Bill limiting vaccines alarms isle doctors
Opponents say the ban on mercury-containing preservatives could spark an immunization crisis
Hawaii medical organizations are urging Gov. Linda Lingle to veto a bill that would ban vaccines with any mercury in 2007-2008 except in cases of shortage.
Some vaccines contain thimerosal, a preservative that contains ethyl mercury, which protects the liquid from bacteriological contamination. Manufacturers have removed thimerosal from typical vaccines for kids, but some still contain the preservative, such as a flu shot, tetanus-diphtheria booster shot and a vaccine for meningococcal (meningitis) infection, said Dr. Galen Chock.
According to the Academy of Pediatrics, thimerosal:
» Is an organic, mercury-based preservative used in vaccines.
» Has been used as an additive to vaccines since the 1930s, because it is effective in preventing bacterial and fungal contamination, particularly in opened multidose containers.
» Is also found in other medicines and products, including some throat and nose sprays and contact lens solutions.
Studies show no safety problems with ethyl mercury, unlike toxic methyl mercury accumulated by fish from the environment, doctors say.
The measure before the governor, SB 2133 SD2, HD 2, CD1, stipulates that flu vaccine with no more than a trace of mercury be used in the 2006-2007 flu season for children under age 12 and pregnant women if it is available.
Dr. Linda Rosen, state Health Department deputy director, said the bill would not have much effect in the first year because those populations already have preference for thimerosal-free flu vaccine.
But she is concerned that the bill excludes even a trace amount of mercury in vaccines for all adults in the following year. She said there is not a consistent supply of thimerosal-free vaccine and will not be in the near future.
The vaccine restrictions were added to a bill with the unrelated goal of establishing a Hawaii Health Commission.
The American Academy of Pediatrics, Hawaii Chapter, Hawaii Medical Association and Kaiser Permanente are among opponents of the vaccine section, which they say would confuse people and impede efforts to encourage vaccinations.
Julianne and Don King of Lanikai, parents of an autistic son, say a rise in autism in the United States coincides with the increase in vaccines in the 1980s.
They were among citizens pushing for legislation to prohibit vaccines with thimerosal in the recent session. Rep. Thomas Waters (D, Lanikai-Waimanalo) introduced a bill that passed the House but died in the Senate.
American Academy of Pediatrics members were "totally surprised" that compromise language from Waters' bill was tacked onto SB 2133 in the last minutes of the session and passed to the governor, said Chock, chapter vice president.
"We think the legislation offers no benefit to the children of Hawaii and has the potential to create a lot of harm in the vaccination programs established for children," he said.
The vaccine-mercury issue has been controversial across the country. Six states have enacted legislation to ban vaccines with mercury, and 14 other states have introduced similar legislation.
Hawaii medical groups and health officials stress that medical research does not support fears of a link between thimerosal and autism.
Chock said the medical community is aware of the rise in autism and looking for the cause, "but it's pretty clear from medical research it is not related to vaccines and thimerosal."
The Kings, in an e-mail, called the compromise language "a good start," but in the 2006-2007 season "it is not a ban, and it is loosely written, so that many women and children may still slip through the holes."
The Kings said they would ask state Health Director Chiyome Fukino to file for an exemption to the mercury-free vaccine requirements "only if absolutely necessary."
They said they were encouraged also because the bill expands limits on mercury in vaccines in 2007-2008, but note that it has a June 30, 2009, repeal clause, so they would have to try to get legislation passed again.
"At that point we are hopeful that public awareness of the issue will have increased and that scientific evidence of the potential harm of mercury in vaccines will be available," they wrote.
SB 2133 originally proposed that a placenta could be released by a hospital to the birth mother. That was eliminated from the Senate bill as it moved through the Legislature, and another bill was passed and signed by the governor to authorize release of placentas.
"I'm not against taking mercury out of vaccine," Rosen said, "but what is the trade-off?" As a doctor, she said she is more concerned about the risks of influenza than thimerosal.
"Our concern is this will make more people afraid of immunizations and reluctant to immunize children," she said.
Paula Arcena, Hawaii Medical Association executive director, said the ban on any vaccine with thimerosal "not only affects the availability of flu vaccine, but routine vaccinations of children from birth to 18 months. It's a huge public health issue and concern."
Chock said the bill would create "a very complicated process" and send the wrong message to the public that the state is declaring vaccines unsafe. Dr. Cynthia Nakasato, Kaiser Permanente pediatrician, said the bill was not spelled out well and was "overreaching not to allow any amount (of mercury) in any vaccine.
"In a lot of manufacturing processes there is some thimerosal, so we're at a loss next year," she said. "I don't think people realize the impact."
Nakasato said Kaiser uses a combination vaccine to protect children against diphtheria, tetanus, pertussis, hepatitis B and polio, and it would be banned. "Children may end up getting five or six shots at one time," Nakasato said.
Travelers to other countries also receive vaccines with thimerosal for encephalitis, she pointed out.
"I'm very concerned that this would really lead to babies not being immunized, or a vulnerable population not being immunized unless we break the law," she said, adding that choices should be left to parents.
In the event of an influenza pandemic, Chock said vaccines likely would come in multidose files requiring thimerosal as a preservative. "If Hawaii has the product banned, we will have difficulty getting vaccine unless the DOH declares an emergency."
He also noted that most vaccine is delivered through private physician offices in Hawaii and must be ordered in January or February for delivery in August or September.
Thimerosal-free flu vaccine for infants 36 months old through adulthood, including pregnant women, is already sold out for purchase in September, he said.