On April 11, 2008, the National Vaccine Advisory Committee took an unusual step: in the name of transparency, trust, and collaboration, it asked members of the public to help set its vaccine-safety research agenda for the next 5 years. Several parents, given this opportunity, expressed concern that vaccines might cause autism — a fear that had recently been fueled by extensive media coverage of a press conference involving a 9-year-old girl named Hannah Poling.
When she was 19 months old, Hannah, the daughter of Jon and Terry Poling, received five vaccines — diphtheria–tetanus–acellular pertussis,
Haemophilus influenzae type b (Hib), measles–mumps–rubella (MMR), varicella, and inactivated polio. At the time, Hannah was interactive, playful, and communicative. Two days later, she was lethargic, irritable, and febrile. Ten days after vaccination, she developed a rash consistent with vaccine-induced varicella.
Months later, with delays in neurologic and psychological development, Hannah was diagnosed with encephalopathy caused by a mitochondrial enzyme deficit. Hannah's signs included problems with language, communication, and behavior — all features of autism spectrum disorder. Although it is not unusual for children with mitochondrial enzyme deficiencies to develop neurologic signs between their first and second years of life, Hannah's parents believed that vaccines had triggered her encephalopathy. They sued the Department of Health and Human Services (DHHS) for compensation under the Vaccine Injury Compensation Program (VICP) and won.
On March 6, 2008, the Polings took their case to the public. Standing before a bank of microphones from several major news organizations, Jon Poling said that “the results in this case may well signify a landmark decision with children developing autism following vaccinations.”
1 For years, federal health agencies and professional organizations had reassured the public that vaccines didn't cause autism. Now, with DHHS making this concession in a federal claims court, the government appeared to be saying exactly the opposite. Caught in the middle, clinicians were at a loss to explain the reasoning behind the VICP's decision.
The Poling case is best understood in the context of the decision-making process of this unusual vaccine court. In the late 1970s and early 1980s, American lawyers successfully sued pharmaceutical companies claiming that vaccines caused a variety of illnesses, including unexplained coma, sudden infant death syndrome, Reye's syndrome, transverse myelitis, mental retardation, and epilepsy. By 1986, all but one manufacturer of the diphtheria–tetanus–pertussis vaccine had left the market. The federal government stepped in, passing the National Childhood Vaccine Injury Act, which included the creation of the VICP. Funded by a federal excise tax on each dose of vaccine, the VICP compiled a list of compensable injuries. If scientific studies supported the notion that vaccines caused an adverse event — such as thrombocytopenia after receipt of measles-containing vaccine or paralysis after receipt of oral polio vaccine — children and their families were compensated quickly, generously, and fairly. The number of lawsuits against vaccine makers decreased dramatically.
