Since Edward Jenner's discover of the smallpox vaccine in 1798, immunization against diseases has become a multi-million dollar industry.

Most children in the U.S. will get at least twenty-one vaccinations before they start first grade. Public health officials argue this is one of the most effective medical interventions we have to prevent disease. So why are physicians faced with increasing numbers of parents who refuse to immunize their children?

This refusal is frustrating and perplexing for many physicians. Parents have many reasons: vaccine safety issues, concerns about side effects, moral concerns about the use of fetal tissue in some vaccines, or the belief that natural immunity can be fostered. Consider the case of a young couple who decided, after great deliberation, not to vaccinate their six-month-old son. They have researched the pros and cons and have discussed the matter with their religious community. The primary care physician strongly disagrees with the decision. The parents explain that they are concerned about possible side effects of vaccination and about some of the ingredients used in vaccinations. The physician assures them that the benefit far outweighs any small risk. They express their unwillingness to have their baby injected with foreign substances, and they explain their belief that God will take care of their son if they are faithful. The physician explains that God had a hand in the discovery of the vaccinations and that their child will be in danger should they decline. The parents stand firm in their conviction. Both parties feel completely justified in their decision, yet frustrated by the lack of understanding. Such clinical encounters place the doctor-patient relationship at risk.

The recent withdrawal of the Rotavirus vaccine due to worries about side effects and the controversy over possible toxicity from thimerosal, a mercury-containing preservative used in vaccines, has raised concerns. In the past year several Congressional hearings have been held on this subject. Danielle Burton Sarkine, whose infant daughter "almost died after a reaction to a hepatitis B vaccination" and whose fourteen-month-old son "was left autistic after receiving nine vaccines on one day," introduced her father, Committee Chairman Congressman Dan Burton. He spoke about exploring the connection between vaccines and brain and immune system dysfunction in children, particularly a suspected link between autism and the measles/mumps/rubella (MMR) vaccine. Such concerns are controversial in the medical establishment. In respected journals such as the British Medical Journal and the Lancet, heated discussions have flared about whether or not vaccination is related to a variety of ills such as autism, diabetes, and Crohn's disease.

To some extent, increased availability of information is responsible for these concerns. Anti-vaccination web sites have proliferated. A survey by Cyber Dialogue, an internet research firm, found that over the last twelve months 7.5 million U.S. adults began using the Internet to find health and medical information. This represents a 43% rate of increase, nearly double the Internet's 22% overall rate of growth last year. Today, 35% of all U.S. adults are online and of these, 38% have used the Internet to gather health and medical information during the last twelve months. In 2000, more than 33.5 million adults are expected to seek health information online. Parents doing an Internet search for information about vaccinations can easily find sites where the dangers of vaccination are presented graphically and emotionally. (See the National Vaccine Information Center web site at http://www.909shot.com/.)

Biomedicine views immunizations as a means of protecting the individual and society against potentially life-threatening illness. The risks associated with immunizations are considered extremely low and must be weighed against the overwhelming benefit imparted by immunity. Refusing vaccinations is tantamount to a mortal sin within biomedicine and is viewed by some as a form of child abuse and neglect.

Richard Moskowitz, M.D., an opponent of vaccination, writes:

The risk-benefit ratio shifts when God enters the equation. A basic tenet of Christianity and Judaism holds that the body is a sacred temple of God. Injecting toxic particles into the body to produce an artificial immune reaction is seen by some religious persons as opposed to natural methods of promoting health. This view was a major source of the opposition to smallpox vaccination in the 1800's. One opponent described it as "an attempt to swindle Nature." Similarly, the benefit of immunity against disease becomes irrelevant for those who believe that faith in God protects the individual from illness. Refusing immunizations may therefore be seen as an act of faith.

The tension between vaccination and religious belief is not new. The British Vaccination Act of 1853 mandated universal vaccination and imposed fines and jail sentences for refusal. As a result, anti-vaccination leagues sprang up to oppose and abolish mandatory vaccination. An example of the almost religious quality of the opposition can be seen in this excerpt from an 1878 newsletter of the Anti-Compulsory Vaccination Society:

A word for the unfaithful

As a rule, those who hate vaccination itself are yet too mean-souled to protect their children if thereby there be any danger of fine or imprisonment ...to have to battle with the vaccination tyranny is hard; but...though the way is longer than we would fain see it, we must just "foot it boldly, strong or weary," and take courage in the assurance that "in due time we shall reap if we faint not."

Opposition may also arise from the perception that society is spiritually insensitive. Many spiritually-oriented people find the modern, information-glutted electronic world, with its biomechanical model of reality, to be overwhelming. They reject the perceived impersonality and homogeneity of the allopathic medical approach and its relative disregard of spiritual and physical integration. Thus, exemptors often seek healers whose model of medicine is based on a top-down approach; that is, the healer first tries to orient himself to the patient's world-view before beginning treatment. By contrast, modern medicine is often bottom-up: the symptom and its cause at the molecular level is the focus, and the big picture is relegated to a lesser significance. For spiritually oriented healers, any treatment is individualized—not in the sense that the dose is adjusted for weight, but in the sense that different treatments may be used for different patients with similar symptoms. Thus, vaccination is often rejected as being "one size fits all." Homeopathy, with its emphasis on individualized, non-toxic treatments, is often preferred for this reason.

The use of aborted fetal tissue is another reason vaccines are rejected. Some current chickenpox and rubella vaccines originated from lung tissue of aborted fetuses. The Catholic Church has justified the use of these cell cultures, arguing that the immoral act which procured the tissues is "complete and sufficiently remote" from the present use of the tissues, so that whoever uses the vaccine today is not morally complicit in the original abortion. They also argue that the present use does not create grounds for objection because the cells constitute "independent, possibly different, life." These points have been forcibly challenged by other Catholics. One anti-abortion writer, Steven Kellmeyor, argues:

A wide variety of spiritual and moral concerns motivate parents to reject vaccination. Does the parents' refusal put the child at risk? This winter an outbreak of measles in the Netherlands among religious exemptors led to 2961 measles cases, with 68 hospitalizations, including three measles-related deaths. Some argue that vaccination would have prevented this tragedy, while others argue that the vaccination would have caused more tragedy. Indeed, a comparison of two groups of parents, one favoring and the other opposing vaccination, found that when given a chart of data about the risks of diphtheria vs. the diphtheria vaccine, their views became more stratified: those who were pro-vaccine were more in favor of vaccination, and anti-vaccinators were more opposed.

Perhaps we should put ourselves in the child's position and ask ourselves: 1) would we prefer a greater or lesser chance of death, and 2) would it matter, from the child's point of view, whether this came about by the parents' act, such as a vaccine-related event or by omission, in the event of disease from failure to vaccinate. One study showed that according to this "Golden Rule" argument, exemptor parents were more likely to vaccinate their children.

Vaccination is unique among government mandates in the modern era, requiring individuals to accept a medicine or medicinal agent into their body. Opposition began with the first vaccinations, has not ceased, and probably never will.