Over the past decade, American parents have become increasingly anxious about following their pediatricians’ recommendations to fully vaccinate their children. As a result, about 40 percent of American parents today have chosen to delay certain vaccines or outright refuse to allow their children’s physicians to vaccinate their children with one or more of the recommended or mandated vaccines. Their anxieties arise from several sources, but the most widely discussed concern among parents is the claim that vaccines may cause autism. Despite assurances from every mainstream scientific and medical institution that vaccines do not cause autism, millions of parents fear that they do, and it shapes their decisions about whether and when to vaccinate their children.1
The modern American debate over vaccines and autism is a proxy debate. It is a debate in which both sides uphold claims that are simplistic stand-ins for real problems. Underlying parents’ fears about a link between vaccines and autism are a complex set of concerns about the modern vaccine schedule that they rarely articulate clearly. Health officials prefer to debate within the limited terms of the claim that vaccines cause autism, because it frames the debate in terms that are familiar to them and because the autism question keeps the controversy within the confines of their scientific and technical expertise. It also allows health officials to avoid admitting that many of the concerns of parents are not scientific in nature, and thus scientists and physicians can have only a limited say in alleviating them.
This book is an account of the emergence of the modern American vaccine controversy. It reveals that, while the polemicists have debated within the confines of the vaccines-cause-autism argument, serious real problems with the current vaccine regime remain unresolved. These problems are discussed in detail in the book’s final chapter. For now, it is enough to say that the debate about vaccines and autism obscures serious problems—some inherent to the vaccines themselves and some unintentionally generated over the last several decades—that animate parents’ anxieties about vaccines. The entire process is conducted under substantial time and financial pressures; so many shots are given at such a young age against so many obscure diseases without parents’ having a clear understanding of why we are vaccinating against certain diseases and not others. No reasonable person ought to be surprised that the process has created apprehension among thoughtful parents.
This is not a history of bogeymen conjured by parents who simply distrust modern science, nor is it a story of how scientists and physicians have silenced quacks. It is a description of how, lacking a clear long-term vision, we have drifted into a situation in which vaccines, one of the most effective tools in the public health arsenal, have become the source of tremendous angst among the very people charged with the power to allow pediatricians to vaccinate children against deadly and debilitating ailments. As we continue to add more and more new vaccines to the already long list of recommended and mandated vaccines, we are priming ourselves for a breakdown of parents’ trust in vaccines and in mainstream medicine generally.
My interest in the modern American vaccine debate emerged on April 6, 2006, when my first child, Annabelle, was born. That same day, USA Today published an advertisement claiming that the 6,000 percent increase in autism that Americans had witnessed during the 1990s was the result of the “ambitious immunization schedule” that the Centers for Disease Control and Prevention (CDC) had adopted. The advertisement claimed that the CDC had more than tripled the number of vaccines required for children before they started kindergarten. Several parent groups, each of which focused in some way on the relationship between vaccines and autism, sponsored the advertisement. They demanded the complete elimination of mercury from all vaccines and a reevaluation of the combined effects of the nearly three dozen mandated and recommended vaccines that children received by the time they were six years old.2
A few hours after her first breath, Annabelle received her first vaccination, half a milliliter of Merck’s Recombivax HB, which promised to prevent her from contracting hepatitis B. The nurse explained that Annabelle would either get the shot that day or she would get it three days later, when we took her to her first pediatrician appointment. The benefit of getting it now, she said, was to avoid the $15 insurance copayment that the pediatrician would have to collect. “Either way,” the nurse told us, “she has to get the vaccine, because it is the law.” Michigan state law does indeed mandate the hepatitis B vaccine—along with vaccines for ten other communicable diseases—for all children who attend childcare centers, preschools, and schools.3
Months later, as I grew increasingly interested in the ongoing public controversy over vaccines, I learned that in fact we did not have to give our daughter a required vaccine to send her to daycare or later to public school because “mandated” in this context does not mean that she must get the vaccine. It turns out that in Michigan, as in many other states, health authorities have little power to coerce us into vaccinating our children. I also later learned that, motivated by a $15 savings, my wife and I had agreed to allow the nurse to vaccinate our day-old daughter against a disease that she could probably only contract by having sex with an infected person or by sharing contaminated needles with an infected drug addict. Why would the state require us to vaccinate Annabelle against hepatitis B given that it would take years—or, better, decades—before she had any risk of contracting the disease?4
Every state has a list of vaccines that it compels all children to receive. Generally, the most effective method of getting parents to vaccinate their children is to require that they present up-to-date immunization records to daycare and school officials before their children can attend public schools or licensed daycare facilities. All states allow parents to secure from their children’s doctors an exemption from any particular vaccine for medical reasons, such as compromised immune systems or allergies, but only about 1 percent of all U.S. children have such exceptions. Every state except Mississippi and West Virginia also allows children to be exempted from vaccination for religious reasons, the details of which vary from state to state and can include specific religious sects’ restrictions against vaccinations, refusal to vaccinate because some vaccines were prepared using cell lines that may have been derived from aborted fetuses, and in some states for religious beliefs against injecting foreign substances into one’s body. As with medical exemptions, the percentage of children with religious exemptions to mandated vaccines is relatively low, usually no more than 2 percent in any particular state.
