text:
Thimerosal in Vaccines
See also "Mercury in Plasma-Derived Products"
- Introduction
- Preservatives in Vaccines
- Thimerosal as a Preservative
- Guidelines on Exposure to Organomercurials
- Thimerosal Toxicity
- Recent and Future FDA Actions
- The Safety Review of Thimerosal-containing Vaccines and Neurodevelopmental Disorders Conducted by the Institute of Medicine
- Tables
- Table 1. Thimerosal Content of the Routinely Recommended Pediatric Vaccines
- Table 2. Preservatives in U.S. Licensed Vaccines
- Table 3. Thimerosal and Expanded List of vaccines
- References
- Bibliography
Additional Information on Thimerosal:
- Frequently Asked Questions (FAQs) on Thimerosal in Vaccines
- Institute of Medicine: Immunization Safety Review: Vaccines and Autism
- National Institutes of Health, National Institute of Allergy and Infectious Diseases
- HRSA - National Vaccine Injury Compensation Program (VICP)
Thimerosal is a mercury-containing organic compound (an organomercurial). Since the 1930s, it has been widely used as a preservative in a number of biological and drug products, including many vaccines, to help prevent potentially life threatening contamination with harmful microbes. Over the past several years, because of an increasing awareness of the theoretical potential for neurotoxicity of even low levels of organomercurials and because of the increased number of thimerosal containing vaccines that had been added to the infant immunization schedule, concerns about the use of thimerosal in vaccines and other products have been raised. Indeed, because of these concerns, the Food and Drug Administration has worked with, and continues to work with, vaccine manufacturers to reduce or eliminate thimerosal from vaccines.
Thimerosal has been removed from or reduced to trace amounts in all vaccines routinely recommended for children 6 years of age and younger, with the exception of inactivated influenza vaccine (see Table 1). A preservative-free version of the inactivated influenza vaccine (contains trace amounts of thimerosal) is available in limited supply at this time for use in infants, children and pregnant women. Some vaccines such as Td, which is indicated for older children (≥ 7 years of age) and adults, are also now available in formulations that are free of thimerosal or contain only trace amounts. Vaccines with trace amounts of thimerosal contain 1 microgram or less of mercury per dose.
In the following pages, a discussion of preservatives, the use of thimerosal as a preservative, guidelines on exposure to organomercurials (primarily methylmercury), thimerosal toxicity, recent and future FDA actions, and the conclusions of the Institute of Medicine's most recent review of thimerosal in vaccines are presented. This narrative on thimerosal contains references to the literature and links to other sites for readers who wish additional information; for quick reference, a number of frequently asked questions (FAQs) and answers are provided.
To begin, we need to answer two questions-what are preservatives and why are they used in vaccines. For our purposes, preservatives may be defined as compounds that kill or prevent the growth of microorganisms, particularly bacteria and fungi. They are used in vaccines to prevent microbial growth in the event that the vaccine is accidentally contaminated, as might occur with repeated puncture of multi-dose vials. In some cases, preservatives are added during manufacture to prevent microbial growth; with changes in manufacturing technology, however, the need to add preservatives during the manufacturing process has decreased markedly.
The United States Code of Federal Regulations (the CFR) requires, in general, the addition of a preservative to multi-dose vials of vaccines; indeed, worldwide, preservatives are routinely added to multi-dose vials of vaccine. Tragic consequences have followed the use of multi-dose vials that did not contain a preservative and have served as the impetus for this requirement. One particularly telling incident from Australia is described by Sir Graham S. Wilson in his classic book, The Hazards of Immunization
In January 1928, in the early stages of an immunization campaign against diphtheria, Dr. Ewing George Thomson, Medical Officer of Health of Bundaberg, began the injection of children with toxin-antitoxin mixture. The material was taken from an India-rubber-capped bottle containing 10 mL of TAM. On the 17th, 20th, 21, and 24th January, Dr. Thomson injected subcutaneously a total of 21 children without ill effect. On the 27th a further 21 children were injected.Of these children .eleven died on the 28th and one on the 29th. (Wilson 1967)
This disaster was investigated by a Royal Commission and the final sentence in the summary of their findings reads as follows:
The consideration of all possible evidence concerning the deaths at Bundeberg points to the injection of living staphylococci as the cause of the fatalities.
From this experience, the Royal Commission recommended that biological products in which the growth of a pathogenic organism is possible should not be issued in containers for repeated use unless there is a sufficient concentration of antiseptic (preservative) to inhibit bacterial growth.
The U.S. requirement for preservatives in multi-dose vaccines was incorporated into the CFR in January 1968, although many biological products had contained preservatives, including thimerosal, prior to this date. Specifically, the CFR states:
Products in multi-dose containers shall contain a preservative, except that a preservative need not be added to Yellow Fever Vaccine; Polio-virus Vaccine, Live Oral; viral vaccine labeled for use with the jet injector; dried vaccines when the accompanying diluent contains a preservative; or to an Allergenic Product in 50 percent or more volume (v/v) glycerin. [21 CFR 610.15(a)]
The CFR also requires that the preservative used
.[s]hall be sufficiently non-toxic so that the amount present in the recommended dose of the product will not be toxic to the recipient, and in combination used it shall not denature the specific substance in the product to result in a decrease below the minimal acceptable potency within the dating period when stored at the recommended temperature. [21 CFR 610.15(a)]
Preservatives cannot completely eliminate the risk of contamination of vaccines. The literature contains several reports of bacterial contamination of vaccines despite the presence of a preservative, emphasizing the need for meticulous attention to technique in withdrawing vaccines from multi-dose vials. (Bernier et al 1981; Simon et al. 1993). The need for preservatives in multi-dose vials of vaccines is nonetheless clear. Several preservatives are used in U.S. licensed vaccines, and these are listed in Table 2. It is important to note that the FDA does not license a particular preservative; rather, the product containing that preservative is licensed, with safety and efficacy data generally collected in the context of a license application for a particular product.
Thimerosal, which is approximately 50% mercury by weight, has been one of the most widely used preservatives in vaccines. It is metabolized or degraded to ethylmercury and thiosalicylate. Ethylmercury is an organomercurial that should be distinguished from methylmercury, a related substance that has been the focus of considerable study (see "Guidelines on Exposure to Organomercurials" and "Thimerosal Toxicity", below).
At concentrations found in vaccines, thimerosal meets the requirements for a preservative as set forth by the United States Pharmacopeia; that is, it kills the specified challenge organisms and is able to prevent the growth of the challenge fungi (U.S. Pharmacopeia 2004). Thimerosal in concentrations of 0.001% (1 part in 100,000) to 0.01% (1 part in 10,000) has been shown to be effective in clearing a broad spectrum of pathogens. A vaccine containing 0.01% thimerosal as a preservative contains 50 micrograms of thimerosal per 0.5 mL dose or approximately 25 micrograms of mercury per 0.5 mL dose.
Prior to its introduction in the 1930's, data were available in several animal species and humans providing evidence for its safety and effectiveness as a preservative (Powell and Jamieson 1931). Since then, thimerosal has been the subject of several studies (see Bibliography) and has a long record of safe and effective use preventing bacterial and fungal contamination of vaccines, with no ill effects established other than minor local reactions at the site of injection.
While the use of mercury-containing preservatives has declined in recent years with the development of new products formulated with alternative or no preservatives, thimerosal has been used in some immune globulin preparations, anti-venins, skin test antigens, and ophthalmic and nasal products, in addition to certain vaccines. Under the FDA Modernization Act of 1997, the FDA compiled a list of regulated products containing mercury, including those with thimerosal (Federal Register 1999). It is important to note that this list was compiled in 1999; some products listed are no longer manufactured and many products have been reformulated without thimerosal. Updated lists of vaccines and their thimerosal content can be found in Table 1 (routinely recommended pediatric vaccines) and Table 3 (expanded list of vaccines).
