Vaccination has greatly diminished death, illness and suffering in the world. But no other medical technology has been so dogged with controversy. The book chronicles the development of the key lifesaving vaccines since the 18th century. It tells the stories of great scientists and their discoveries, of the protests and pain along the stumbling path of progress. This is the first book to tell the whole story of vaccination for a general audience. In light of controversies about flu vaccine and autism, it will be of particular interest to parents, pediatricians, public health workers and anyone fascinated by medical history. Read More>>

Also Available: Table of Contents and Index

Arthur Allen is a Washington DC-based journalist who has written on vaccine issues in The New York Times Magazine, the Washington Post Magazine, The New Republic, Atlantic Monthly, Salon and Slate.

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Other Articles by the Author

Arthur Allen’s published journalism includes hundreds of wire service and newspaper articles, 30 full-length magazine feature stories and more than 55 featured Web articles. He has also edited two book-length collections of investigative journalism, on water privatization and Latin American military affairs.

Vaccine-related Articles:

Salon articles

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Slate articles

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And Now, the HPV VaccineWarts and all.

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The Unsung Vaccinologist: Maurice Hilleman deserves the praise being lavished on Jonas Salk.

The New Republic

New Republic March 23, 1998
Copyright 1998 The New Republic, Inc.
The New Republic

HEADLINE: INJECTION REJECTION

BYLINE: Arthur Allen
HIGHLIGHT: The dangerous backlash against vaccination.