In recent years, a third category of exemption has emerged, the philosophical or personal belief exemption. It varies from state to state and can include justifications drawn from parents’ political, ideological, or religious views, their chosen lifestyles, and even their personal opinions or political beliefs. Often, parents only have to sign a form stating they have a philosophical objection to vaccination, and at most they need to appear in person or present a signed and notarized form claiming their objection. In many states, obtaining an exemption requires much less effort from the parent than does fulfilling immunization requirements. This was indeed the case for me recently. Annabelle’s daycare notified me that she had not yet received a mandated vaccine, and I was unable to get an appointment with her pediatrician quickly enough to satisfy the daycare’s requirements. So, I simply filled out an exemption form and wrote “philosophically opposed to mandatory vaccinations” in the area labeled “Reasons.” A couple of months later, after I was able to get her into the pediatrician’s office, I handed the daycare’s administrative assistant an updated vaccination record and Annabelle was no longer among the children with a philosophical exemption.5
By 2006, twenty states allowed for philosophical exemptions, some of the nation’s most populous states among them. More than half of U.S. parents now have the option to exempt their children from mandated vaccines on the basis of philosophical objections. Over the last several years, public health authorities have become increasingly concerned about the effects of these easily obtained exemptions in reducing “vaccine compliance rates,” the formal term for the percentage of children who have received all their mandated shots. A 2001 study of the processes for obtaining an exemption for mandated vaccinations found that states with the easiest requirements for exemption also had the highest percentage of them. The growing number of available exemptions and their increasing use by parents highlight the fact that, in the United States, vaccinating our children is a parent’s choice, and increasingly parents are recognizing their rights to choose for or against particular vaccines or vaccines generally.6
At almost every “well-baby” doctor visit during her first two years, Annabelle received at least one of her mandated vaccines. Because a sick child cannot be vaccinated, the periodic well-baby visits are the only time outside of specific trips to the doctor’s office that she could get the nearly three dozen shots that she is expected to receive before she starts kindergarten. Anyone who has pinned down their child for a shot—or in some cases three or four shots administered quickly one after another—knows the trauma both parents and children experience as well as the mantra parents repeat in their minds as their kids scream in pain, fear, and frustration: “This is for her own good.” In the hours and days following each vaccination, my wife and I watched for any one of the many adverse reactions described to us, from the relatively mundane “pain at the injection site” or low-grade fever to the more worrisome febrile seizure (which are convulsions or the loss of consciousness brought on by a fever) to the terrifying threat of ailments like thrombocytopenia (very low levels of platelets in the blood) or acute encephalopathy (brain malfunctions that range in severity from personality changes to coma). After nearly every shot, Annabelle seemed cranky and tired or “fretful,” as the CDC describes the temporary condition of approximately half of the children who receive a vaccination. We anxiously anticipated the symptoms detailed in the brightly colored sheets that the nurses handed us as we left our appointments and, after a couple of days, thankfully, Annabelle returned to her normal self.7
A couple of months after Annabelle was born, I found myself back at the hospital, this time to visit Fiona, the two-year-old daughter of a close friend. Fiona had developed flu-like symptoms, and she quickly grew dehydrated and exhausted. Her parents, Chris and Nickie, had taken her to the emergency room after her fever had spiked and she had grown dangerously dehydrated from diarrhea and vomiting. Fiona was admitted to the hospital after being diagnosed with rotavirus, a nasty illness common among young children whose bodies have not yet developed resistance to it. Rotavirus attacks the lining of the small intestine and causes severe fluid loss, and Fiona was one of the fifty-five thousand children hospitalized in the United States in 2006 after contracting it. It is the most common cause of diarrhea in American children and the leading cause of death among children in developing countries. Worldwide, a child dies every minute from the symptoms of rota-virus. Happily, after several days of isolation, saline I.V.s, and sleep, Fiona fought off the virus and regained her health.8
