Just a month short of 3 years old, Robert is healthy, but has had some food allergies that were first thought to be asthma. Asthmatic children, as well as those who have diabetes, cerebral palsy or other heart or lung conditions are recommended to be among the first to get the vaccine. But Stuart-Nystrom, who feels confident that her son's "asthmatic" episode has been managed by dietary changes, says that she too will probably take a pass on vaccinating her child when the time comes.
"I haven't seen enough evidence to show that swine flu is as deadly and as scary as it's made out to be," says Stuart-Nystrom, who last week was fighting a respiratory infection. Stuart-Nystrom thinks that media outlets have whipped up the threat in a bid to gain viewers. And "anything brought out by big business, by corporations, that makes me wary for sure. . . . I'm not sure they have our interests in mind."
She also voiced the widely held belief that immunity acquired the natural way -- through a child's having caught an illness -- is stronger and longer-lasting than that acquired by vaccination. That claim is much debated among physicians and infectious-disease specialists, with evidence falling on both sides of the debate.
In approaching childhood vaccines in general, neither Stuart-Nystrom nor Reed is reflexively against them. Each woman has had her child immunized against a wide range of childhood diseases. But each has also decided to wait, at least, for her child to get older before getting the vaccine cocktail that immunizes against measles, mumps and rubella. Though the MMR vaccine has not been formulated with the preservative thimerosol since 2001, it remains a common source of concern among parents, because many families of children with autism, as well as vaccine refusers, have charged that the MMR vaccine is the cause of the developmental disorder.
Some formulations of the H1N1 influenza vaccine are expected to contain a small amount of thimerosol to prevent contamination during manufacture and shipment. The American Academy of Pediatrics, in an effort to blunt these and other concerns, recently posted to its website an exhaustive accounting of studies that have failed to link thimerosol with harm. But the preservative's low-level presence in some flu vaccines, including some H1N1 formulations that will be offered for children this year, may make some pediatricians and parents squeamish. Some parents will seek out formulations that are free of the preservative, but others may just stay away.
Finally, there is the hassle factor. As busy parents ponder the prospect of bringing their kids to the doctor twice -- once for a seasonal flu shot and again for the H1N1 vaccine -- some are expected to take their chances with less vaccine than recommended. If the H1N1 flu appears to have run its course before vaccine becomes available, many parents may decide their kids can skip both vaccines altogether.
"Complacency is a big challenge," Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases, noted recently. Federal officials, she added, "are trying to strike a balance between complacency and alarm" as they undertake what many believe will be a mass-vaccination of unprecedented scale.
For Reed and Stuart-Nystrom, neither complacency nor alarm is the problem. The problem is a swirling debate in which opinion passes for science and the motives of long-trusted sources -- physicians, scientists and government health officials -- have come in for questioning.
"There's so much information out there," Stuart-Nystrom says. "The scary thing is, you don't know what's right and what's wrong."