Guidelines on Exposure to Organomercurials
Mercury is an element that is dispersed widely around the earth. Most of the mercury in the water, soil, plants and animals is found as inorganic mercury salts. Mercury accumulates in the aquatic food chain, primarily in the form of the methylmercury, an organomercurial. Organic forms of mercury are more easily absorbed when ingested and are less readily eliminated from the body than are inorganic forms of mercury. Humans are exposed to methylmercury primarily from the consumption of seafood (Mahaffey et al. 1997).
Methylmercury is a neurotoxin. The toxicity of methylmercury was first recognized during the late 1950s and early 1960s when industrial discharge of mercury into Minimata Bay, Japan led to the widespread consumption of mercury-contaminated fish (Harada 1995). Epidemics of methylmercury poisoning also occurred in Iraq during the 1970s when seed grain treated with a methylmercury fungicide was accidentally used to make bread (Bakir et al. 1973). During these epidemics, fetuses were found to be more sensitive to the effects of methylmercury than adults. Maternal exposure to high levels of methylmercury resulted in infants exhibiting severe neurologic injury including a condition resembling cerebral palsy, while their mothers showed little or no symptoms. Sensory and motor neurologic dysfunction and developmental delays were observed among some children who were exposed in utero to lower levels of methylmercury.
More recently, several epidemiological studies have examined the effect of low dose dietary exposure to methylmercury, with inconsistent results. Studies from the Faroe Islands reported that subtle cognitive deficits (e.g., performance on attention, language, and memory tests), detectable by sophisticated neuropsychometric testing, were associated with methylmercury levels previously thought to be safe (Grandjean et al 1997). Studies in the Seychelles, evaluating more global developmental outcomes, did not reveal any correlation between abnormalities and methylmercury levels (Davidson et al. 1998).
Various agencies have developed guidelines for safe exposure to methylmercury, including the U.S. Environmental Protection Agency (Mahaffey et al. 1997), U.S. Agency for Toxic Substances and Disease Registry (ATSDR 1999), the FDA (Federal Register 1979)1, and the World Health Organization (WHO 1996). These exposure levels range from 0.1 µg/kg body weight/day (EPA) to 0.47 µg/kg body weight/day (WHO)2. The range of recommendations is due to varying safety margins, differing emphasis placed on various sources of data, the different missions of the agencies and the population that the guideline is intended to protect. All guidelines, however, fall within the same order of magnitude. While these guidelines may be used as screening tools in risk assessment to evaluate the "safety" of mercury exposures, they are not meant to be bright lines above which toxicity will occur. However, as exposure levels increase in multiples of these guidelines, there is increasing concern on the part of the public health community that adverse health consequences may occur (Mahaffey 1999).
To address the issue of conflicting methylmercury exposure guidelines, Congress asked the National Academy of Sciences to study the toxicological effects of methylmercury and provide recommendations on the establishment of a scientifically appropriate methylmercury reference dose (RfD) (National Research Council 2000; http://www.nap.edu/catalog/9899.html). Their report concluded that the EPA's current reference dose, the RfD, for methylmercury, 0.1 µg/kg/day is a scientifically justifiable level for the protection of human health. The FDA is considering this and other data relevant to its exposure guideline for methylmercury.
The various mercury guidelines are based on epidemiological and laboratory studies of methyl mercury, whereas thimerosal is a derivative of ethyl mercury. Because they are different chemical entities - ethyl- versus methylmercury - different toxicological profiles are expected. There is, therefore, an uncertainty that arises in applying the methylmercury-based guidelines to thimerosal. Lacking definitive data on the comparative toxicities of ethyl- versus methylmercury, FDA considered ethyl- and methyl-mercury as equivalent in its risk evaluation. There are some data and studies bearing directly on thimerosal toxicity and these are summarized in this Section.
Allergic responses to thimerosal are described in the clinical literature, with these responses manifesting themselves primarily in the form of delayed-type local hypersensitivity reactions, including redness and swelling at the injection site (Cox and Forsyth 1988; Grabenstein 1996). Such reactions are usually mild and last only a few days. Some authors postulate that the thiosalicylate component is the major determinant of allergic reactions (Goncalo et al. 1996). In a clinical setting, however, it is usually not possible to determine whether local reactions are caused by thimerosal or other vaccine components.
The earliest published report of thimerosal use in humans was published in 1931 (Powell and Jamieson 1931). In this report, 22 individuals received 1% solution of thimerosal intravenously for unspecified therapeutic reasons. Subjects received up to 26 milligrams thimerosal/kg (1 milligrams equals 1,000 micrograms) with no reported toxic effects, although 2 subjects demonstrated phlebitis or sloughing of skin after local infiltration. Of note, this study was not specifically designed to examine toxicity; 7 of 22 subjects were observed for only one day, the specific clinical assessments were not described, and no laboratory studies were reported.
Several cases of acute mercury poisoning from thimerosal-containing products were found in the medical literature with total doses of thimerosal ranging from approximately 3 mg/kg to several hundred mg/kg. These reports included the administration of immune globulin (gamma globulin) (Matheson et al. 1980) and hepatitis B immune globulin (Lowell et al. 1996), choramphenicol formulated with 1000 times the proper dose of thimerosal as a preservative (Axton 1972), thimerosal ear irrigation in a child with tympanostomy tubes (Rohyans et al. 1994), thimerosal treatment of omphaloceles in infants (Fagan et al. 1977), and a suicide attempt with thimerosal (Pfab et al. 1996). These studies reported local necrosis, acute hemolysis, disseminated intravascular coagulation, acute renal tubular necrosis, and central nervous system injury including obtundation, coma, and death. (IOM)
Several animal studies have evaluated the toxicity of thimerosal. In 1931 Powell and Jamieson reported acute toxicity studies in several animal species. Maximum tolerated doses not associated with death of the animals were 20 mg thimerosal/kg (rabbits) and 45 mg/kg (rats). Blair evaluated the administration of thimerosal intranasally for 190 days and observed no histopathological changes in the brain or kidney (Blair et al. 1975). Magos et al. directly compared the toxicity of ethyl- versus methylmercury in adult male and female rats administered 5 daily doses of equimolar concentrations of ethyl- or methylmercury by gavage (Magos et al 1985). Magos concluded that ethylmercury, the mercury derivative found in thimerosal, is less neurotoxic than methylmercury, the mercury derivative for which the various guidelines are based.
One final piece of data regarding thimerosal is worth noting. At the initial National Vaccine Advisory Committee-sponsored meeting on thimerosal in 1999, concerns were expressed that infants may lack the ability to eliminate mercury. More recent NIAID-supported studies at the University of Rochester and National Naval Medical Center in Bethesda, MD examined levels of mercury in blood and other samples from infants who had received routine immunizations with thimerosal-containing vaccines. [Pichichero ME, et al. Lancet 360:1737-1741 (2002)] Blood levels of mercury did not exceed safety guidelines for methyl mercury for all infants in these studies. Further, mercury was cleared from the blood in infants exposed to thimerosal faster than would be predicted for methyl mercury; infants excreted significant amounts of mercury in stool after thimerosal exposure, thus removing mercury from their bodies. These results suggest that there are differences in the way that thimerosal and methyl mercury are distributed, metabolized, and excreted. Thimerosal appears to be removed from the blood and body more rapidly than methyl mercury. NIAID is sponsoring a follow-up study with larger numbers of infants in Buenos Aires where thimerosal-containing vaccines are still administered to children. See the NIH/NIAID vaccines/thimerosal web site http://www.niaid.nih.gov/factsheets/thimerosalqa.htm.