BODY: President Clinton's ongoing initiative to immunize every American child against infectious disease seems like the kind of safe-as-milk, baby-step health policy that everyone should love. The ultimate motherhood issue. But Clinton, presumably, didn't consult Len Horowitz. A former dentist-turned-" healthcare motivational speaker," Horowitz is carving out a new niche in the history of the paranoid style in American politics. His message: The aids and Ebola epidemics resulted from the contamination-- Arthur Allen is a Washington, D.C.-based freelance journalist who reports regularly on medical and scientific issues. possibly intentional--of common vaccines by the military-medico-industrial complex. The Rockefeller Foundation, the Centers for Disease Control, famed aids researcher Dr. Robert Gallo, and--yes--Henry Kissinger all figure in Horowitz's gallery of germ-warfare conspirators. Horowitz, who apparently honed his expertise on such matters by drilling teeth in Gloucester, Massachusetts, has urged the government to stop immunizing children until independent researchers can determine if the shots are spreading disease. He charges up to $3,500 to share his theories with holistic-medicine groups, survivalist conventions, and other pockets of suspiciousness. During the past couple of years, he has rarely lacked for speaking engagements. The pronouncements of Len Horowitz might safely be filed away next to the Protocols of the Elders of Zion and the Roswell alien snapshots were it not for the fact that they are reaching an audience that has few antibodies to quackery. Most distressing to the Centers for Disease Control and the Food and Drug Administration, and to public health experts more generally, Horowitz and Louis Farrakhan have found each other. According to a Nation of Islam official, Farrakhan heard Horowitz last year on a talk-radio program in Phoenix and invited him to dinner. A joint news release followed from Horowitz and Dr. Abdul Alim Muhammad, Farrakhan's " minister of health and human services," calling for a moratorium on the immunization of Nation of Islam children. (Muhammad was already notorious in public health circles for having race-baited the National Institutes of Health into conducting a clinical study of Kemron, a drug he has dispensed to aids patients at his D.C. clinic. The study, begun in 1996, quickly closed for lack of patients.) Alarmed that already underimmunized ghetto populations were about to get goaded into forgoing vaccinations altogether, the National Medical Association--a mainstream professional group for black physicians-- hastily arranged for public health officials to meet with Muhammad at a Washington hotel last summer. Afterward, Muhammad agreed to shelve the moratorium, at least temporarily. Solicitous CDC and FDA officials later accepted his invitation to debate Horowitz in a panel discussion at the Nation of Islam's annual Savior's Day festival on February 20 in Chicago. It appears unlikely that the Nation of Islam will truly dispense with immunizations, but, as it happens, Horowitz and Muhammad are merely the most baroque figures in a widespread and growing anti-vaccination movement. Its adherents range from clueless paranoids to parents and physicians with more or less genuine concerns about the safety of vaccinations and more or less solid scientific evidence to back them up. The movement poses a counterweight to what is arguably among the most encouraging developments in medicine: a generation of new vaccines for everything from aids and dengue fever to common childhood ear and gut infections. For years, vaccination has been a basic tenet of public health and one of its unqualified successes. The elimination of polio and diphtheria along with the decline of such potential killers as measles, mumps, whooping cough, and rubella are well-documented triumphs. A less known and more recent success story is that of the HIB vaccine, which inoculates children against the Haemophilus influenza type B bacteria, the main cause of bacterial meningitis. In 1984, the year before HIB was introduced, the disease struck about 20,000 Americans, mostly children, killing about 1,000 and causing brain damage or permanent hearing loss in a few thousand others. In 1997, only 150 cases of bacterial meningitis were reported. Notwithstanding its achievements, vaccination is a counterintuitive biological process. Dead or weakened forms of a fearsome microorganism are injected into a healthy person, provoking an immune response--and often a few symptoms of the disease in question. The immune system's antibodies in turn protect the inoculated person from future attack from the "wild" forms of the germ. Since Edward Jenner smeared his first patient with cowpox to shield him from the more dangerous smallpox germs in 1796, immunization has inspired anxiety. The turn-of-the-century American anti-vaccinationist movement spread across the country and set off riots in Milwaukee. The "state quackery" of " compulsory blood poisoning" is an "abomination against God and human nature itself, and every intelligent, conscientious person regards it accordingly," a physiology professor wrote in a 1902 edition of The Vaccination Inquirer, the mouthpiece of the anti-vaccination movement (which was funded by a mail- order patent medicine company in Battle Creek, Michigan). For the early anti-vaccinationists, immunization was a crime against hygiene and a get-rich scheme for doctors. But they didn't see it, exactly, as a political issue. Today, in contrast, some of the loudest opponents draw their support and arguments from left-meets-right anti-governmentalism. Horowitz, for example, has appeared at survivalist conventions cheek-by-jowl with right-wing militiamen and as a guest on Gary Null's "Natural Living," a holistic health program that airs several times a week on left-wing Pacifica radio stations in Washington and New York. Null himself is a florid example of the new conspiracy thinking about public health. In a voice that suggests Mister Rogers with a hangover, Null warns that fluoridation kills (the John Birch Society made similar claims during the early 1960s) and denies that HIV causes aids. He hosts everyone from right-wing media critic Reed Irvine to JFK assassination obsessive Robert Morningstar-- with a lot of chiropractors in between. Anti-vaccination guests have included Viera Scheibner, a shrill Australian who insists that vaccines suppress immunity. (Scheibner obfuscated so wildly during a speaking tour of Australia last year that The Skeptic magazine honored her with its annual Bent Spoon Award for Australia's biggest charlatan.) One Null show that aired last December 17 on wpfw in Washington featured a Brooklyn " researcher" named Curtis Cost, who shared