Chris and Nickie never had the option to vaccinate Fiona against rota-virus, because she was a young child during a window of time when there was no available vaccine against it. In 1998, the pharmaceutical company Wyeth had licensed RotaShield, a vaccine against rotavirus, for use in the United States. Clinical trials in the United States, Finland, and Venezuela had shown that the live-attenuated, oral vaccine was highly effective in preventing the severe diarrhea and hospitalization associated with rotavirus. In October 1997, the New England Journal of Medicine declared, “The vaccine is safe,” although 15 percent of the vaccinated infants had fevers of at least 100.5 degrees within a week after vaccination. Nonetheless, it afforded children 88 percent protection against severe dehydration and a 70 percent reduction in the number of hospital admissions for the symptoms caused by rotavirus.9
RotaShield was introduced in the United States in the fall of 1998, and within nine months, fifteen cases of intussusception, a particular type of blockage of the small intestine, appeared among recently vaccinated infants. Intussusception, when it is treated, is rarely fatal, and most of the time it is easily remedied by an enema. About 20 percent of the cases require minor surgery, and the prognosis for children with intussusception who receive medical treatment is very good. The number of cases of intussusception associated with the RotaShield vaccine was minute. In the clinical trials it had shown up less than once in every two thousand cases, but that was still more than twice as frequently as it was found in the control group. The CDC quickly recommended the temporary suspension of the use of RotaShield. Over the next three months, the Vaccine Adverse Events Reporting Systems (VAERS), a vaccine safety surveillance program operated by the U.S. Food and Drug Administration (FDA) and the CDC, reported on data from the one and a half million American children who had received the vaccine. That report, combined with findings in the vaccine’s prelicensure clinical evaluation showing an elevated number of cases of intussusception shortly after vaccination, led officials to suspect there was a causal relationship between RotaShield and at least some of these cases of intussusception. In October 1999, by which time fifty-seven cases of intussusception had been identified in recently vaccinated children, the CDC and the U.S. Advisory Committee on Immunization Practices officially withdrew their recommendation for RotaShield, and Wyeth voluntarily withdrew the vaccine from the U.S. market. For the next seven years American infants were unprotected from the threat posed by rotavirus, and in the summer of 2006 Fiona contracted an especially nasty case of it that left her hospitalized for the better part of a week. Annabelle will probably never become as sick from rotavirus as Fiona because she received Merck’s RotaTeq vaccine, which was released later in 2006, after clinical trials involving over seventy-two thousand infants in eleven countries did not show an increased risk of intussusception.10
Fiona’s terrible experience with rotavirus demonstrated to us the potential threat of communicable diseases, and we were thankful that Annabelle had received the RotaTeq vaccine. Nonetheless, there is a striking contrast between our experience with Annabelle’s vaccination against hepatitis B and Fiona’s inability to be vaccinated against rotavirus. In one case, the public health goal of universal vaccination against hepatitis B led to what we came to believe was the premature administration of a vaccine to a newborn who had no reasonable risk of contracting that particular disease. In the other case, the medical community’s prudence and concern to do no harm, along with parents’ high expectations for the safety of vaccines, led to removal from the market of a vaccine had been incredibly effective in preventing a common and often lethal illness and that offered a very low risk of a generally nonfatal side effect.
Annabelle is now six, and she has received all of her recommended vaccines—a total of thirty-five different inoculations so far. For her first two dozen (that is, for the first nineteen months of Annabelle’s life), my wife and I jointly made the decision of whether to vaccinate her. We were both well-educated, politically moderate professionals, and we trusted our health care providers. We surveyed the claims about vaccines’ benefits and risks and talked with our pediatrician about each of the vaccines that Annabelle was scheduled to receive. In browsing the Internet and bookstore offerings, we recognized a fringe movement on the political right that fretted about governmental interference in citizens’ personal lives along with another that seemed to emerge from the political left that advocated natural products and worried about the unintended effects of vaccines on children’s bodies. The left/right divisions were not at all clear in this controversy, and we often found examples of partisans borrowing and advancing arguments that were more typically offered by authors on the opposite side of the political spectrum.
