Reviewed by Laurie Garrett
Sunday, February 11, 2007
The Controversial Story of Medicine's Greatest Lifesaver
By Arthur Allen
Norton. 523 pp. $27.95
When I was six days old, I nearly died of chicken pox. This was explained to me almost casually by my mother six years later as she commanded me to sleep over at a friend's home, where another child was suffering from the rubella form of measles. It was just possible, Mother said, that I got chicken pox because she had been exposed to the disease during the final days of her pregnancy but had no immunity to the virus -- and thus failed to pass on protective antibodies to poor little me. To make sure that I would not one day give birth to a rubella-damaged baby or miscarry, Mother sent me to that dreaded sleep-over. I did indeed become infected. And for several miserable days, I lay in quarantine, delirious, dehydrated and bored, covered in red blotches and angry as heck that Mother had put me through the ordeal.
Such stories used to be commonplace. In Vaccine, Arthur Allen tells us that by the early 1960s, rubella was a leading cause of some types of birth defects and miscarriages in America, as well as the motivation for thousands of therapeutic abortions aimed at avoiding giving birth to babies damaged by the virus. By the decade's close, however, pediatricians were able to vaccinate youngsters against polio, rubella, diphtheria, measles and tetanus with shots and droplets. The vaccine inventors were hailed as heroes and international celebrities.
But within a generation, such diseases were all but forgotten in wealthy nations, and parents began weighing the risks of the diseases against the possible side effects of the vaccines. Today, we have come full circle, with many of the vaccine pioneers now vilified and their products blamed for everything from AIDS to autism. For all too many American parents, the risk equation has changed, leading them to oppose immunization with one or more of the key pediatric vaccines. Allen, a former Associated Press reporter who writes a column on risks for Slate, began thinking hard about these issues after facing decisions regarding the vaccination of his own two children.
Vaccine is two books, really. The first is a historical account of experiments with vaccination from the early 18th century, when Cotton Mather tried to inoculate his neighbors in colonial Boston against smallpox, through the peak of vaccine development in the 1960s. Written in a straightforward fashion, this book offers few surprises to students of vaccine history, but it does deliver a very accessible account of American (and, to a lesser degree, European) scientific discoveries, public health campaigns and their controversies. The take-home message: Though vaccines have clearly saved lives and stopped epidemics, the practice of immunization has always been controversial, with organized skeptics claiming that vaccines would anger God, kill children, cause innumerable diseases, worsen epidemics and produce defective offspring.
Then, in what feels like a separate book, Allen offers his own analysis of the current state of anti-vaccine sentiments in the United States. This section alone is well worth the price of admission. With genuine panache, Allen describes the "legislative jihad against vaccines" led by Rep. Dan Burton (R-Ind.), as well as the mind-boggling array of political and religious forces that have, over the last decade, claimed child vaccination to be responsible for everything from brain disorders and autism to causing the very diseases the products are designed to prevent.
The modern skeptics' primary target is a mercury-based vaccine stabilizer called thimerosal, which critics charge has caused a sharp increase in autism in America. Between 1992 and 2002, the skeptics note, doctors in the United States diagnosed 10 times more cases of the syndrome. But anti-vaccine critics fail to note that between 1987 and 2004, the American Psychiatric Association's official Diagnostic and Statistical Manual of Mental Disorders revised its definition of autism twice; each time that resulted in an immediate surge in the number of children identified as autistic. Further, when the definitions of autism were standardized, it turned out that Denmark (where no thimerosal was used in vaccines) and Minnesota had the same per capita incidence of autism. Finally, studies show that boys are at least four times more likely than girls to suffer from functional autism, but boys and girls are equally likely to be vaccinated.
Because Allen does not often reflect on the ways that contemporary battles may mirror those described in his earlier historical treatise, the two halves of his book are not well-linked. For example, he offers a concise analysis of the early days of the development of a vaccine for polio, when the pioneering Hilary Koprowski tried out an innovative oral vaccine on thousands of youngsters in Congo. In passing, Allen notes that during the 1990s, a British journalist named Edward Hooper falsely claimed that Koprowski's experiments spawned the AIDS pandemic. But Allen misses the next chapter in that sorry saga: Having read Hooper's claims, a cluster of imams in northern Nigeria announced that Muslims should refuse to have their children vaccinated against polio. Overnight, the global fight against polio shifted; the disease, which had been on the brink of complete eradication, again spread throughout the Muslim world and parts of India.
Similarly, Allen misses the impact that doubts about mercury contamination of vaccines had in some far-flung parts of the former Soviet Union. By the time Mikhail Gorbachev took over control of the Kremlin, less than a third of families in Moscow, Kiev, St. Petersburg and Siberia were allowing doctors to fully vaccinate their children. In the 1980s, Soviet soldiers returning from combat in Afghanistan brought diphtheria back to the largely unvaccinated population, with devastating results. By the early 1990s, Russia and Ukraine combined had a diphtheria epidemic involving a quarter of a million people.
Twenty years ago, the Science magazine reporter Jon Cohen -- arguably the greatest observer of contemporary vaccine research -- set out to write a book about the discovery of an AIDS vaccine. He was optimistic that scientists would soon find the key to stopping the dreaded virus. Today, more than 30 million people are living with HIV, the pandemic continues to spread, and vaccine manufacturers openly express skepticism that a product to stop this hideous disease will ever pass American safety standards. As Allen's book tells us, we have come a long, depressing way from the glory days of vaccine heroism. ·
Laurie Garrett is senior fellow for global health at the Council on Foreign Relations and the author of "Betrayal of Trust: The Collapse of Global Public Health."