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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HPV - Massa's vaccine?

To change the subject from thimerosal for a moment, in today's Washington Post, Courtland Milloy goes off against making the human papilloma virus vaccine mandatory. Milloy argues, in his usual competent and convincing way, that it would be better if the D.C., Virginia and Maryland governments--among at least 10 states currently considering making the HPV shot mandatory for pre-teen girls--encouraged people to get their daughters vaccinated against the virus, rather than acting like "some antebellum massa" by forcing the vaccine down their throats, or rather jamming it into their daughter's arms.

Who can argue with this noble liberal sentiment? Me, for one

Milloy points to the example of New Hampshire, which has a voluntary educational program to help convince people to vaccinate their girls against HPV. "Are they more concerned about their children than the rest of us? Hardly. What they have that we do not is the right attitude. They take their state motto seriously: "Live Free or Die," while too many of us are content to live and die as slaves," Milloy writes.

Milloy has stumbled upon the crux of the vaccination dilemma, which is that vaccination programs in the U.S. generally rely upon a modicum of coercion.

In most of Europe, vaccination against diseases like whooping cough, measles, rubella and polio is optional, yet uptake of these vaccines is very high. In Britain, for example, it is even higher than it is here. Stateside, however, there are many barriers to regular medical procedures like vaccination, which is not the case in the socialized medical world of Europe. In order to make vaccination happen in the US, public health authorities use the carrot and the stick--mandatory school-age vaccination.

The explanation goes like this: Vaccines have two protective functions. One is to protect the person who gets the vaccine. The second is to protect the rest of society that may come in contact with that person as a "vector" for a particular disease. By vaccinating 1-year-olds against measles, for example, we protect the babies but also their schoolmates, siblings, parents and grandchildren. By vaccinating young girls we protect them--and their partners, and their partners' partners--in sexual encounters they will have later in life.

50 years of experience have shown that in the absence of mandatory vaccination laws (which are passed state by state), germs continue to spread. (I get into this in detail in the "Measles" and "No Good Deed Goes Unpunished" chapters of my book). Even if the state urges people to vaccinate their children, 10 to 20 percent of the population will fail to do so. Now, the data shows that very few of these people are shirking on principle. They will get their kids vaccinated if forced to do so, in order to get them into school. But the unvaccinated are usually the poorest, least educated part of the population, people who have other things to worry about unless the state puts a bug in their ear.

Now this population of indifferent shirkers is particularly important when it comes to HPV vaccine. Cervical cancer can usually be stopped in the early, harmless growth stage if the woman gets regular pap smears and cervical exams. But guess what population of women doesn't get pap smears regularly, and makes up the majority of those who get cervical cancer? Right--the same population that doesn't get vaccinated unless someone forces their parents to take them in.

So yes, mandatory vaccination is a paternalistic policy. But it's the only policy that works.

As for those who oppose HPV vaccine, for whatever reason--they can opt out. In nearly every state there is a religious exemption, for Christian Scientists and others who don't believe in vaccination. In many states, Colorado and California among them, you can opt out with a "philosophical" exemption--meaning you just don't want your kid vaccinated, for whatever reason.

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