In addition to the public and political commentaries on vaccines, we read the orthodox medical recommendations from the CDC and from our state’s health department. We also read horror stories from vaccine proponents and opponents alike, stories about delicate babies ravaged by communicable diseases as well as accusations from parents who believed their children had been harmed by a vaccine. Finally, we found a substantial body of literature that asserted that the civic responsibility all parents was to vaccinate their children lest they infect the small number of children who could not be vaccinated because they were immunocompromised. Clearly, this was not a topic about which one could be both informed and dispassionate.
We chose to vaccinate Annabelle with all of the recommended vaccines—so far she has been vaccinated against hepatitis B, diphtheria, pertussis, tetanus, polio, pneumococcus, Haemophilus influenzae type b, measles, mumps, rubella, varicella, influenza, and rotavirus. But we chose to give them to her one at a time. She was so small and each inoculation was followed by a low-grade fever and general fussiness, so it seemed entirely sensible to space the shots apart by at least a couple of weeks so that we could watch for any severe side effects that she might have to a particular vaccine. That, of course, meant extra trips to the doctor and sometimes a little out-of-pocket expense for insurance copayments, but it seemed like a reasonable thing to do. We found no scientific evidence to validate our concerns about giving her multiple shots at a single visit but plenty of common sense arguments about the capacity of vaccines to overwhelm a baby’s body.
When Annabelle was nineteen months old, her mother died. Like the millions of other single parents in the United States, I found myself solely responsible for every decision regarding my daughter’s upbringing—decisions like where to send her to school, what opportunities and experiences to provide her, what time she goes to bed, when she can get her ears pierced, and which vaccines (if any) to give her. Somehow, the decision to vaccinate her seemed a lot easier when I had a like-minded partner reinforcing my choice. In addition, I had already begun writing a book on the modern American anti-vaccination movement, and I found myself with a tremendous amount of information and with an intense sense of responsibility. I am no different from any thoughtful and well-informed parent—solo parenting just concentrates these decisions onto one person’s shoulders—and I have continued to feel much the same way about vaccines as I did when I had a partner parenting alongside me. I think vaccines are a vital tool in maintaining health and in preventing or substantially limiting outbreaks of troublesome communicable diseases. But I have also continued to be concerned about the growing number of vaccines we give to infants, their unintended consequences, and problems that may arise from our increasing use of them.
Becoming Annabelle’s sole surviving parent did not change her vaccination schedule, but it did profoundly change this book. When I began my research in 2007, I had intended to explore the relationship between political ideologies and anxieties about vaccines. I was intrigued by how members of both the political left and the political right in the United States had developed such strikingly strong and similar anxieties about vaccines, and I had hoped to explore the underlying influences in their concerns about vaccines. Over the course of my research—and motivated in no small part by the changes in my family—I came to appreciate that a parent’s love owes no allegiance to their politics, even though decisions about a child’s healthcare or education might be expressed in terms similar to those used in their discussions about politics. That is, while the political orientation of worried parents most certainly frames their critique of vaccines, anti-vaccination sentiment seems to emerge from something deeper than parents’ political perspectives. I have found left- and right-leaning parents borrowing from one another in expressing their concerns about state-mandated vaccines, and I have found staunchly partisan Democrats and Republicans embracing one another’s arguments about vaccines across the aisle. Partisans from both sides, in their own way and employing their own terms, exhibit concerns similar to my own about the growing number and potential side effects of our reliance on vaccines. What exactly is it about vaccines that inspires trepidation among Americans?
