Critics Finding Holes in Overseas Vaccination Law

At first glance, the regulation seems beyond debate.

As part of the immigration law passed last year, all individuals seeking permanent entry into this country must prove that they have been inoculated against all vaccine-preventable diseases.

But health experts, especially those who specialize in medical issues for children adopted from abroad, are alarmed that the rule will do more harm than good to the thousands of foreign-born youngsters who arrive here for adoption.

Among other things, the experts are worried about the quality of the vaccines available, as well as the possibility that substandard medical practices will contribute to the transmission of dangerous diseases as vaccines are administered.

“Sometimes, things that seem like good ideas really aren’t,” said Dr. Dana Johnson, director of the University of Minnesota’s division of neonatology. “Apparently no one thought through all the ramifications.”

The requirement, which goes into effect July 1, “potentially endangers vulnerable children,” said Dr. Laurie C. Miller, director of the International Adoption Clinic at New England Medical Center in Boston. “The risk is very real in most countries from which international adoptees come.”

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Johnson said he would prefer that the State Department assume responsibility for overseas vaccination programs rather than trusting local physicians to do the job, but this is considered unlikely.

An alternative touted by some health experts is to waive the requirement for infants and children and allow adoptive families to have the shots administered by their own pediatricians when children arrive--which already occurs in most instances, he said.

Last year, 11,316 children were adopted from overseas, the Immigration and Naturalization Service says.

The numbers of such adoptions have been on the upswing in recent years. As it has become more difficult to adopt U.S.-born babies, Americans have turned to other countries, among them Russia, Romania, India, China and Latin American nations.

Many of these children live in poverty, or have been in orphanages where medical care is scarce or nonexistent. Often there is little or no medical history available on the youngsters, according to the Joint Council on International Children’s Services, a coalition of international adoption agencies.

A chief fear among health experts is that the required injections will be administered with unsterile needles--a frequent practice outside the United States because of a shortage of disposable needles and syringes. This can transmit such potentially deadly blood-borne infections as Hepatitis B and C and HIV. Diseases like Hepatitis B, rare in U.S.-born children, are endemic to Asia and Eastern Europe.

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Furthermore, many countries cannot afford high-quality vaccines more readily available here. Instead, they use biologically impotent products, those that have expired or have not been properly refrigerated or stored.

The experts also are worried that foreign orphanages may not be equipped to deal with medical emergencies that could result from vaccinations. Some children, for example, are allergic to certain vaccines. And some vaccines, such as polio, are made from live but weakened virus and actually can cause the disease in a small number of children.

Rep. Bill McCollum (R-Fla.), House sponsor of the vaccination provision, expressed surprise at the concerns being raised. He said: “It certainly wasn’t meant to put anyone’s health at risk. If that’s the case, then maybe we ought to explore it and, if necessary, correct it.”

But a spokesman for Sen. Jon Kyl (R-Ariz.), who sponsored the provision in the Senate, said the law provides for waivers to the requirement in certain circumstances. These include religious objections or cases where the injections are deemed “medically inappropriate.”

The latter includes situations in which a child is too young to be vaccinated or in which an individual is known to be allergic to a vaccine. However, the waiver provisions do not appear to apply to questionable vaccine standards or sterilization practices.