FDA has been actively addressing the issue of thimerosal as a preservative in vaccines. Under the FDA Modernization Act (FDAMA) of 1997, the FDA conducted a comprehensive review of the use of thimerosal in childhood vaccines. Conducted in 1999, this review found no evidence of harm from the use of thimerosal as a vaccine preservative, other than local hypersensitivity reactions (Ball et al. 2001).
As part of the FDAMA review, the FDA evaluated the amount of mercury an infant might receive in the form of ethylmercury from vaccines under the U.S. recommended childhood immunization schedule and compared these levels with existing guidelines for exposure to methylmercury, as there are no existing guidelines for ethylmercury, the metabolite of thimerosal. At the time of this review in 1999, the maximum cumulative exposure to mercury from vaccines in the recommended childhood immunization schedule was within acceptable limits for the methylmercury exposure guidelines set by FDA, ATSDR, and WHO. However, depending on the vaccine formulations used and the weight of the infant, some infants could have been exposed to cumulative levels of mercury during the first six months of life that exceeded EPA recommended guidelines for safe intake of methylmercury.
As a precautionary measure, the Public Health Service (including the FDA, National Institutes of Health (NIH), Center for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) and the American Academy of Pediatrics issued two Joint Statements, urging vaccine manufacturers to reduce or eliminate thimerosal in vaccines as soon as possible (CDC 1999) and (CDC 2000). The U.S. Public Health Service agencies have collaborated with various investigators to initiate further studies to better understand any possible health effects from exposure to thimerosal in vaccines.
Available data has been reviewed in several public forums including the Workshop on Thimerosal held in Bethesda in August 1999 and sponsored by the National Vaccine Advisory Committee, two meetings of the Advisory Committee on Immunization Practices of the CDC, held in October 1999 and June 2000, and the Institute of Medicine's Immunization Safety Review Committee in July 2001 and May 2004. Through its Vaccine Safety Datalink, the CDC has examined the incidence of autism as a function of the amount of thimerosal a child received from vaccines. Preliminary results indicated no change in autism rates relative to the amount of thimerosal a child received during the first six months of life (from 0 micrograms to greater than 160 micrograms). A weak association was found with thimerosal intake and certain neurodevelopmental disorders (such as attention deficit hyperactivity disorder) in one study, but was not found in a subsequent study. Additional studies are planned in these areas.
Much progress has been made to date in removing or reducing thimerosal in vaccines. New pediatric formulations of hepatitis B vaccines have been licensed by the FDA, Recombivax-HB (Merck, thimerosal free) in August 1999 and Engerix-B (Glaxo SmithKline, thimerosal free) in January 2007. In March 2001 the FDA approved a second DTaP vaccine formulated without thimerosal as a preservative (Aventis Pasteur's Tripedia, trace thimerosal). Aventis Pasteur, Ltd was also approved to manufacture a thimerosal-free DTaP vaccine, Daptacel, in 2002. In September 2001 Chiron/Evans was approved for manufacturing a preservative-free formulation of their influenza vaccine, Fluvirin, that contained trace thimerosal. In September of 2002, Aventis Pasteur, Inc was approved to manufacture a preservative-free formulation of their influenza vaccine, Fluzone that contained trace thimerosal, and in December 2004, a thimerosal-free formulation of Fluzone was approved. Two Td vaccines are also available in preservative-free formulations, Aventis Pasteur Inc's Decavac, and Aventis Pasteur, Ltd's Td vaccine. Also, Aventis Pasteur Inc's DT vaccine is now available only in a preservative-free formulation. These changes have been accomplished by reformulating products in single dose vials that do not contain a preservative. At present, all routinely recommended vaccines for U.S. infants are available only as thimerosal-free formulations or contain only trace amounts of thimerosal (≤1 than micrograms mercury per dose), with the exception of inactivated influenza vaccine. Inactivated influenza vaccine for pediatric use is available in a thimerosal-preservative containing formulation and in formulations that contain either no thimerosal or only a trace of thimerosal, but the latter is in more limited supply; see Table 1. A more extensive tabulation of vaccines and thimerosal content may be found in Table 3.
The Safety Review of Thimerosal-containing Vaccines and Neurodevelopmental Disorders Conducted by the Institute of Medicine
In 2001, the Institute of Medicine convened a committee (the Immunization Safety Review Committee) to review selected issues related to immunization safety. [For more information regarding this committee, their charge, and their reports, see the IOM web site.] The IOM has, to date, completed reviews in two areas. The first review by this committee focused on a potential link between autism and the combined mumps, measles, and rubella vaccine. The second review focused on a potential relationship between thimerosal use in vaccines and neurodevelopmental disorders (IOM 2001). This latter issue was brought to the fore primarily as the result of the hypothesis, formulated by S. Bernard and others from Cure Autism Now, that autism is a novel form of mercury poisoning (Bernard et al. 2001); this hypothesis, linking autism to mercury, was based on a comprehensive review of the scientific literature on mercury toxicity.
In its report of October 1, 2001, the IOM's Immunization Safety Review Committee concluded that the evidence was inadequate to either accept or reject a causal relationship between thimerosal exposure from childhood vaccines and the neurodevelopmental disorders of autism, attention deficit hyperactivity disorder (ADHD), and speech or language delay. Additional studies were needed to establish or reject a causal relationship. The Committee did conclude that the hypothesis that exposure to thimerosal-containing vaccines could be associated with neurodevelopmental disorders was biologically plausible.
The Committee believed that the effort to remove thimerosal from vaccines was "a prudent measure in support of the public health goal to reduce mercury exposure of infants and children as much as possible." Furthermore, in this regard, the Committee urged that "full consideration be given to removing thimerosal from any biological product to which infants, children, and pregnant women are exposed."
In 2004, the IOM's Immunization Safety Review Committee issued its final report, examining the hypothesis that vaccines, specifically the MMR vaccines and thimerosal containing vaccines, are causally associated with autism. In this report, the committee incorporated new epidemiological evidence from the U.S., Denmark, Sweden, and the United Kingdom, and studies of biologic mechanisms related to vaccines and autism since its report in 2001. The committee concluded that this body of evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism, and that hypotheses generated to date concerning a biological mechanism for such causality are theoretical only. Further, the committee stated that the benefits of vaccination are proven and the hypothesis of susceptible populations is presently speculative, and that widespread rejection of vaccines would lead to increases in incidences of serious infectious diseases like measles, whooping cough and Hib bacterial meningitis.
The FDA is continuing its efforts to reduce the exposure of infants, children, and pregnant women to mercury from various sources. Discussions with the manufacturers of influenza virus vaccines (which are now routinely recommended for pregnant women and children 6-23 months of age) regarding their capacity to potentially increase the supply of thimerosal-reduced and thimerosal-free presentations are ongoing. Discussions are also underway with regard to other vaccines. Of note, all hepatitis B vaccines for the U.S., including for adults, are now available only as thimerosal-free or trace-thimerosal-containing formulatons. In addition, all immune globulin preparations including hepatitis B immune globulin, and Rho(D) immune globulin preparations are manufactured without thimerosal. For additional information on the issue of thimerosal in vaccines, see Frequently Asked Questions (FAQs)).