the following pearls of wisdom: "If you take the measles vaccine, you have a sixty, sixty-five percent chance of getting measles. If you take polio vaccine, you have a roughly eighty, eighty- seven percent chance you will get polio." This is, of course, pure rubbish. Nevertheless, if you follow the foolishness to its source, you find that there are some real problems with vaccines. In a sense, mass childhood immunization has become a victim of its own success. Infant mortality rates in the U.S. are a quarter of what they were in 1950. The average child's of risk contracting polio, measles, or diphtheria is vanishingly low. No one questioned whether Normandy had been worth it after Hitler was crushed. But, the more the killer germs of the century (with the exception of HIV) fade from memory, the more the public's attention focuses on the adverse reactions vaccines themselves inevitably, if only occasionally, cause. Take the polio scourge. "Polio was such a frightening specter that a few people's bad reactions to the vaccine simply didn't register," says Dr. Edgar Marcuse, chair of the National Vaccine Advisory Committee. "But the diseases that terrified our grandparents are no longer part of anyone's experience." While "wild" polio struck 21,269 people in 1952, it has not been reported in the United States since 1979. Since then, however, oral polio vaccines have given about 200 people the crippling disease. While that's awful enough if one of the 200 happens to be your child, it's still just one in 2.4 million doses--pretty good odds by any measure. Another illustrative case study is the controversy over the whole-cell pertussis vaccine--the P in the DPT shot. In 1982, a group of parents who were convinced that the vaccine had harmed their children began organizing to press the government to do something about it. Barbara Loe Fisher is the president of the group, the National Vaccine Information Center, which is run out of a second-story office in a strip mall in suburban Vienna, Virginia. Fisher's oldest child, now 20, suffered a seizure and became learning- disabled after his fourth DPT shot in 1979. "The afternoon after the shot I went up to his room, and he was sitting in his little chair, staring straight ahead," she says in an interview. "I held him, and he pitched forward, with his eyes rolling around in his head. Later that night he had terrible diarrhea and then he slept, and I couldn't wake him. He's never been the same. " To be sure, Fisher's group has had at least some salutary impact: its pressure helped spur development of the even safer acellular pertussis vaccine, which became widely available last year. And, in 1986, after thousands of lawsuits against vaccine manufacturers threatened the supply of cheap vaccines, Fisher's group, the vaccine industry, and the CDC pushed Congress to pass the National Childhood Vaccine Injury Act. That act created a no-fault claims court, funded by a levy on vaccines, where the parents of sickened or dead children could collect compensation. The vaccine court has handed out cash to more than 2,600 people whose children died or were seriously injured after vaccination--with DPT, in a large majority of the cases. Yet, while that number must be read as a tacit admission that vaccines carry some risk, neither it nor the 63,000 vaccine reactions (including 1,094 deaths) recorded in the past seven years by an FDA- CDC vaccine injury reporting system are necessarily proof of widespread vaccine failures. As CDC officials explain it, the reactions the system records are rarely distinctive enough for doctors to be sure a particular vaccine caused them. Babies suffer terrible illnesses, and since babies are often vaccinated it is likely that illness will occur not long after some immunization or another. In a 1994 report on vaccine safety, the Institute of Medicine reported that "the vast majority of deaths reported ... are temporally but not causally related to vaccination." A later report amended that finding to acknowledge that the whole-cell pertussis vaccine could lead to permanent brain damage, but the bottom line, as one institute official puts it, remains that "a lot of bad things happen to small children that we don't understand." The problem, in any event, is not the cases for which the government implicitly accepts responsibility, but the thousands--even millions--more that advocates like Fisher claim go unrecorded. "Kids get shots, something happens to them, and nobody makes the connection," says Fisher. "Why can't we do a better job of admitting we've got a problem here? Why can't they do the science to figure out what's going on?" Her group has trumpeted some recent studies that suggest vaccination may trigger autoimmune problems, in which the body attacks itself, and may be responsible for the increased incidence of diseases like asthma and diabetes and, for that matter, Gulf war syndrome. "You have to ask whether we're simply trading childhood sickness for chronic diseases," Fisher says. This is a fascinating thought--and a rather disturbing one, particularly since it's so easy to disseminate. Although few scientists share it, there have been enough widely disparate studies on vaccine safety over the years that anybody--well, anyone with computer access to medline--can document anything he or she wants to say on his or her personal website, with all the sites hyperlinking back and forth in a frenetic group grope. Vaccine anxiety is the perfect symptom of what British medical writer Paul Hodgkin describes as postmodern medicine. "Utterly unquestioned biological givens are disintegrating all around us: the stability of the climate, the immutability of species ... the unchangeable genetic makeup of one's unborn children," Hodgkin wrote recently in the British Medical Journal. With certainties fading, it is easy for people who feel medically vulnerable to build seductive hints and fragments into a coherent, if warped, belief system. " Trust is fragile," says Regina Rabinovich, chief of clinical studies in microbiology at the National Institute for Allergy and Infectious Diseases, " and in science we're not very good at proving the negative." In 1994, Heather Whitestone became the first Miss America with a disability. She went deaf at the age of only 18 months, the initial news reports said, after suffering an adverse reaction to a DPT shot. In fact, as Whitestone's pediatrician later confirmed, it was not DPT but a bout of bacterial meningitis--the disease now nearly eliminated by the HIB vaccine--that cost Whitestone her hearing. The Whitestone case helped spur public health officials to begin an initiative last month to improve vaccine-safety information. They chose to run the project under the auspices of the Infectious Disease