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"In mandatory immunization programs, a system of conscription is employed to recruit soldiers for this anti-disease campaign. Most of the recruits in the war on infectious disease are children...As in all wars, some soldiers are injured...At present, the draftees who are injured in the war on infectious diseases are in effect told by the conscripting authorities, 'Thank you for your contribution to the war effort, and best of success in coping with your disability.' In the military context, such treatment of wounded soldiers and their families would be unthinkable."

-Dr. Leroy B. Walters, Center for Bioethics, Washington, 1979.

WASHINGTON -- When the concerned Dr. Walters made this statement, American children were vaccinated agains a half-dozen or so diseases. Today, the mandatory number is 10 disease, with multiple shots. Parents and pediatricians--some of whom are already complaining--ain't seen nuthin' yet. After the first decade of the new century, there may be two dozen more new childhood vaccines.

The National Institutes on Health says that estimate may be conservative. At midsummer, the National Institute for Allergy and Infectious Diseases counted 104 separate vaccines various stages of research and development for everything from herpes to ricketts to stomach ulcers. Private lab researchers in Massachusetts are even working on a vaccine that would protect against cocaine addiction by eliciting antibodies that would prevent the drug from triggering response in the brain's pleasure centers. Administration of such a shot is another problem.

In all, 98 separate vaccines are licensed by the Food and Drug Administration against 28 diseases. Not all of the new vaccines in the pipeline are aimed at children, of course, but the idea of a "supervaccine"--given orally at birth, perhaps, with microscopic time-release particles dissolving over time--is increasingly talked of in federal health circles. The Children's Vaccine Initiative, a global organization of several private and government groups, spurred on by estimates from the World Health Organization that as many as 8 million children around the planet die each year from preventable diseases, envisions development within a decade, costing perhaps $500 million.

The "supervaccine" would not only cover the existing childhood protections against mumps, measles, rubella, chicken pox, polio, whooping cough, tetanus, diphtheria, hepatitis B, and meningitis. It would target several varieties of other illnesses, including pneumonia, typhoid, encephalitis, diarrhea, strep and influenza. Others think success will be much more incremental. A supervaccine, said John LaMontagne, director of the NIH division of microbiology and infectious diseases, is "many, many years down the road." What's far more likely, he said, are four new childhood vaccines within the next five years:

• Rotavirus (a form of diarrhea), which the FDA licenses Monday.
• Children's Influenza (probably a nasal flu mist).
• Pneumoccocal infections (including one that leads to the middle-ear affliction called "otitis media," today's single leading cause of pediatric visits).
• Respiratory Syncytial Virus (a form of viral pneumonia, or "croup").

With 2-year-olds facing as many as four injections in a single pediatric visit, the number of shots is already a problem. Bruce G. Weniger, the Centers for Disease Control's assistant chief for vaccine development, said earlier this summer that many parents and physicians balk at this number. "Children are not pincushions," he said.

As a result, scientists and federal health policy makers are trying to combine new and existing vaccines. Weniger and a team of CDC researchers listed all the existing brands, types and combinations of required vaccines, and found more than 16,000 distinct vaccine stocking lists are possible for providers to assemble. This, Weniger said, amounts to "combination chaos." Costs for all childhood shots, from birth to 6 years, range from roughly $450 to $530, the CDC estimates. No one has assembled a projected cost for the new vaccines listed above.

Some scientists are squawking now about the number of shots babies will have to take. One is Dr. J. Anthony Morris, the former FDA research virologist who first labeled the notorious swine flu vaccine dangerous in 1976. He thinks undeveloped immune systems of those so young are particularly susceptible to damage from overload. "That is absolutely the wrong approach, to give so many new vaccines," he said.

LaMontagne at NIH thinks there's little to worry about. "There is a lot we need to learn about the maturing immune system of a child," he acknowledged. "But I don't know there is a limit on the number of antigens a child can respond to. There is a day-in, day-out continual assault on the immune system in natural surroundings anyway. I don't know that vaccines are that much worse."
 
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