Table 1. Thimerosal Content of Vaccines Routinely Recommended for Children 6 Years of Age and Younger - (updated 7/18/2005*)
*Since this update, a biologics license application was approved for Rotavirus Vaccine, Tradename-RotaTeq (Merck), that is thimerosal free and never contained thimerosal.
|Thimerosal Status Concentration**(Mercury)
|Approval Date for Thimerosal Free or Thimerosal / Preservative Free (Trace Thimerosal)*** Formulation
(GlaxoSmithKline Biologicals)
|Never contained more than a trace of thimerosal, approval date for thimerosal-free formulation 9/29/2000
(Sanofi Pasteur, Ltd)
|Never contained Thimerosal
(Sanofi Pasteur, Inc)
|Trace(≤0.3 µg Hg/0.5mL dose)
(GlaxoSmithKline Biologicals)
|Never contained more than a Trace of Thimerosal, approval date for thimerosal-free formulation 1/29/2007
|Pneumococcal conjugate
(Wyeth Pharmaceuticals Inc)
|Never contained Thimerosal
|Inactivated Poliovirus
(Sanofi Pasteur, SA)
|Never contained Thimerosal
|Varicella (chicken pox)
(Merck & Co, Inc)
|Never contained Thimerosal
|Mumps, measles, and rubella
(Merck & Co, Inc)
|Never contained Thimerosal
|Hepatitis B
|Recombivax HB
(Merck & Co, Inc)
|Engerix B
(GlaxoSmithKline Biologicals)
|03/28/00, approval date for thimerosal-free formulation 1/30/2007
|Haemophilus influenzae type b conjugate (Hib)
(Sanofi Pasteur, SA)
|Never contained Thimerosal
(Merck & Co, Inc)
|HibTITER, single dose
(Wyeth Pharmaceuticals, Inc.)1
|Never contained Thimerosal
|Hib/Hepatitis B combination
(Merck & Co, Inc)
|Never contained Thimerosal
(Sanofi Pasteur, Inc)
|0.01% (12.5 µg/0.25 mL dose, 25 µg/0.5 mL dose)2
(Sanofi Pasteur, Inc)3
(no thimerosal)
(Novartis Vaccines and Diagnostics Ltd)
|0.01% (25 µg/0.5 mL dose)
(Novartis Vaccines and Diagnostics Ltd)
(Preservative Free)
|Trace (<1ug Hg/0.5mL dose)
|Influenza, live
(MedImmune Vaccines, Inc)
|Never contained Thimerosal
** Thimerosal is approximately 50% mercury (Hg) by weight. A 0.01% solution (1 part per 10,000) of thimerosal contains 50 µg of Hg per 1 mL dose or 25 µg of Hg per 0.5 mL dose.
*** The term "trace" has been taken in this context to mean 1 microgram of mercury per dose or less.
1 HibTiITER was also manufactured in thimerosal-preservative containing multidose vials but these were no longer available after 2002.
2 Children 6 months old to less than 3 years of age receive a half-dose of vaccine, i.e., 0.25 mL; children 3 years of age and older receive 0.5 mL.
3 A trace thimerosal containing formulation of Fluzone was approved on 9/14/02 and has been replaced with the formulation without thimerosal.
Table 2: Preservatives Used in U.S. Licensed Vaccines
|Vaccine Examples (Tradename; Manufacturer)
|TT (one)
Influenza (several)
|Typhoid Vi Polysaccharide (Typhim Vi; Sanofi Pasteur, SA)
Pneumococcal Polysaccharide (Pneumovax 23; Merck & Co, Inc)
|Benzethonium chloride (Phemerol)
|Anthrax (Biothrax; Emergent BioDefense Operations Lansing Inc.)
|DTaP (Infanrix; GlaxoSmithKline Biologicals)
DTaP (Daptacel; Sanofi Pasteur, Ltd)
Hepatitis A/Hepatitis B (Twinrix; GlaxoSmithKline Biologicals)
IPV (IPOL; Sanofi Pasteur, SA)
Table 3: Thimerosal and Expanded List of Vaccines - (updated 3/14/2008)
Thimerosal Content in Currently Manufactured U.S. Licensed Vaccines
|Trade Name
|Thimerosal Concentration1
|Anthrax vaccine
|Emergent BioDefense Operations Lansing Inc.
|Sanofi Pasteur, Inc
|≤ 0.00012%
|≤ 0.3 µg/0.5 mL dose
|GlaxoSmithKline Biologicals
|Sanofi Pasteur, Ltd
|GlaxoSmithKline Biologicals
|No Trade Name
|Sanofi Pasteur, Inc
|< 0.00012% (single dose)
|< 0.3 µg/0.5mL dose
|Sanofi Pasteur, Ltd3
|25 µg/0.5 mL dose
|No Trade Name
|Mass Public Health
|8.3 µg/0.5 mL dose
|Sanofi Pasteur, Inc
|≤ 0.00012%
|≤ 0.3 µg mercury/0.5 ml dose
|No Trade Name
|Sanofi Pasteur, Ltd
|Sanofi Pasteur, Ltd
|GlaxoSmithKline Biologicals
|No Trade Name
|Sanofi Pasteur, Inc
|25 µg/0.5 mL dose
|Sanofi Pasteur, SA
|Wyeth Pharmaceuticals, Inc.
|PedvaxHIB liquid
|Merck & Co, Inc
|Merck & Co, Inc
|Hepatitis B
|GlaxoSmithKline Biologicals
|Recombivax HB
Adult (adolescent)
|Merck & Co, Inc
|Hepatitis A
|GlaxoSmithKline Biologicals
|Merck & Co, Inc
|GlaxoSmithKline Biologicals
|< 0.0002%
|< 1 µg/1mL dose
|Sanofi Pasteur, SA
|Sanofi Pasteur, Ltd
|CSL Limited
|0 (single dose)
0.01% (multidose)
|0/0.5 mL (single dose)
24.5 µg/0.5 mL (multidose)
|Sanofi Pasteur, Inc
|25 µg/0.5 mL dose
|Novartis Vaccines and Diagnostics Ltd
|25 µg/0.5 ml dose
|Fluzone (no thimerosal)
|Sanofi Pasteur, Inc
|Fluvirin (Preservative Free)
|Novartis Vaccines and Diagnostics Ltd
|< 0.0004%
|< 1 µg/0.5 mL dose
|GlaxoSmithKline Biologicals
|< 0.0004%
|< 1 µg/0.5 ml dose
|ID Biomedical Corporation of Quebec
|25 µg/0.5 ml dose
|Influenza, live
|MedImmune Vaccines, Inc
|Japanese Encephalitis7
|Research Foundation for Microbial Diseases of Osaka University
|35 µg/1.0mL dose
17.5 µg/0.5 mL dose
|Merck & Co, Inc
|Menomune A, C, AC and A/C/Y/W-135
|Sanofi Pasteur, Inc
|0.01% (multidose)
0 (single dose)
|25 µg/0.5 dose
|Menactra A, C, Y and W-135
|Sanofi Pasteur, Inc
|Prevnar (Pneumo Conjugate)
|Wyeth Pharmaceuticals Inc
|Pneumovax 23
|Merck & Co, Inc
|Sanofi Pasteur, SA
|Novartis Vaccines and Diagnostics
|Smallpox (Vaccinia), Live
|Acambis, Inc.
|Typhoid Fever
|Typhim Vi
|Sanofi Pasteur, SA
|Berna Biotech, Ltd
|Merck & Co, Inc
|Yellow Fever
|Sanofi Pasteur, Inc
|Table Footnotes
- Agency for Toxic Substances and Disease Registry. Toxicological profile for mercury. Atlanta, GA: Agency for Toxic Substances and Disease Registry;1999.
- Axton JMH. Six cases of poisoning after a parenteral organic mercurial compound (merthiolate). Postgrad Med J 1972;48:417-421.
