochmologia 01:12  |  David 05/01/08
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  6.   Those who do not immunize endanger us all 09:11  |  Rachel 05/01/08
  7.   vaccinations 10:18  |  grandma 05/01/08
  8.   why oh why is the truth always twisted 20:23  |  ruth 05/01/08
  9.   Vaccine Toxicity 06:22  |  David 07/01/08
  10.   It`s the vaccinated who pose danger 21:31  |  Pat 07/01/08
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