Tammy Reed, the 28-year-old mother of a toddler, is not given to belief in
conspiracy theories and is not the type to be rattled by the phrase "pandemic
flu." The Menifee, Calif., resident is the kind of mom who gathers a good deal
of her medical intelligence on government websites, trusts a friend who is a
nurse practitioner and is raising her bright, strong-willed daughter with all
the confidence of a former nanny and the second-born in a family of six.
She's the kind of mom who thinks that when the vaccine for H1N1 influenza
becomes available for her daughter, she may just take a pass on it.
"It's a different brand of flu, but it is still the flu, and I think she's
already built a pretty strong immune system," Reed says of her blond, blue-eyed
14-month-old. At the same time, the tests on the vaccine in development against
H1N1 aren't even completed yet, and that, to Reed, sounds like a formula for
unforeseen problems down the road.
"I'm really more concerned about the long-term effects and lifelong damage it
could do to her," Reed says.
So for now, at least, she's made her peace with the prospect that her daughter,
Coral, could have a few miserable days and a lifetime immunity from this novel
strain of flu.
She'll seek her pediatrician's opinion next month when Coral is due for a
checkup, Reed says. "But I don't think it'll sway me at this point."
As the nation braces for a season of pandemic contagion, omnipresent vaccine
clinics and debate over healthcare reform, the myriad doubts of parents and
citizens like Reed represent a new and potent strain of vaccine ambivalence.
Physicians say they are hearing young parents -- many of whom have neither seen
nor suffered any of the once-common diseases of childhood -- express doubts
about inoculating their children against the novel strain of influenza.
This new generation of vaccine skeptics has been forged by the stubbornly
persistent belief -- discredited by a welter of studies -- in a link between
vaccines and autism. And it is further fueled by a combustible mix of distrust
of drug manufacturers, media outlets and the federal government.
And although many pediatricians are readying stern lectures in support of
vaccinating children, several in Southern California contacted by The Times
acknowledged they have doubts about recommending a vaccine that is still in
testing for all of their young patients.
"A significant proportion of our population don't want to get it," says Sherman
Oaks pediatrician Mikayel Abramyan. "I don't even know whether I will advocate
for it right now."
To date, notes Abramyan, who saw a fair amount of novel H1N1 over the summer,
the illness has been mild, and many parents of the children he cares for "want
them to get their immunity that way instead of a flu shot," he says. While
Abramyan says he rarely lets such preferences go unchallenged, "it's a
reasonable position, and I understand it on an individual level. . . . I
understand where they're coming from."
New generation
Americans in their 20s, 30s and 40s have been largely spared the yearly
deliberations over seasonal flu vaccine, either for themselves or their kids.
School-aged children and their parents are mostly in robust health. Until very
recently, they have been an afterthought in vaccination drives, which have
focused instead on reaching the very old and very young -- populations
considered at highest risk of complications from seasonal flu.
The new H1N1 virus has changed all that. Epidemiologists have found that
children, young adults and pregnant women who catch the new flu run a greater
risk than the elderly of developing complications; as a result, all three groups
top the list of those recommended to get H1N1 vaccine this year. And even before
the new strain emerged, many epidemiologists had embraced the view that
vaccinating schoolchildren -- the most prolific spreaders of germs -- might be
the best way to reduce the seasonal flu's hold on the entire population.
The collective doubts of this generation of parents, say experts in infectious
disease control, could stymie the efforts of government officials and the
medical establishment to stem the spread of a new contagion, and to ready for
other infectious diseases that may emerge down the road.
"Swirling around parents this fall will be a lot of myths, misinformation and
legitimate and factual communications," says Sandra Quinn, a University of
Pittsburgh public health professor who recently completed a national survey of
attitudes about the flu vaccine. Of all the messages parents of young children
are receiving, Quinn says, the parents of young children seem to be fixating on
the word "uncertainty" -- about the severity and scope of the flu, the status of
the vaccine and the need for mass vaccinations.