- Bakir F, Damlugi SF, Amin-Zaki L, Murtadha M, Khalidi A, Al-Rawi NY, Tikriti S, Dhahir HI, Clarkson TW, Smith JC, Doherty RA. Methylmercury poisoning in Iraq. Science 1973;181:230-241.
- Ball LK, Ball R, Pratt RD. An assessment of thimerosal use in childhood vaccines. Pediatrics 2001;1147-1154.
- Bernard S, Enayati A, Redwood L, Roger H, and Binstock T. Med. Hypotheses 2001, 56: 462-471.
- Bernier RH, Frank JA, Nolan TF. Abscesses complicating DTP vaccination. Am J Dis Child 1981;135:826-828.
- Blair AMJN, Clark B, Clarke, AJ, Wood, P. Tissue Concentrations of Mercury after Chronic Dosing of Squirrel Monkeys with Thimerosal. Toxicology 1975;3:171-1766.
- Centers for Disease Control and Prevention. Notice to Readers: Thimerosal in Vaccines: A Joint Statement of the American Academy of Pediatrics and the Public Health Service. Morb Mort Wkly Rep 1999;48:563-565.
- Cox NH, Forsyth A. Thimerosal allergy and vaccination reactions. Contact Dermatitis 1988;18:229-233.
- Davidson PW, Myers GJ, Cox C, Axtell C, Shamlaye C, Sloan-Reeves J, Cernichiari E, Needham L, Choi A, Wang Y, Berlin M, Clarkson TW. Effects of prenatal and postnatal methylmercury exposure from fish consumption on neurodevelopment: Outcomes at 66 months of age in the Seychelles child development study. JAMA 1998;280:701-707.
- Fagan DG, Pritchard JS, Clarkson TW, Greenwood MR. Organ mercury levels in infants with omphaloceles treated with organic mercurial antiseptic. Arch Dis Child 1977;52:962-964.
- Federal Register, January 19, 1979;44;3990.
- Federal Register. November 19, 1999;64:63323-63324.
- Goncalo M, Figueiredo A, Goncalo S. Hypersensitivity to thimerosal: the sensitivity moiety. Contact Dermatitis 1996;34:201-203.
- Grabenstein JD. Immunologic necessities: diluents, adjuvants, and excipients. Hosp Pharm 1996; 31:1387-1401.
- Grandjean P, Weihe P, White RF et al. Cognitive deficit in 7 year old children with prenatal exposure to methylmercury. Neurotoxicol Teratol 1997;6:417-428.
- Harada M. Minamata disease: Methylmercury poisoning in Japan caused by environmental pollution. Crit Rev Toxicol 1995;25:1-24.
- IOM (Institute of Medicine). Thimerosal-containing vaccines and neurodevelopmental disorders. Washington DC: National Academy Press; 2001.
- Lowell HJ, Burgess S, Shenoy S, Peters M, Howard TK. Mercury poisoning associated with hepatitis B immunoglobulin. Lancet 1996:347:480.
- Magos L, Brown AW, Sparrow S, Bailey E, Snowden RT, Skipp WR. The comparative toxicology of ethyl- and methylmercury. Arch Toxicol 1985,57:260-267.
- Mahaffey KR, Rice G, et al. An Assessment of Exposure to Mercury in the United States: Mercury Study Report to Congress. Washington, DC: U.S. Environmental Protections Agency; 1997. Document EPA-452/R097-006.
- Mahaffey KR. Methylmercury: A new look at the risks. Public Health Rep 1999;114:397-413
- Matheson DS, Clarkson TW, Gelfand EW. Mercury toxicity (acrodynia) induced by long-term injection of gammaglobulin. J Pediatr 1980: 97:153-155Moller H. All these positive tests to thimerosal. Contact Dermatitis 1994; 31:209-213.
- Pfab R, Muckter H, Roider G, Zilker T. Clinical Course of Severe Poisoning with Thiomersal. Clin Toxicol 1996;34:453-460.
- Powell HM, Jamieson WA. Merthiolate as a Germicide. Am J Hyg 1931;13:296-310.
- Rohyans J, Walson PD, Wood GA, MacDonald WA. Mercury toxicity following merthiolate ear irrigations. J Pediatr 1994;104:311-313.
- Simon PA, Chen RT, Elliot JA, Schwartz B. Outbreak of pyogenic abscesses after diphtheria and tetanus toxoids and pertussis vaccine. Pediatr Infect Dis J 1993;12:368-371.
- U.S. Pharmacopeia 24, Rockville, MD: U.S. Pharmacopeial Convention; 2001.
- Wilson GS. The Hazards of Immunization. New York, NY: The Athlone Press; 1967:75-84.
- World Health Organization. Trace elements and human nutrition and health. Geneva: World Health Organization;1996:209.
Studies on Safety and Effectiveness of Thimerosal:
- Batts AH, Narriott C, Martin GP, et al. The effect of some preservatives used in nasal preparations on mucociliary clearance. Journal of Pharmacy and Pharmacology 1989; 41:156-159.
- Batty I, Harris E, Gasson A. Preservatives and biological reagents. Developments in Biological Standardization 1974;24:131-142.
- Beyer-Boon ME, Arntz PW, Kirk RS. A comparison of thimerosal and 50% alcohol as preservatives in urinary cytology. Journal of Clinical Pathology 1979;32:168-170.
- Gasset AR, Itoi M, Ishii Y, Ramer RM. Teratogenicities of ophthalmic drugs. II. Teratogenicites and tissue accumulation of thimerosal. Archives of Ophthalmology 1975;93:52-55.
- Goldman KN, Centifanta Y, Kaufman HF, et al. Prevention of surface bacterial contamination of donor corneas. Archives of Ophthalmology 1978;96:2277-2280.
- Keeven J, Wrobel S, Portoles M, et al. Evaluating the preservative effectiveness of RGP lens care solutions. Contact Lens Association of Ophthalmologists Journal 1995;21:238-241.
- Naito R, Itoh T, Hasegawa E, et al. Bronopol as a substitute for thimerosal. Developments in Biological Standardization 1974;24:39-48.
- Wozniak-Parnowska W, Krowczynski L. New approach to preserving eye drops. Pharmacy International 1981;2(4):91-94.
1 FDA's guideline is based in part on a maximum tolerable daily intake of 30 µg/day of methylmercury from the diet; for purposes of comparison this would translate to approximately 0.43 micrograms/kg/day for a 70 kg adult. The FDA recommends that pregnant women, women of childbearing age who may become pregnant, nursing mothers and young children do not consume certain kinds of fish that may contain high levels of methylmercury (i.e., shark, swordfish, king mackerel, and tilefish); see http://www.cfsan.fda.gov/~lrd/tphgfish.html
2 The WHO guideline is expressed as 3.3 µg/kg/week and has been converted to a daily dose for purposes of comparison.


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Safe (Starring Jason Statham) [Movie Trailer]
A former elite agent takes on a two-tier mission: rescue a Chinese girl who's been abducted by the Triads, then use a safe combination to outwit the Russian Mafia, corrupt NYC officials, and the Triads themselves.
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Libya judge orders Gadhafi son tried by video link
TRIPOLI, Libya (AP) — A Libyan judge in the trial of former regime officials decided Monday that Moammar Gadhafi's son, held by a militia in the country's west, can be tried in the proceedings via a video link.
Since the end of Libya's 2011 civil war, Seif al-Islam Gadhafi has been held by a militia in Zintan that has refused to hand him over for a separate trial in the capital, Tripoli, and the weak central government has been unable to force the issue.
