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Dear Dr. Katz:

Thank you for your prompt response to my letter.

I would like to clarify some points.

I do not know of any children who have actually been taken from their parents and placed in foster care because of refusing an immunization. However, this threat is being made. Do you not think that this is an extremely coercive method?

When a mother asks a physician to delay or omit the third dose of hepatitis B vaccine because a child screamed for days after each of the first two doses, do you think that it is appropriate for the physician to say: "The baby needs this vaccine today, and if you don't accept it I am going to call CPS right now?"

In this case, the mother was so frightened that she allowed the vaccine to be given, and the baby screamed inconsolably for days again. Whether this signified potential for long-term neurological damage, I do not know. I suspect this physician would have called any such damage "coincidental." What would the AAP and the CDC call it? (And what do the neighbors and CPS think about a baby that screams for days?)

No practicing physician that I have spoken to will defend this doctor. What do you think about her response? Assuming that the description of events is accurate, would you defend her?

As you say, immunization is often used as a hallmark of responsible child care. "Failure to immunize" (your term-a neutral term would be "declining a vaccine"), as you clearly imply, places a parent under suspicion. Do you think that it should?

Do you think that administering vaccines should require informed consent? Or do you think that precise adherence to the vaccine schedule should be required, unless the child meets CDC-approved criteria for a medical exemption?

Frankly, I think it is disingenuous to say that "all states provide medical exemption for immunization." To most people, this implies that children may be exempted if a physician agrees that a vaccine at a particular time is not in a child's best interest (say due to family history, illness, or previous reaction). In fact, the CDC's criteria are extremely narrow. School districts may reject a physician's request for medical exemption. In that case, they exclude the child from school altogether.

When you say that a child is excluded from school "if/when a case of vaccine preventable disease (ex. whooping cough, measles) occurs in the school," do you not mean if and only if the child qualifies for a state-approved exemption? (Otherwise, the child is forbidden to attend school, even if there has never been a case, ex. hepatitis B, in the school.) Do you think that banning children only when there is a case of disease is adequate protection?

I think your letter implies that parents have the right to decline immunizations, and physicians have the right to advise against them, and that coercive measures (such as threats of seizing children) are outrageous. Please let me know if this is NOT a fair conclusion to draw, as I would not want to misquote you or to make an unwarranted inference.

cc Ted Koppel, Dr. Bruce Gellin, Mrs. Barbara Alexander Mullarkey