WASHINGTON - The government began an unprecedented effort Friday to give vaccine critics a say in shaping how the nation researches safety questions surrounding immunizations.
The meeting, the first in a planned series, came amid new controversy about vaccines and autism - and a fledgling theory that vaccinations might worsen a rare condition called mitochondrial dysfunction that in turn triggers certain forms of autism.
Federal health officials said the work, being planned for two years, wasn't in response to that controversy, and encompasses many more questions than autism - from rare side effects of the new shingles vaccine to how to predict who's at risk for encephalopathy sometimes triggered by other inoculations.
A government-appointed working group is charged with picking the most important safety questions for the Centers for Disease Control and Prevention to research over the next five years. What's unique is that the group also is supposed to get significant public input in setting those priorities, an effort to ease skepticism that authorities hide or discount important information about vaccines.
"A crisis of trust is going to be a crisis of public health," said Dr. Bruce Gellin, head of the National Vaccine Program Office.
"There's been a lot of anger and a lot of distrust over issues of vaccine safety," Dr. Andrew Pavia, a University of Utah pediatric infectious disease specialist who is chairing the group, told the meeting Friday.
"There's a need to engage as many voices as possible," he added. "It's a chance to make sure the right questions are going to be asked."
Numerous studies have addressed vaccines and autism and found no link, including with a once-common mercury-based preservative.
The newest question surfaced last month, with news that the government had agreed to pay the family of 9-year-old Hannah Poling for injuries linked to vaccines. Her family said Hannah was a healthy 19-month-old when she received five shots, encompassing nine vaccines. She became sick and later developed autism, and her parents filed a claim under the federal vaccine compensation act. The government granted that claim late last year on the theory that the vaccines aggravated an underlying mitochondrial disorder - although federal health officials have insisted the compensation does not mean vaccines cause autism.
But the mitochondria question is on the list of top research questions the CDC made public Friday.
And Hannah's mother joined other anti-autism advocates Friday in making a plea for that research to speed forward.
"We have a lead, a very strong lead. We need to look at the mitochondria," Terri Poling told the government panel. "We need to identify children at risk, and we need to learn how to immunize them safely. We need to develop methods and criteria to screen for susceptible children. Maybe we need to wait to vaccinate until critical developmental milestones have been met."
Mitochondria are energy factories for cells, and mitochondrial disease - estimated to affect about 1 in 5,000 births - can thus attack any organ, including the brain, by depriving it of energy. Scientists believe that stress such as an infection can set off that cascade of damage in people with underlying mitochondrial dysfunction, but whether a vaccine alone causes enough stress to do so isn't known.
A bigger question for some of the government's advisers Friday was what the CDC's proposed research agenda didn't include - the question of how many vaccines should be given in one visit, and if they're all really needed by age 2.
"We all have to have our kids vaccinated by the time they go into daycare or kindergarten, but ... does it all have to happen in the first two years?" asked panelist Dr. Christopher Carlson of the Fred Hutchinson Cancer Research Center, himself the father of a 9-year-old with a mild type of autism called Asperger's. "I'm not saying there's proof one way or the other. But the lack of options is a concern I think we should think about."