Seif al-Islam faces charges along with 39 other Gadhafi regime figures — including notorious spymaster Abdullah al-Senoussi — for alleged crimes during the civil war. Both men are also wanted by the International Criminal Court for the murder and persecution of protesters in the uprising.
The judge, in the courtroom set up in a Tripoli prison facility, ordered a satellite link with Seif al-Islam in the Zintan prison and adjourned the proceedings until April 27.
Gadhafi's last prime minister al-Baghdadi al-Mahmoudi complained that he was allowed to sit with his lawyers only in court and asked for more meetings with them. He also asked the judge to allow his non-Libyan lawyers to attend the hearings. There was no immediate response from the judge.
Al-Senoussi asked the judge for more family visits, and Prosecutor Al-Seddik al-Sur told the court that al-Senoussi was granted three visits.
Meanwhile, Human Rights Watch, in a statement released on Monday, expressed concerns about the trial including the defendants' limited access to lawyers and key documents on the evidence against them.
"This case has been riddled with procedural flaws right from the beginning, which have made it grossly unfair to the defendants," said Richard Dicker, international justice director at Human Rights Watch.


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The 2011 Princeton Lectures on
Youth, Church, and Culture
The church's call to tend the soil of adolescents' faith is a joyful yet daunting task. We long for young people to develop a durable faith in Christ that sustains and empowers them to "seek first the kingdom of God" in a world where consumerism reigns, change is rapid, the economy is uncertain, and people of other religions are our neighbors. We want young people to engage such a world, fully knowing that they are beloved children of God and that life in Christ is a worthy adventure.
The theme for the 2011 Princeton Lectures on Youth, Church, and Culture is "Faith". These lectures consider what evangelism and interreligious dialogue look like in our postmodern context and examine faithful ways to engage religious pluralism. Eboo Patel addresses the complexities of raising children in their own faith tradition while living in a religiously diverse world. Rick Osmer discusses how important both Christian evangelism and interreligious dialogue are to the Church today as it seeks to live the gospel in a religiously diverse culture. May the ideas and stories shared here spark conversation around these topics in your own community and empower you in your ministry.
Director, Institute for Youth Ministry
Princeton Theological Seminary
2011 Lectures
- Eboo Patel
American Muslim Child
- Richard R. Osmer
Evangelism in an age of Religious Diversity
- Richard R. Osmer
Interreligious Dialogue in an Age of Diversity
Interreligious Dialogue in an Age of Diversity
In my first lecture, I pointed to the increased diversity of religion as an important dimension of the contemporary American context. America is in the midst of a second great wave of immigration, which brought 22 million immigrants to the United States during the last third of the twentieth century. Many of these immigrants were Hindus, Muslims, or Buddhists, expanding the range of religious traditions with a visible presence in contemporary America.
Social science research has repeatedly found that Americans in principle are tolerant toward other religions. 1 It is part of their civic morality. They affirm the separation of church and state and the right of all religions to assemble and practice their own faith. They also believe that non-Christian religions should not be singled out for discrimination and their members should not be subject to hate crimes.
The problem is that this civic morality does not go very deep. It represents ideals that are quickly compromised when matters become local or personal. Muslims, for example, have the right to practice their own faith, as long as they do not build a Mosque in my neighborhood. Hindus are welcome to live in my neighborhood, but I grow concerned when their son begins to date my daughter. A highly vocal minority of Americans go so far as to question the long-term impact of religious diversity on America's special destiny and support curbing some First Amendment Rights of certain groups. 2 They believe that America's greatness is a by-product of the moral and spiritual foundations of Christianity. They do not welcome the increased presence of other religions, at least in part, because they believe it will compromise American "exceptionalism" in the long-run.
1. Transition or Shift?
In American Grace: How Religion Divides and Unites Us, Robert Putnam and David Campbell describe American society as currently experiencing a transition in its response to the most recent wave of immigration. Many Americans are uncomfortable with the visible presence of people who are different than themselves at work, in schools, and in their neighborhoods. They also remind us that the noisy response of a minority was also present during the first wave of American immigration between 1890 and 1920. During that period, the Ku Klux Klan spread from the South to states like Michigan and Indiana. The anger of its members was not just directed toward African Americans, but also toward Roman Catholics and Jews who page 2 had recently immigrated in large numbers to the United States. They offer a hopeful perspective, reminding us that today Jews are the religious group viewed most favorably by Americans, and Roman Catholics second most favorably. 3
It is possible for Americans to move beyond their current discomfort with new immigrants and for the negative response of a vocal minority to become a thing of the past. But this is not automatic. Every historical moment in a society is different, and there is no guarantee that we are in the midst of a transition, not a shift in our ability to welcome immigrants. How Americans respond today will shape the future of their country. This is especially true of Christians who remain the largest religious community in contemporary America.
In this lecture, I focus on the importance of interreligious dialogue. In light of the new wave of immigration and increasing religious diversity, it is an important ministry of the church. At a recent conference I attended, one of the presenters used the term "dialogue" in his paper. In the ensuing discussion, his wording was attacked by one of the participants, with many others around the room nodding in agreement. The respondent said something like this, "Dialogue inevitably leads to compromise. In the end, it means we have to compromise Christian truth." I disagree with the perspective. It reflects what I called in my first lecture the "opposing magnet" approach to evangelism and interreligious dialogue. The more we place evangelism at the center of church life, the further interreligious dialogue is pushed to the side. Either we convert people so they think like us or we listen and learn from them, compromising our Christian perspective. These are false alternatives.
Evangelism and interreligious dialogue are both important, but they take place in different ways and have different purposes. Interreligious dialogue is best viewed as part of the educational ministry of the church. It involves growth, learning, and change over time. It includes learning about our non-Christian neighbors so we might better understand who they are and what they need. How else will Christians be in a position to practice neighbor love? How else will they contribute to a healthy civil society in which strangers as well as friends learn to trust one another and work together toward the common good? The willingness of Christians to dialogue with religions that are different than themselves demonstrates good will on the church's part. It builds a "cultural atmosphere" of trust, mutual understanding, and conflict resolution. Educating Christians in the capacities of dialogue goes hand in hand with the church's evangelical witness. If churches cannot even dialogue with those who are different than themselves, especially religious minorities, then what sort of message does this send to their neighbors? Evangelism includes embodying the gospel, not simply winning an argument. It goes hand in hand with interreligious dialogue.
Unfortunately, "No compromise. Hold on to my truth," has become the default mode in contemporary American culture. Opposing sides refuse to even listen to one another. Dialogue and compromise have become dirty words, from the halls of Congress to radio talk shows. How did we arrive at this point? In American Grace, Putnam and Campbell provide a helpful account of recent American history that underscores the role of religion in the current polarization of American society. 4 They also point to the possible role of religion in healing our divides, providing a perspective on the importance of interreligious dialogue in American churches today.
2. Polarization and Recent American History
The story Putnam and Campbell tell begins in the 1960s and falls into three chapters. The first chapter describes the "long sixties" as a major earthquake in American culture. It is followed by two aftershocks, the reaction of conservative Christianity to the sixties and, more recently, the "rise of the nones," (those who do not affiliate with any religion). By the end of this story, America is a divided nation and religion plays a major role in this polarization. 5
The cultural earthquake of the sixties was driven by the Baby Boomers, who moved through adolescence and young adulthood during this period. They represent the largest cohort in recent American history and their movement through the life course has impacted American culture in different ways. They were shaped by a convergence of unique events: the widespread availability of birth control pills, the period of economic prosperity that followed World War II, and the rise of various social movements, including the second wave of feminism, the anti-Vietnam war movement, the counter-culture, and the ecological movement. As Putnam and Campbell note, the Boomers represent a classic example of generational change. The cohorts coming of age during the sixties would move toward values and beliefs very differently than their parents, and these would gradually disseminate across the rest of society as the Boomers grew older.