So, this is a book about something deeper than politics or scientific research. It is a book about something more than just my own experiences, something more inspiring than scientific certainty, and more motivating than a citizen’s responsibility to the larger community. This book explores the peculiar context within which modern American parents must make decisions about their children’s bodies and reveals a troubling set of problems at the root of parents’ current anxieties about vaccines. As both the number of vaccines and the number of vaccine critics has increased, our complicated, confusing, and increasingly contentious environment has grown even more chaotic and bewildering. Never before have we had such capacity to so fundamentally alter our children’s bodies and—according to many of the critics of vaccines—their minds. In this book, I hope to put my finger on the source of parents’ concerns about vaccines, to understand what exactly makes so many of us anxious about what on the surface seems like such a powerfully good weapon in the public health arsenal. It is my hope that by exploring some of the information available to parents and by examining both the scientific claims and the political issues involved in the modern vaccine debate, I can help other parents who, like me, struggle to do what is best for their children. Unlike many of the decisions we confront in our lives, the decision of whether or not to vaccinate our children is one that we must make, be it by default, rejection, or deliberation. It is a situation like the one that Neal Peart, channeling Ayn Rand, described in Rush’s song, Freewill: “If you choose not to decide, you still have made a choice.” In this case, it is the choice to accept the recommended schedule, to reject it, or to somehow alter it.11
This book also has something useful to say to the public health officials who ardently defend the recommended vaccine schedule. I share with them an earnest respect for the capacities of vaccines to protect citizens from deadly and debilitating communicable diseases. I, too, fear the return of childhood scourges like polio and diphtheria, and I recognize how deeply dependent we are on vaccines to prevent epidemics of truly horrible communicable diseases. For parents—who are vested with responsibility first to their child and who are granted the political right to fulfill that responsibility as they see fit—the “big picture” of public health is generally of only secondary concern. Claims about the safety and efficacy (as well as the danger and ineffectiveness) of vaccines are so widespread and wide-ranging that parents are often overwhelmed with information. As an historian of science, someone whose career has been devoted to studying complicated and controversial issues regarding science, medicine, and American society, I can provide some perspective for public health officials as they struggle to find ways to maintain high levels of vaccine compliance in light of the increasing ease with which parents can exempt their children from mandated vaccinations. Because we live in a representative democracy that shows intense respect for individual liberties, and because we have collectively decided that medical decisions ought to be freely made by individuals, not imposed on them, health officials have had to continually adapt their tactics to deal with the public’s anxieties about vaccines. Instead of merely offering tactical suggestions to lull parents into compliance and maintain relatively high levels of vaccine coverage, I will uncover for them the source of modern American parents’ anxieties about vaccines. Just as parents’ reliance on common-sense notions can sometimes lead them astray in making medical decisions, public health officials’ notions about the best way to ensure high levels of compliance may very well backfire if they do not realize the true source of parents’ concerns.
The book begins with a description of the problem and an overview of the concerns that seem to motivate parents to question the recommended vaccine schedule. We have a very strange situation here: Vaccines are commonly listed among the most valuable tools in the maintenance of the public’s health. Their usefulness in decreasing childhood death and lengthening our average lifespan rival or exceed other important public health measures like improved nutrition, antibiotics, and sanitation efforts. Nonetheless, there have always been concerns about injecting healthy people with foreign substances, and lately those concerns have grown more widespread among a group of middle-class, educated Americans. To make matters worse, many state legislatures have responded by loosening the requirements that have brought us closer to universal vaccination. So, we find ourselves in a situation with the most and best vaccines ever available while at the same time a virulent anti-vaccination movement is developing among citizens whom we would otherwise assume to be the most ardent proponents of vaccines. What are we to do?
The second chapter explores the sources of anti-vaccination sentiment that existed in the early 1990s, prior to the full flowering of the movement at the turn of the twenty-first century. It examines the limited opposition to vaccines found among some ideologically motivated Americans of the political left and right prior to the late 1990s. I look at the claims that emerged from many members of the alternative medicine community, who have long expressed concern about vaccines’ efficacy and their long-term effects on our health. The concerns introduced by the alternative medicine community in the late twentieth century found their way into mainstream discussion by way of two medical mysteries: the origin of HIV/AIDS and Gulf War Syndrome. The book’s second chapter shows how anxieties about vaccines played a role in both of these public health issues. In turn, the mysterious origins of HIV/AIDS and Gulf War Syndrome added fuel to the embers of concern that many Americans already had about vaccines.
In the middle of the book, I describe the origin of the widespread notion that there is a causal link between vaccines and what appears to be an epidemic of autism in the United States. Autism, I argue, has become the battleground on which the struggle between parents’ anxieties about vaccines and public health officials’ goals of universal vaccination is fought. For parents, the threat of vaccine-induced autism is, in my view, a proxy for a complex set of concerns they have about the modern vaccine schedule, and many parents have seized on it because it provides a ready-made venue for discussing their concerns about vaccines within a group of like-minded advocates. The claim that vaccines might cause or trigger autism emerged in the 1990s from two separate sources—one American and one British—and merged in the public’s mind sometime around the turn of the twenty-first century. In the 1970s, 1980s, and 1990s, American public health officials had conducted an aggressive campaign against environmental toxins like lead, mercury, and arsenic. They had a great deal of success in compelling legislation that would limit children’s exposure to these dangerous substances and in encouraging parents to rid their homes of them. At the same time, changes in the diagnoses of autism and a substantial increase in public awareness of the disorder generated widespread concern about an apparent autism epidemic in the United States. In the midst of all this, it became known that most childhood vaccines used the preservative thimerosal, which contained mercury. Here was a perfect storm. A large number of parents and some medical professionals connected the apparent autism epidemic, environmental toxins, and vaccines with one another and began assertively questioning the increasingly large number of vaccines routinely given to children, their contents, and their efficacy.
