The vaccine news that flooded the media recently is bound to raise much concern among parents and healthcare providers. At the core of the issue is the "admission" by government scientists that childhood vaccines "could have contributed" to the development of autistic behavior in a child born with mitochondrial disease, and therefore allowing the family to receive financial compensation because of "vaccine injury."

As a pediatrician specialized in infectious diseases, I have seen vaccine issues from various points of view, listening to worried parents and understanding policies from public health perspectives. It is clear that decades of controversy will not end with the removal of thimerosal from current vaccines, as skeptics will just take on other agents or additives as "other causes of vaccine injury."

Public health authorities make vaccine recommendations based on many factors:

• Disease epidemiology and impact on health of individuals and society

• Benefits of vaccine-induced immunity far outweighing potential vaccine side-effects and

• Projected or proven cost-effectiveness of vaccine programs to maintain quality life for the individual, at an affordable expense to society.

The outcome of these complex analyses is an immunization program simple enough to be implemented at a large population level, but that is too often designed as a "one-size-fits-all" policy.

Parents and individuals make their health decisions differently. Certainly for most, "expert opinion" matters. For others, trust or distrust play a more significant role.

May I even say that medicine, like religion, is a matter of faith. Just as there never is enough "scientific reasoning" or "evidence" that will change the mind of someone who believes in creationism and not in the theory of evolution, there never will be enough safety data to reassure skeptics who have already chosen not to weigh in the overall benefits of vaccines.

So, where do we go from here? I believe we can all be helped if we re-examine our vaccine policies at the public health level, and make reasonable decisions at a personal level.

Some vaccine policies that were made from old data should be updated to reflect the changing epidemiology of diseases in the new century.

Except for pertussis, diphtheria and tetanus, and a couple of bacterial infections (Haemophilus influenzae and pneumococcus) which can cause life-threatening diseases in infants, the risk of exposure to other vaccine-

preventable diseases is extremely rare among American children.

There are rare reports of illness from imported cases or travel (such as for measles, rubella, or poliomyelitis) or household exposure (like hepatitis B). For these diseases, with an increasing herd immunity due to current vaccine programs, it may be possible to re-schedule

vaccine administration until infants have been screened for early autism signs, now possible by a year or two of age, or even as early as 6 months. Better late than never.

For parents, I still urge everyone to follow the current immunization schedule, which is safe and effective for the vast majority of children. Discuss with your child's provider to ease your fears, or to select and prioritize the vaccines for which the risk-benefits are immediately relevant for your infant' s health. And then proceed with all catch-up immunizations when the fear of autism has passed.

Sir William Osler said it best over a century ago: "Medicine is an art of uncertainty, and a science of probability." As humans, we do not make the same choice even if given the same chance of probability or uncertainty, yet all life decisions are a balance of perceived benefits versus risks. When making choices for our children, let us do so not out of fear, but out of trust.

Dr. Chinh Le of Corvallis is a pediatrician at the Benton County Community Health Clinic. His views do not necessarily represent those of the Benton County Public Health Department or the American Academy of Pediatrics.