One of the clearest markers of this cultural shift was a change in the Boomers' attitudes toward premarital sex. Between 1969 and 1973, the number of young people indicating on social surveys that premarital sex is "not wrong" doubled from 24 to 47 percent. This drifted upward through the 1970s to reach 62 percent in 1982. A second marker is the Boomers' attitudes toward religion. The percentage of college freshmen who claimed no religious identification more than doubled in the five years between 1966 and 1971. This marked the beginning of Spiritual Shoppers (in Wuthnow's sense) on a wide scale in American society. The markers of premarital sex and religious identification signal much broader shifts in values and beliefs. In the decades that followed, cultural norms on fundamental matters would be questioned, like the role of women, divorce, homosexuality, and the nature of the family.
The first "aftershock" took place during the late 1970s and the 1980s. It represented a reaction against the sexual revolution, the decline of the "traditional family," and other cultural changes unleashed by the sixties. During this period, conservative Protestantism experienced significant growth. This included not only traditional Protestant denominations, but also non-denominational congregations, some of whom became widely influential mega-churches. Willow Creek, for example, was founded in 1975. In 1973, evangelical Christianity represented 23 percent of the American population. By the late 1980s, it had risen to 28 percent. During this period, "born again" Christianity received a great deal of media attention, and the Religious Right became a national force in American politics, driven by the Moral Majority, Focus on the Family, and other conservative groups.
A substantial number of young people were affected by this resurgence of conservative Protestantism. Weekly attendance of young adults with some college education rose from 24 to 32 percent during this period, an increase of one-third. Most of this increase was found in evangelical and non-denominational churches. The attitudes of evangelical youth were different than their peers, moreover. They were more than twice as likely as their peers to respond that premarital sex is wrong in social survey research. Young people's attitudes beyond evangelicals also became more conservative. In 1974, for example, 62 percent agreed that homosexuality is always wrong; this rose to 79 percent in 1987. Opposition to the legalization of marijuana also rose from 50 percent in 1976 to 80 percent in 1990.page 4
Contrary to common perceptions, the growth of evangelicalism peaked in the late 1980s and the surge was over by the early 1990s. By 2001, it represented 23 percent, the same percentage as in 1973. The resurgence of conservative Protestantism elicited a response, that Putnam and Campbell call the second aftershock following the earthquake of the sixties. They name this the "rise of the nones," that is, the rapid increase in the number of people claiming no affiliation with any religious community. At the end of "long sixties" the nones had risen to 7 percent of the American population, where it remained until the 1990s, when it began to increase rapidly. Today it represents 16 to 18 percent of the American population. Social science research, Putnam and Campbell argue, has discovered that the recent spike in nones can largely be attributed to a negative response to conservative Protestantism, especially among young people. As they put it, "They became unaffiliated, at least in part, because they think of religious people as hypocritical, judgmental, or insincere." The nones, they continue, believe that "religious organizations focus too much on rules and not enough on spirituality." 6
Like the sixties, Putnam and Campbell believe, the nones represent a cohort effect. After 2000, 20 to 30 percent of young people coming of age were nones. Even those who continued their affiliation with a religious community began to hold values and beliefs that were different than those of the previous generation. For example, in 1990, 22 percent approved of homosexuality; this rose to 63 percent in 2008. Approval of the legalization of marijuana rose from 21 to 41 percent during this same period. On these and other issues, the nones aggregate at the most liberal end of the spectrum and are younger than the American population as a whole.
Much of the so-called culture wars, Putnam and Campbell argue, is rooted in the real differences on social issues, lifestyles, and voting patterns among the nones and evangelicals. Taken together, these two groups represent a larger proportion of the American population than in the past. In 1973, evangelicals plus nones comprised 30 percent of the American population. By 2008, this had risen to 41 percent. In effect, people have sorted themselves out religiously according to their moral and political views.
3. Interreligious Dialogue
On the surface, the prospects of interreligious dialogue look very dim in the story that I have just summarized. Conventional wisdom might lead us to conclusions like the following. Evangelicals, we might assume, are not really interested in interreligious dialogue—they are after conversion. The nones are interested in exploring various religious traditions to enhance their own spirituality, but they are not really interested in exploring in depth the differences in belief and practice of the major religious traditions. The religious center, which would appear to have the most groups likely interested in interreligious dialogue, is seriously weakened today. Yet things are more complex than conventional wisdom. Potentially, there are a variety of Christian groups and movements that might lead the way toward greater interreligious dialogue.
There is a growing sector of post-evangelical, emergent, post-liberal, and "new monastic" communities among the young. While these groups remain relatively small, they may represent the leading edge of change in the contemporary American landscape. They are very explicitly seeking to move beyond the liberal/conservative impasses of the present and demonstrate a willingness to cross theological, cultural, and economic boundaries. It is possible that they may be among the first to engage interreligious dialogue in new and creative ways. They are not threatened by such encounters and realize that evangelism must first be lived, embodied, and demonstrated before the gospel can be shared with any credibility.page 5
Evangelicals, moreover, have become more diverse over the past fifty years. The growth of nondenominationalism and mega-churches has given rise to churches that are not constrained by the "party line" of denominational headquarters. It is possible that these congregations may acknowledge the importance of interreligious dialogue in an era of religious diversity. There are also mainline Jewish and Christian communities. Though they make up a much smaller percentage of the American population than in the past, they continue to contain a disproportionately large number of people who are highly educated, have strong financial resources, and are used to dealing with complexity on theological and moral matters. Their voice, if added to the voices of others as described above, might make an important difference.
We would be remiss if we failed to grasp the importance of the voices of new immigrants and adherents of non-Christians themselves. As Wuthnow discovered in his research, they simply want to be understood and respected, above all else. 7 They are cognizant of the awkwardness that many in the Christian majority experience in broaching the subject of religion in relationships at work, in the neighborhood, and on the sidelines. As they become a larger portion of the American population in future decades, it is quite possible that they will develop the confidence to take the initiative in personal conversations and to encourage their own religious communities to engage in interreligious dialogue with other communities.
Unfortunately, at present there is very little interreligious dialogue taking place. Wuthnow's research discovered that leaders of Christian congregations do not view this as a pressing issue, even when they are located near another religious community. They employ what he calls "strategies of avoidance." 8 When asked why they do not initiate interreligious dialogue, leaders are apt to respond in the following ways:
"My congregation's members are so focused on Jesus that they're not really interested in learning about the teachings of other religions."
"If I tried something like this, nobody would come."
"Ecumenical efforts inevitably involve compromise."
"We focus on racial and ethnic diversity and that's more important than religious diversity."
"I'm very busy and this, frankly, is not high on my list of priorities."
Suppose these leaders were to have a change of heart. Suppose they were to recognize that interreligious dialogue is imperative in an age of religious diversity, not only for the sake of America's future, but also for the sake of a religiously diverse world that is becoming more interconnected. What might they do? I want to end this lecture by pointing to two approaches to interreligious dialogue grounded in large bodies of social science research. They do not represent everything that might be said, but they do represent a good starting point.
