June 12, 2007— -- The final outcome of hearings in the U.S. Federal Claims Court on the purported link between certain vaccines and autism could have a major impact on vaccination practices across the country, experts in the field say.
And most agree that a ruling against vaccine manufacturers would represent nothing short of a public health disaster.
"Awarding a claim would fly in the face of reason and science," says Dr. Susan Fisher-Hoch, professor at the University of Texas School of Public Health in Brownsville.
"If the judiciary wish to do this they will open Pandora's box. The effect on vaccine acceptance would be a disaster."
Dr. Robert Schooley, professor of medicine and head of infectious diseases at the University of California at San Diego, says such a decision "would only further increase the cost of vaccines and lead to worsening of the public health."
Others say the hearings on vaccines distract from needed attention to other aspects of autism research and care.
"To have hearings, it's unfortunate first of all," says Dr. Peter Hotez, president of the Sabin Vaccine Institute in Washington D.C., whose own daughter is autistic.
"We need to do a lot for kids with autism, but focusing on vaccines is really misplaced energy."
Dr. David Witt, assistant clinical professor of medicine at the University of California at San Francisco agrees.
"My personal opinion is that if there is a victory, it is a sad comment on how energy can be diverted from real health issues and causes, to faddish beliefs and diverted angst toward a handy target," he says. "The parents are really suffering, but in their need to find a villain, they are misguided."
Concerns about thimerosal's possible link to autism have gained publicity in recent years, as the occurrence of autism in children has climbed steadily in the United States. Doctors have struggled to find a clinical reason for the increase. Because vaccinations are mandatory for all children at a certain age, some parents and doctors believe the vaccines indicate a common link that cannot be ignored.
However, current research weighs heavily against the premise of a thimerosal-autism link, as so far a number of large scientific studies have shown no association between the two.
Most recently, a review of past research published this month in the journal Current Opinion in Infectious Diseases suggests "increasingly convincing epidemiologic and laboratory evidence against a causal relation of several alleged adverse events following immunization."
The findings bolster the position that has been steadfastly held by the Institute of Medicine that no link can be established between thimerosal and autism.
Hotez says it would be impossible to draw a clear line between vaccines and a condition as complex as autism.
"There have been at least five studies showing no link," he says. "There's not only evidence to support the nonlink, there's also evidence that refutes [a link]."
But since no clear-cut cause of autism has yet been determined, physicians say many parents and some doctors cling to the idea that an obvious cause exists.
"The parents of children with autism understandably try to identify an obvious cause, and childhood immunizations have provided some of them with the answer," says Dr. Pascal James Imperato, chairman of preventive medicine and community health at State University of New York Downstate Medical Center.
"The scientific evidence to date does not support their claim. Consequently, I do not see that they have a scientifically based claim against the vaccine manufacturers."
"I think part of it is you're a parent of an autistic kid, you get desperate," Hotez notes. "There aren't services available. You're pretty much on your own.
"You ask, why did this happen? And then someone offers that the 'government did this to your child.' And you grab on to it."
Imperato says he is concerned a ruling in favor of the plaintiffs' families, though unlikely, could lead to vaccine shortage problems.
"If the courts were to rule in their favor, one result would be that the few manufacturers who still produce vaccines might abandon the field as have others in the recent past," he says. "This would create a significant childhood vaccine shortage problem in the U.S. with obvious public health consequences."
Hotez shares his concern. "Vaccines don't make a lot of money. We're already down from 20 manufacturers to five. There are, for the first time, shortages of vaccines."
But even if the ruling goes in the manufacturers' favor, many worry that enduring fears over vaccination could have a scare effect among parents -- fears that could lead to a truly frightening situation.
"I've seen kids die of measles, whooping cough, terrible spasms from tetanus," Hotez says. "The thought that that would happen in the United States, it would really be a horrible human tragedy."