Jane M. Orient, MD
Executive Director
1601 N. Tucson Blvd, Suite 9
Tucson, AZ 85716-3450

Dear Dr. Orient:

Your letter of 25 October awaited my return from a number of out-of-town commitments. It is a bit confusing for me to decipher your first paragraph regarding the discussion with Mrs. Mullarkey. She did approach me at the ACIP meeting and we discussed the issue of infants and children allegedly removed from the care of their parents and entered into foster care because of failure to immunize. Once again, I stated that I was totally unaware of any such instance and that it would be a responsibility of Social Services, not the CDC, to invoke any such measure. My experience suggests that when such measures are threatened or invoked it is not because of immunization. Immunization is sometimes used as a hallmark of responsible infant and childcare. If parents have repeatedly missed child health visits which involve both physical and social evaluations and treatment, then they might be "threatened" with referral to Child Protection Services-not because of the immunization failure but because of overall failure of appropriate parenting.

As I discussed, all states provide medical exemption for immunizations, 48 states allow religious exemptions and 15 states (at last count) permitted "philosophical" exemptions. In any one of the states, a parent may decline immunization for his/her infant, but the consequence may be failure of admission to day care centers or exclusion from elementary school if/when a case of vaccine preventable disease (ex. whooping cough, measles) occurs in the school and unimmunized children are then banned until an incubation period has passed without new cases.

To answer your question (paragraph 4), I certainly do see my responsibility as a physician to persuade patients and parents to follow the best measures in health care for their children. I also feel that I have public health responsibilities to the community and that immunizations (similar to traffic stoplights, fire regulations, etc.) have an impact on other children as well as the individual. I have no need to "sign a statement" but I am certainly aware that declining immunization does not by itself constitute child neglect or abuse. Indeed, my niece is one of those who for philosophical reasons has never had her three youngsters immunized. Because she and her husband in all other respects fulfill the best qualities of parenthood, I would never feel that her children were abused or neglected. However, I certainly believe that their health "insurance" is faulty.

Your statement that vaccines are "in effect being imposed by coercion" is not correct. That is gross hyperbole. Surveys that have been done in a number of states indicate that there is great variability in the acceptance of vaccines by parents and that the range may be from less than 1% to as high as 9% in some communities declining immunization for their children. I am unaware that any of these parents has lost a child to foster care because of this decision.

Yours very truly,

Samuel L. Katz


Cc: Mr. Ted Koppel
ABC Nightline

Bruce Gellin, MD
Dept. of Preventive Medicine
Room A-1124 MCN
Vanderbilt University School of Medicine
Nashville, TN 37232-2637

Mrs. Barbara Alexander Mallarkey
P.O. Box 946
Oak Park, IL 60303