Contact Theory
There is a long body of research indicating that contact among people of different social groups reduces prejudice. This is commonly known as the social contact theory. It has focused on the factors reducing prejudice and promoting understanding across the boundaries separating racial and ethnic communities, different religious groups, and people with mental and physical disabilities. In a review of this literature, page 6 Thomas Pettigrew and Linda Tropp discovered that social contact alone does not account for changed attitudes. 9 Rather, four conditions must be present, harking back to Gordon Allport's early formulation of contact theory. 10 They add a fifth to Allport's original proposal. I will illustrate these conditions with my own experience growing up in a mid-sized town in North Carolina in the 1960s. During this period in the South, the dividing lines between white, Anglo-Saxon Protestants, Roman Catholics, and Jews was only beginning to break down.
The first condition is relative equality among the parties. Social contact between a homemaker and a maid or yard worker is unlikely to reduce prejudice. The two parties must meet on relatively equal grounds. As a child, I barely knew any Catholics or Jews. When I reached middle school, however, this changed. I became good friends with Geoff King, with whom I played on the school's basketball team, and Sigmund Tannenbaum, with whom I built transistor radios. To say that our relationships were equal is an understatement. Geoff was a star player. Sigmund was a nerd before nerds were in; he could take apart and put together radios in his sleep. I became good friends with both.
A second condition is common goals. Social contact promotes mutual understanding and reduces prejudice when the parties are working together on something they both care about. The social chairmen of black and white fraternities might work together to throw a party so they could bring in a big-name band. They might work together on the PTA. In the case of my relationship with Geoff King, this was working together as part of a team to win games. With Sigmund Tannenbaum, our goals were more nebulous. Obviously, we wanted to be successful in taking apart and building transistor radios. But we also shared a love for science fiction and our exploration of the inner workings of the latest electronic gadget probably was fueled by some vague idea that we were exploring together the latest frontier of science.
A third condition is the support of authorities, law, or custom. While I understand what is being pointed to here, this condition gives me pause. Pettigrew and Tropp's review of the research finds that social contact across cultural divides is more likely to take place and reduce prejudice if it is sanctioned by relevant authorities. In my case, my parents heartily approved of my friendship with Geoff and Sigmund. If they had not, then it would have been much less likely that these relationships could blossom. As it was, I spent many nights at their homes, and they at mine. I can only hope that even if my parents had not approved, I would have found ways to build these friendships. The reason I hesitate in affirming this condition is that, often, duly constituted authorities, law, or custom are the last to acknowledge changing attitudes across racial, ethnic, and disability divides. Often, this starts on the margins. As hearts and minds are changed among the few and this begins to spread, only then do the authorities get on board. It is important for Christians to keep this in mind.
The fourth condition is intergroup cooperation. When groups work together cooperatively on common goals, they have the opportunity to move beyond widespread, prejudiced stereotypes. The integration of the military and sports teams is an important case in point. This has given the members of different racial groups the opportunity to learn that they have certain things in common and even share a common humanity. It also has given them the chance to meet as individuals and to begin to realize that stereotypes eradicate the very real diversity within various groups. This certainly was the case in my relationship to Geoff and Sigmund.
Pettigrew and Tropp add a fifth condition to those originally proposed by Allport: friendship. The relationship among friends is, perhaps, the single best social contact in which the first four conditions are page 7 met and a level of mutual affection and caring is added. We do not take it lightly when one of our friends is subject to prejudice. We notice the slights and the barriers. We are more likely to speak out against such things and to even work for their eradication.
Social Network Theory
A more recent body of research focuses on the impact of the social networks to which people belong. Over several decades, researchers have studied the ways that social networks influence individuals' attitudes and behaviors on a range of matters including obesity, smoking, sexual practices, divorce, and church attendance. Information flows through such networks, often at an unconscious level. How this takes place is influenced by the structure of the network. It is also influenced by the kinds of ties people have with others in a particular network. Our relationship to our spouse or friends is different than our relationship to coworkers, church members, or internet contacts. Different kinds of information flows through the different networks to which we belong.
Many social network theorists argue that influence extends up to three degrees of separation. 11 This means that our influence on others and their influence on us extends to our friends (one degree), our friends' friends (two degrees), and even our friends' friends' friends (three degrees). We rarely think of our influence on others and their influence on us as extending beyond the immediate circle of people with whom we interact with on a regular basis—our family and immediate circle of friends or the small group of co-workers with whom we have contact with on a regular basis. Yet it is the network, not just our immediate contacts, that shapes many of our attitudes and behaviors. Many studies, for example, have traced the impact of such networks on obesity. The average obese person is more likely to have more friends, friends of friends, and friends of friends of friends who are overweight than would be expected due to chance alone. Our social network communicates a local norm of acceptable weight, which may begin with one or two people but then ripples across the relationships in which we are embedded (up to three degrees).
While this is the barest introduction to social network theory, enough has been said for me to make my point. Social network theory allows us to see the ways that changes in attitudes and behaviors among a small number of people can influence their social networks. For example, when my sister marries the member of another religion, and this alters my perception of her new husband's religion, my attitudinal shift may influence the attitudes of my immediate circle of friends, their friends, and even their friends' friends—three degrees of separation. This is especially the case if my friendship network is clustered together, that is, if some of my friends' friends are my friends as well. This intensifies mutual influence and the flow of information.
When coupled with contact theory, social network theory helps us see how social change at a local level—up to three degrees of separation—can be fostered. It is especially helpful in thinking about change within a congregation and its members' influence in their networks beyond the church. It allows us to imagine some of the ways interreligious dialogue and friendship might have a ripple effect. Here, I briefly point to four possible avenues of change.
First, it is important for the leaders of congregations to model and lift up the importance of friendships with the members of other religious communities. Interreligious friends are developing naturally among young people at schools, on sports teams, and in many other settings. Youth leaders are strategically located to interpret the importance of such friendships in our current context. Their words will carry greater weight if they are embodied in their own relationships with religious others. They will do well to encourage young people to process what they are learning in these relationships and to be open in sharing this with others, with their church friends and peers.page 8
Second, it is important for congregations to make the study of other religions a regular part of the church school curriculum and to invite leaders of these religious communities to speak as part of these classes. Cognitive change is not as powerful as social contact, but it can prepare the way for such contact and help eliminate some stereotypes of the media.
Third, when it is feasible, congregations should seek opportunities to work with other religious communities to address important local issues. Urban settings often have organizations that bring Muslims, Hindus, Jews, and Christians together to work in a food pantry or night shelter or to address some local issue like gang violence. These organizations often embody the optimal conditions necessary for social contact to actually change people's attitudes towards the members of other religious communities. With the support of relevant religious authorities, people gather as equals in an intergroup cooperative venture in which they share common goals and have the possibility of becoming friends.
Finally, Christian leaders have a special obligation to call out people in the media or their local community who draw on stereotypes and foment fear toward the members of other religions. Like obesity, smoking, binge drinking, and other negative cultural norms, prejudice, if left unchallenged, can spread silently through social networks. Christian leaders have the obligation to serve as counter-voices and to encourage others to do the same.
By way of conclusion, it is important to note that our examination of social contact theory and social network theory has altered the way many church members think about interreligious dialogue. It is not primarily a formal process for church leaders to examine the similarities and differences of their beliefs and practices. Rather, it is primarily about relationships, especially friendships. The possibility of such friendships is everywhere in American society today—at work, in our neighborhoods, among our children and youth, and in our service to the local community. Congregations are well situated to encourage interreligious dialogue at this level and to interpret the importance of this sort of dialogue in the contemporary American context. It may well be that the current level of discomfort and fear that many Americans experience today in the face of increasing religious diversity is only a transitional phenomenon, as Putnam and Campbell contend. But as they also note, religious communities play an important role in deepening divisions and in healing them. My goal in this lecture has been to help you recognize the importance of this ministry among Christian communities and to reimagine how it might be encouraged.


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Detroit Pistons vs Indiana Pacers
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