Chapter 4 explores the controversy over autism and the combined vaccine for measles, mumps, and rubella by analyzing the work of Andrew Wake-field, a British surgeon and researcher. In 1998, Wakefield and a dozen of his colleagues at the prestigious Royal Free Hospital in London published an article in the premier British medical journal, the Lancet, which suggested a link between the measles, mumps, and rubella (MMR) vaccine and the neurological problems associated with autism. Wakefield had long been interested in intestinal problems like colitis (inflammation of the gastrointestinal tract), and by the mid-1990s he began asserting what he called the “gut-brain link,” which hypothesized that certain neurological and developmental disorders might be caused by gastrointestinal ailments that were themselves initiated by some children’s bodies’ responses to the combined MMR vaccine. When his group published their paper in 1998, Wakefield took their claims a step further by asserting that, until scientists could demonstrate the safety of the combined MMR vaccine, health care providers should give each of the three vaccines separately instead of in the combined form. Wakefield quickly became a pariah in the British medical community and the target of allegations of conflict of interest and ethical misconduct. His claims, however, added to American concerns about environmental toxins and the potential threat posed by some of the components in vaccines. When he immigrated to the United States in 2004, he found a large and supportive constituency among parents of autistic children and among alternative health care providers. Mainstream American health officials have been every bit as critical of him as were their British counterparts, and Wakefield has taken a place at the center of the American controversy over the alleged link between vaccines and autism.
Chapter 5 examines the most vocal American opponents and proponents of vaccines. Under the harsh light of the media and coming from the most polemic figures in the debate, discussions about vaccines—both their potential promise and their peril—are expressed in the most frightening of terms. Jenny McCarthy, a former Playboy model and comedian turned actress, author, and activist, is perhaps the best known among the detractors. But vaccines have celebrity supporters as well, including the actress Amanda Peet, along with many ardent supporters from the medical and scientific communities, such as vaccine researcher and advocate Paul Offit. Their rhetoric has fanned the flames of the debate, escalating concerns of both vaccine proponents and detractors.
The book’s last chapter offers a description of what in my estimation are the real issues underlying American parents’ anxieties about vaccines. Public health officials lament what they take to be “anti-science” attitudes among some members of the public, and they wring their hands over parents’ unwillingness to accept what, by now, has become a solid medical consensus against claims of a link between autism and vaccines. In a vain attempt to quiet the storm, they attack any public figure willing to openly state some of the concerns that millions of Americans hold. In doing so, they are simply treating the symptoms of the problem. Anxieties about vaccines are, I believe, indicators of a set of underlying problems, and in the book’s final chapter I lay out what I see as the issues that really need to be addressed—or at least admitted—if we are to continue to see the high rates of vaccine compliance we enjoy today.
Finally, I conclude with what I believe is a potential way forward for parents and policy-makers alike. It is not a manifesto of any sort or even a checklist of priorities. Rather, it is the promotion of a worldview that recognizes the potential value of vaccines, the economic and public health pressures that continue to lengthen the list of mandated and recommended vaccines, and the responsibilities we have to our children and to one another. We must also acknowledge that ultimately parents—not scientists, physicians, or politicians—have the choice to vaccinate their children or to refuse vaccinations. Parents’ vaccine anxieties are a symptom of deeper problems, and no amount of debate, scientific evidence, or celebrity endorsement will make these problems go away. We can begin to address parents’ anxieties and perhaps resolve this dilemma only after we recognize the bases for parents’ concerns. For better or for worse, scientists or physicians alone cannot assuage our worries about vaccines with their research results or their professional authority. Vaccine-anxious parents are motivated by deeply felt concerns about the modern American vaccine schedule that must be understood and addressed. This book attempts to uncover the source of those concerns, explain the evolution of the controversy, and move us past the proxy debate over vaccines and autism that has dominated the discussion since the turn of the century.