These adults have never been an easy sell on flu vaccine for themselves, either.
Even among adults 18-49 with chronic health conditions -- a population urged by
government health officials to get vaccinated against seasonal flu -- only 37%
last year got a flu shot or flu mist.
Susanne Stuart-Nystrom, a 37-year-old Venice resident whose son Robert entered
preschool for the first time Thursday, is among those weighing the decision to
vaccinate her child against the novel H1N1 flu.
Just a month short of 3 years old, Robert is healthy, but has had some food
allergies that were first thought to be asthma. Asthmatic children, as well as
those who have diabetes, cerebral palsy or other heart or lung conditions are
recommended to be among the first to get the vaccine. But Stuart-Nystrom, who
feels confident that her son's "asthmatic" episode has been managed by dietary
changes, says that she too will probably take a pass on vaccinating her child
when the time comes.
"I haven't seen enough evidence to show that swine flu is as deadly and as scary
as it's made out to be," says Stuart-Nystrom, who last week was fighting a
respiratory infection. Stuart-Nystrom thinks that media outlets have whipped up
the threat in a bid to gain viewers. And "anything brought out by big business,
by corporations, that makes me wary for sure. . . . I'm not sure they have our
interests in mind."
Nor is the Venice mother confident that the Food and Drug Administration can
reliably assure the overall safety of the vaccine. Pointing to a recent spate of
contaminated-food recalls, she said that the FDA's relationship with the
industries it regulates may be too close for the agency to operate effectively
as an honest broker.
She also voiced the widely held belief that immunity acquired the natural way --
through a child's having caught an illness -- is stronger and longer-lasting
than that acquired by vaccination. That claim is much debated among physicians
and infectious-disease specialists, with evidence falling on both sides of the
debate.
Wider suspicion
In approaching childhood vaccines in general, neither Stuart-Nystrom nor Reed is
reflexively against them. Each woman has had her child immunized against a wide
range of childhood diseases. But each has also decided to wait, at least, for
her child to get older before getting the vaccine cocktail that immunizes
against measles, mumps and rubella. Though the MMR vaccine has not been
formulated with the preservative thimerosol since 2001, it remains a common
source of concern among parents, because many families of children with autism,
as well as vaccine refusers, have charged that the MMR vaccine is the cause of
the developmental disorder.
Some formulations of the H1N1 influenza vaccine are expected to contain a small
amount of thimerosol to prevent contamination during manufacture and shipment.
The American Academy of Pediatrics, in an effort to blunt these and other
concerns, recently posted to its website an exhaustive accounting of studies
that have failed to link thimerosol with harm. But the preservative's low-level
presence in some flu vaccines, including some H1N1 formulations that will be
offered for children this year, may make some pediatricians and parents
squeamish. Some parents will seek out formulations that are free of the
preservative, but others may just stay away.
Finally, there is the hassle factor. As busy parents ponder the prospect of
bringing their kids to the doctor twice -- once for a seasonal flu shot and
again for the H1N1 vaccine -- some are expected to take their chances with less
vaccine than recommended. If the H1N1 flu appears to have run its course before
vaccine becomes available, many parents may decide their kids can skip both
vaccines altogether.
"Complacency is a big challenge," Dr. Anne Schuchat, director of CDC's National
Center for Immunization and Respiratory Diseases, noted recently. Federal
officials, she added, "are trying to strike a balance between complacency and
alarm" as they undertake what many believe will be a mass-vaccination of
unprecedented scale.
For Reed and Stuart-Nystrom, neither complacency nor alarm is the problem. The
problem is a swirling debate in which opinion passes for science and the motives
of long-trusted sources -- physicians, scientists and government health
officials -- have come in for questioning.
"There's so much information out there," Stuart-Nystrom says. "The scary thing
is, you don't know what's right and what's wrong."
Source : The Los Angeles Times
