Charleston (S.C.) Post and Courier

Journalist Arthur Allen navigates a tremendous amount of research to tell the story of vaccine, perhaps the world's greatest medical achievement.

In this comprehensive work, colorful anecdotes, compelling arguments and historical insights shed light on this revolutionary and controversial weapon against infectious disease. At the same time, Allen tells a parallel history of failure, deadly reactions and the public's confusion over vaccine's efficacy and necessity. He raises complex questions about individual rights versus public good, and the moral ambiguity of sacrificing the one to save the many.

Allen claims the anti-vaccine movement is nearly as old as vaccines themselves, beginning with the Puritans who thought scratching a small amount of smallpox virus into the skin a challenge to God's will. Counted among the most famous detractors, British dramatist George Bernard Shaw and Henry Bergh, founder of the SPCA. And the movement's most unlikely, yet most enduring symbol: the Raggedy Ann doll.

Since the early 20th century, contaminated vaccines, DTP injuries and a purported link to autism have fueled efforts to ban mandatory immunization in America. The most recent controversy stems from efforts to vaccinate preteen girls against HPV, or human papillomavirus, a sexually transmitted virus that causes cervical cancer.

Allen also details public health's role, its early triumphs and failures as it tries to produce safer vaccines and enforce immunization in the midst of smallpox epidemics.

Vaccine's champions also are profiled, beginning with Edward Jenner's 1796 smallpox discovery that formed the basis for understanding immunity. Allen includes Louis Pasteur's work with rabies and cholera and Albert Sabin's and Jonas Salk's polio breakthroughs. He credits the Army's fear of bioterrorism and tropical disease, as well as a polio-stricken president, for ushering in the golden age of immunization in the 1940s.

Small chapters divide in a readable format the discovery of vaccines for nearly forgotten diseases, such as diphtheria, measles, typhoid, typhus and whooping cough.

It's hard to imagine, but according to this history, in the early 20th century, some diseases killed more young American children in one day than SARS has in a year. A sobering thought for parents who ignore their babies' booster shots or complain about school-entry laws.

Informative histories on infectious disease, including a spate of works on the black plague and 1918 superflu, appear to be a publishing trend that mirrors, no doubt, our own current events. "Vaccine," which includes a number of illustrations and photographs, is a commendable companion to these histories.--Victoria Hood, March 4, 2007.

The Independent of London

What is the most important medical advance of the last 160 years? When the British Medical Journal put that question to its readers recently they responded in their thousands. Sanitation topped the poll, followed closely by antibiotics and anaesthesia. In fourth place came vaccines. While a similar poll of lay people might have agreed on the first three, would they have ranked vaccines similarly highly?

It seems doubtful. Vaccines have never had the kind of uncritical support that, say, antibiotics enjoy. Although vaccination has saved hundreds of millions of lives it remains controversial, subject to scares, driven by political imperatives, testing our faith in medical authority and our own judgement.

One of the enduring puzzles of the great MMR scare that gripped Britain for much of the last decade is not how it started - the 1998 Lancet paper linking the triple jab with bowel disease and autism is well known - but how it was sustained. Why did parents - predominantly well-educated, professional people - continue for years to doubt the safety of the vaccine in the face of repeated reassurances from medical authorities and in the almost complete absence of evidence to support claims to the contrary?

At least part of the answer is to be found in this enthralling book. Though it does not discuss the MMR controversy in detail, it demonstrates in case after case how, through its 300-year history, the benefits of vaccination have been oversold and the risks underplayed. The eagerness of the authorities to protect the public health has, too often, blinded them to the true scale of the threat, or to the risks of the vaccine.

In April 1947, New York registered its first death from smallpox in 35 years. A rug importer from Mexico had carried the virus to the city and caused panic. In three weeks more than six million New Yorkers were immunised against smallpox, jamming hospital clinics and queuing for hours - all entirely voluntarily - after the city's health commissioner announced his intention to vaccinate the city.

Yet by isolating and vaccinating each contact the outbreak was contained within days and the disease ultimately infected just 12 people. Meanwhile, six people died from brain inflammation caused by the vaccine and 100 others suffered serious injuries such as encephalitis.

In 1954, huge excitement greeted the launch of the Salk polio vaccine against one of the most feared childhood diseases. But within months it became clear that the version manufactured by Cutter Laboratories was crippling children. The vaccine had become contaminated by live virus which infected up to 220,000 people, made 70,000 ill, and was linked to 164 cases of severe paralysis and 10 deaths.

The Cutter incident inspired major reforms. But while these improved safety they could not prevent vaccination's use as a political weapon. In December 2002, President George Bush rolled up his sleeve to be vaccinated against smallpox - a disease eradicated in 1980. He was launching what was supposed to be a campaign to immunise 10 million police and health workers against the threat of biological warfare.

Yet by 2005, fewer than 40,000 had come forward. Just as the Bush administration had failed to find weapons of mass destruction in Iraq, health workers saw the smallpox campaign as an unjustified attempt to build national consensus by stoking fear.

This is a fascinating, meticulously researched history of vaccination which is admirable for its even-handedness. In this fevered debate it is rare to find an author prepared to examine the arguments without taking sides. Yet the moral of Arthur Allen's story is clear. By eliminating many diseases of childhood, vaccines have become a victim of their own success. Vaccination is no longer seen as a necessary rite of passage but a matter of individual choice, even though each person who vaccinates their child helps protect every other child.

Risks must be set out, but individuals must recognise that complete personal responsibility is unattainable. By accepting vaccination, we all help look after one another, as we must. That, as Allen says, is our social contract.--Jeremy Laurance is health editor of 'The Independent'. March 16,  2007

HPV, HBV, Rotateq and the Taliban

While I was on NPR's Science Friday discussing the latest vaccination controversy--over the human papilloma virus vaccine--several past controversies were playing themselves out with interesting, at times sad results.