A shot wide of the mark

This fall in Westfield, N.Y., a school superintendent threatened to yank a 7th-grade girl from her home and take her into state custody. Her mother, Debra Moore, was thrown into a panic. Her daughter was healthy, well behaved, and made good grades. What had the mother done wrong?

She refused to have the girl vaccinated for hepatitis B, a disease usually caught by drug abusers and the sexually promiscuous.

The government Centers for Disease Control now recommends hepatitis B vaccination for infants and adolescents, even though the CDC website acknowledges that children rarely catch the disease: Those at risk are adults who are "sexually active with more than one sex partner ... ; men who have sex with men; illicit injection drug users"; and certain health-care workers. Yet targeting these populations has "not been a successful public health strategy," as the CDC delicately puts it.

Translation: Targeting these groups is not politically correct. As a result, New York and many other states now require all children to receive the vaccine-despite admitted risks. As Jane Orient, executive director of the Association of American Physicians and Surgeons (AAPS), points out, "Government studies show that children under the age of 14 are three times more likely to die or suffer adverse reactions after receiving hepatitis B vaccines than to catch the disease itself." In 1998 France suspended the hepatitis B vaccine requirement for schoolchildren because of evidence that it causes serious neurological problems, with symptoms often resembling multiple sclerosis.

Ms. Moore's daughter had a history of bad reactions to vaccines, so she claimed a medical and a religious exemption-both permitted under state law. Yet when she submitted an affidavit, the superintendent threatened to call Child Protective Services, then required her to submit documentation verifying the "sincerity" of her religious beliefs. New York officials are regularly employing such draconian threats: In Utica, officials threatened to take 77 middle-schoolers into state custody unless they were vaccinated for hepatitis B.

State public-health laws stem from the 18th and 19th centuries when unpredictable epidemics of contagious diseases such as yellow fever, typhoid fever, and smallpox would sweep through crowded, unsanitary port cities, often brought in by diseased immigrants. Under these conditions, it made sense to assign police powers to public-health officials to enforce quarantines. Around the turn of the century, it also became common to exclude unvaccinated children from school during smallpox epidemics.

But in recent years, new vaccines have been developed that appear to cause harmful reactions in susceptible individuals-calling into question the idea of a one-size-fits-all forced vaccination policy. Children now receive 33 doses of 10 different vaccines by age 5. Some doctors worry that children's immature immune systems are being stretched to the limit. Meanwhile we are in danger of using vaccines like hepatitis B as a quick fix for "lifestyle" diseases, instead of addressing the underlying social and behavioral causes.

Even more controversial vaccines are on the horizon. If an HIV vaccine is developed, it will likely be mandated for preadolescent children. And the "Holy Grail" of vaccine researchers is to create a genetically engineered "supervaccine," given orally at birth, containing raw DNA from 20 to 30 viruses, parasites, and bacteria that will insert itself directly into babies' cells.

Meanwhile, the federal government is putting increased pressure on states for blanket immunizations. In 1993, the Clinton administration launched an "Immunization Initiative" and Congress authorized more than $400 million in financial incentives for states that enforce mandatory vaccination by using Social Security numbers to track children from birth. Simultaneously, a grant program rewards state health departments with up to $100 for each fully vaccinated child.

Vaccines have come under increasing public scrutiny since 1982, after NBC-TV showed the documentary "DPT: Vaccine Roulette." The result was a 1986 federal law setting up a compensation system that has awarded more than $1 billion to families whose children have died or developed serious injuries from vaccines, and also mandating new research studies on vaccine safety. Those studies showed that standard immunizations can in rare cases lead to severe consequences, even death, though overall, the benefits have outweighed the risks.

As government officials push for more vaccinations, including some for "lifestyle" diseases, parents should have the right to weigh the risks and benefits-practicing informed consent just as they do with their children's other medical care. The trick will be to determine when vaccines are useful and beneficial, and when they substitute for moral behavior.