Polio vaccine debate hits High Court

As hundreds of thousands of children are inoculated against the virus, judges must decide whether the campaign is safe

A child is inoculated with the oral polio vaccine at a children's health clinic in Jerusalem. (Yonatan Sindel/Flash90)
A child is inoculated with the oral polio vaccine at a children's health clinic in Jerusalem. (Yonatan Sindel/Flash90)

A petition filed with the High Court of Justice demands that the government stop its current campaign of vaccinating children against polio, claiming that, among other things, the solution could be a lot more dangerous than the problem itself.

Yaakov Gurman, director of the Izun Hozer organization, which filed the petition, told The Times of Israel that the risks inherent in the few samples of the wild strain polio virus discovered in several places in Israel could be multiplied many times over once a million kids are given the oral polio vaccine (OPV) — essentially a weakened form of polio that, like most inoculations, introduces the virus and lets the body build up a resistance by developing the antibodies needed to battle a full-on invasion of polio.

“One of the reasons they stopped inoculating children with OPV in 2005 was because it caused an outbreak of polio, with dozens contracting the disease each year,” said Gurman. “The current situation is even worse, because the reconstituted OPV uses a somewhat different formula, and has never been used in Western countries.”

It has, however, been used in India and Nigeria, and in both those countries, the rates of non-polio acute flaccid paralysis (NPAFP) climbed. NPAFP is a disease that partially or fully paralyzes children, as polio does (although it is not necessarily connected to polio).

In fact, a study by several prominent Indian physicians shows a correlation between a sharp increase in NPAFP rates among children over the past decade, the period when Indian authorities aggressively attacked polio with OPV. Data published by the World Health Organization identified 8,000 cases of NPAFP in the country in 2003, when inoculations began in earnest, shooting up to more than 60,000 cases identified by 2011.

In its High Court petition, the Izun Hozer group alleges that the use of the oral vaccine is dangerous. Part of the strategy, said New York pediatrician and author Dr. Stuart Ditchek, is to actually spread the disease around in order to “infect” others who have not taken the vaccine.

“Historically, wild polio virus exposures have been put to rest by utilizing the strategy of implementing the live oral polio vaccine,” Ditchek told The Times of Israel. “By using oral polio vaccine, the recipient actually sheds small amounts of live polio virus and passes on the exposure to others by fecal-oral route. Simply put, when you give one child the OPV, three others will likely also receive it as the virus is shed in stool and passed on to others.”

The strategy is tried and true and has successfully tamped outbreaks in many areas, said Ditchek, but Izun Hozer claims in its petition that the program is risky at best and dangerous at worst.

“Whatever the risk there is of a wild strain of polio in the environment, all medical authorities agree that the worst damage could be that several dozen people may get infected, and it is not at all clear that they will suffer from the worst consequences of the disease,” said Gurman. “Now, with the virus in the bodies of a million children, polio will be spread far and wide. What will happen if the disease mutates and gets out into the environment? If the authorities are worried about a plague, that’s the one to worry about.”

Endangering Israelis in this way, he added, violates Israel’s Basic Law on Human Dignity, and laws on the rights of patients, Gurman added.

Gurman said he can only guess at the reasons behind the vaccination program, but Izun Hozer’s Facebook page (Hebrew), where members of the group contribute articles and opinions, has plenty of ideas.

According to posts on the page, there are many unanswered questions about the program, among them the connection between the ministry and the manufacturer of the vaccine being distributed in Israel, GlaxoSmithKline. The state is getting a bargain rate for the vaccines, paying less than half a shekel per child.

“Why are they selling it so cheap? GSK is supposed to be a profit-making company,” one member wrote.

Other posts attribute the reason for the program to “experiments on the Israeli public” or to simple panic on the part of authorities who are trying to put into place a program that will “protect them from media criticism. If a major outbreak occurs, at least they can say they tried.”

“This is the age of the Internet,” said Gurman. “In the past the authorities were able to hide information from us, but now they cannot. We have found dozens of scientific studies that show how dangerous this operation is, and the Israeli people should not have to be subjected to this.”

Gurman stressed that he is not against inoculations in general, and said media attempts to portray him and others who question the medical establishment as irrational and primitive-minded are unfair and intellectually dishonest.

“They try to paint us, to paint me, as a hillbilly fanatic anti-intellectual, but actually they are the anti-intellectuals, swallowing the ‘party line’ as it is fed to them. We base our opposition to this project on scientific studies and research. There are many doctors around the world who agree with us. Our organization advocates healthy living and healthy eating, which by itself can provide the human body with much of the protection it needs from many kinds of diseases,” he said.

The court gave the state until Thursday to respond to the petition. In a statement, the Health Ministry said, “Israel is a democratic state in which any citizen is free to appeal to the High Court on any issue. Doctors throughout the entire health system in Israel have accepted that steps need to be taken to prevent an outbreak of polio and to ensure the public’s health. The reasons for our decision and our answers to the specific points raised in the petition will be presented in court. We are sure that the court will agree with us that there was a great need to inoculate Israeli children against polio.”

Ditchek agrees. “The benefits of using OPV by far outweigh the risks in this scenario, thus the recommendation,” he said. “The recommendation being implemented in Israel is smart and guided by advisement of the [US] Centers for Disease Control. The group in the lawsuit simply disregards the CDC as an honest adviser,” and thereby risks the public’s health, he said. “There is no documentation scientifically of their concerns.”

Other experts dismissed the group’s concern regarding acute flaccid paralysis. Professor Dan Engelhard, a top pediatrician in the Department of Pediatrics at Hadassah Ein-Kerem Hospital, said that the OPV formula in Israel is different from the one administered in India. There is little if any risk of acute flaccid paralysis, according to a Beit Shemesh pediatrician who attended a recent guidance session.

“The beauty of vaccine science is that countries and communities have to adapt based on need and circumstance,” said Ditchek. “The oral vaccine is clearly the better choice during wild polio variant outbreaks. Yes, there is a minimal increased risk for rare side effects with the oral version but the CDC and World Health Organization know the epidemiology of the outbreak and use very sophisticated analysis when making these recommendations.

“Wild strain polio is simply dangerous and can easily trigger a much wider outbreak. No rational person could argue the conscientious CDC/WHO advisory.”

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