For the parents that converged on a courthouse in Prince George's County, Md., on Saturday morning, the choice seemed clear: Vaccinate your kids or go to jail.
In fact, there are exemptions for medical or religious reasons in the state of Maryland. But few parents standing in lines that stretched down the sidewalk outside the county courthouse said they were aware of them.
Flanked by protesters and television crews, parents said they just wanted to sort out immunizations, so their kids could go back to school – and they could avoid penalties of up to 10 days in jail and $50 a day in fines.
"I've got too many children to raise to go to jail," says Remy Durham, who cares for her nephew, Lamonte Hyter, along with seven other children.
All states require that children be immunized from some childhood diseases, but the crackdown in Prince George's County has attracted international attention.
"We've had calls and e-mail from all over the country, especially the Midwest, as well as England, Germany, and Poland," says Glenn Ivey, state's attorney in Prince George's County, in a phone interview.
A lot of the uproar over the county's new approach to this issue was fueled by misinformation, he said – especially websites that said "we were going to start arresting people." One critic "called me a jackbooted representative of a United Nations, international pharmaceutical conspiracy," he says.
In fact, no decision has been made yet on what steps to take next, and it was never intended to scare people, he says. He's boiled his answer to critics down to one line: "It's about getting kids back in school, not to put parents in jail," he said.
By the start of the 2007 school year, more than 2,800 children in Prince George's County were not in compliance with state mandates on immunizations. The school board asked the courts to help by setting up a date for parents to either have their children vaccinated on site or provide evidence that they were in compliance with the law.
"This seemed like a great idea. We did not order people to do anything. We invited them to the court house to talk about it," said Circuit Court Judge C. Philip Nichols in a phone interview.
Luis Hernandez says that buff-colored letter, which arrived a day before his Nov. 17 court date, got his attention. He gave up a day of work mounting dry wall to figure it out with a judge.
"I was a little afraid to see 'Court House' [on the letterhead]," he said. "I thought: 'Wow, what's wrong? I didn't do anything.' " He unfolds a full-page record of vaccinations and booster shots for his 12-year-old son, Hector. "It's the school that got it wrong," he says.
"That's not necessarily a bad thing," said John White, spokesman for the 132,000-student school system, commenting on this case. "For two years we've been asking parents to get right with the requirements, and now they are."
By the end of the day, more than 100 children had been immunized and some 70 records corrected and updated.
But protesters outside the courthouse say that the summons to the courthouse amounted to a campaign of intimidation, and that parents weren't adequately informed of their rights as parents or possible risks to their children.
"I think it's offensive that the government would forcibly vaccinate kids. Individual rights are a good thing, and when you're dealing with health issues, informed consent is an important value," says Donna Hurlack, a Virginia gynecologist protesting outside the courthouse.
"There was a feeling of intimidation. Children were basically put in that building, lined up and given vaccines without any information given to parents about how to monitor their children for adverse vaccination reactions," says Barbara Loe Fisher, president and cofounder of the National Vaccine Information Center, which advocates for more parental rights in immunization.
She notes that many of the parents she met said they had lost records, and that children may have been revaccinated.
"Vaccines carry risks. Those risks are greater for some than others. At the very least there should have been screening for those children and information given to parents," Ms. Fisher adds.
"The heavy-handed 'vaccine roundup' instigated by Mr. Ivey obliterates informed consent and parental rights," said the Association of American Physicians and Surgeons, Inc. in a Nov. 18 letter to Maryland Gov. Martin O'Malley.
"Vaccines can and do save lives.... But this episode has demonstrated that we must take a much more deliberative approach in crafting and enforcing vaccine policy without sacrificing the rights and liberties of individuals and families," the letter stated.
Twenty-eight states, including Florida, Massachusetts, and New York, allow parents to opt out of required vaccinations only for medical or religious reasons. Twenty others, such as California, Texas, Pennsylvania, and Ohio, also permit parents to give personal or philosophical reasons. Mississippi and West Virginia allow exemptions only for medical reasons, according to the Associated Press.