Society of America rather than the federal CDC. "There's too much anti-government, anti-industry sentiment out there," says one physician involved in the effort. One of the major concerns of the project is the relatively low vaccination rate among poor blacks. In 1996, the CDC's National Immunization Survey found only 63 and 65 percent compliance with a recommended vaccination regimen for children in majority-black Newark and Detroit, respectively, compared to the U.S. average of 79 percent and the high of 88 percent in the state of Connecticut. Since vaccinations can be had for free, the major reasons for these low rates are clearly social--family disorganization and high dropout rates on the one hand, suspicion of the government on the other. Meanwhile, Barbara Loe Fisher recently embarked on a new crusade to win parents the federally guaranteed right to enroll their children in school without vaccinations if they don't believe in them. "It is not in the best interest of the citizens of this free society, or of public health officials in positions of authority, to use the heel of the boot of the state to crush all dissent to mandatory vaccination laws," she said in a recent speech. Fisher may not be Horowitz, but her position on mandatory vaccination worries public health officials--for good reason. About half of one percent of all parents in the United States currently take advantage of religious exemptions from immunization, permitted in all states except for Mississippi and West Virginia, or of variously defined philosophical exemptions, which are allowed in 17 states. While public health officials generally see families who exempt their children as free-riders enjoying "herd immunity" without participating in the risk, they're usually willing to grant exemptions to any family that whines insistently enough, if only because a crackdown could provoke a more serious backlash. But with Fisher and others stirring up more support, public health officials worry that the anti-vaccination movement will gain footholds in the socially isolated groups that have distorted views of reality--and are, already, at greater risk of disease. Farrakhan's dalliance with Horowitz, for example, enraged many black physicians because they fear the target population's reliance on urban legends. "It's one thing to talk about aids as genocide and a whole different thing to fan the flames of mistrust and fear about immunizations," says Stephen Thomas, director of the Institute for Minority Health Research at Emory University's school of public health. "We know vaccines save lives." There's no evidence that current exemptions are causing major disease outbreaks in the United States--at least for now. But infectious diseases have a way of finding the chinks in a society's immunological armor. In the January 31 issue of The Lancet, epidemiologists led by Eugene Gangarosa of Emory University charted the return of whooping cough after a decline of DPT shots in countries that had vaccination scares during the late 1970s. In Japan, after the deaths of two children who had gotten DPT shots in 1974, the percentage of school-age children receiving the pertussis vaccine fell from 80 percent to ten percent. Whooping cough, which had nearly disappeared, returned with a vengeance: in 1979, there were 13,000 cases and 41 deaths. Similar outbreaks followed declining vaccine coverage in Australia, Britain, and Sweden. The most crushing evidence of the continued need for vaccines comes from Russia, where crumbling public health services and Rasputin-like anti-vaccinationists have led to a collapse of immunizations in many areas and an explosion of long-dormant infectious diseases. In 1995, to cite the most tragic statistic, 1,700 Russians died of diphtheria, a disease of the 1920s. In the United States, officials have gotten some sense of the opportunism of infectious diseases by studying small outbreaks. Of the 508 measles cases reported in 1996, 107 occurred in and around the town of St. George, Utah. In a fascinating study of that outbreak, CDC epidemiologists were able to demonstrate just how risky a few unvaccinated children could be. The St. George area has a high rate of schoolchildren with religious and philosophical exemptions from vaccination. Of the 107 measles cases, 48 were in exempted, unvaccinated children who played the key role in spreading the disease. Measles takes two weeks to incubate, so officials were able to track six successive generations of the outbreak. According to Daniel Salmon, a fellow at the CDC, two of the three children in the first generation were unvaccinated. The measles vaccine is thought to be 95 percent effective, which accounts for the 59 vaccinated children who contracted the disease. As the outbreak slowly spread through successive generations, exposing more and more children, the germs eventually found the small percentage of kids whose vaccinations had failed. Whooping cough has increased slightly in the United States since Fisher's movement got underway. No one has linked the two, but, as it happens, no one is more aware of the risks than Fisher herself. After her son's episode with the DPT shot, Fisher decided not to vaccinate her two younger children. And, in a peculiarly bitter twist of fate, of the several thousand U.S. cases of pertussis in 1992, two were Fisher's children. "I watched as my five-year-old daughter's face turned white," she recalled in a recent speech. "Her lips turned blue, and her eyes bulged out of her head during a paroxysm of whooping cough that I thought would take her life." (Copyright 1998, The New Republic)


"Exposed: Did the DTP shot make some children catastrophically sick?”Washington Post Magazine August 30, 1998"

“The Not-so-Crackpot Autism Theory,” The New York Times Magazine, Nov. 10, 2002.

“Bucking the Herd,” The Atlantic Monthly September 2002

Abbreviated List of non-vaccine-related Publications

More than 400 bylined stories for The Associated Press from Mexico and Central America, Europe, Africa and the U.S. More than 50 stories for Salon.com’s Health and “Mothers Who Think” sections.

The New York Times – “Old Wounds in Cincinnati,” April 14, 2001.

Lingua Franca Magazine,

  •     “Cracking the Maya Code,” October 1992
  •     “Open Secret: A German Academic Hides in Plain Sight,” March 1996 (cover story)
  •     “Policing the Gene Machine,” March 1997 (cover)

The New Republic

  •     “Operation Hades: German Police Stings Create Market for Plutonium,” August 5, 1995
  •     “Mighty Mice,” (Patenting issues in genetic technology) August 10, 1998
  •     “Sex Change,” (Uganda’s struggle with AIDS) May 16, 2002

Mother Jones

  •     “Prodigal Sun,” (Solar energy) March 2000

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