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>>
A timely, fair-minded and crisply written account of ‘medicine’s greatest lifesaver….’ As more children go unvaccinated in the United States, there has been a rise in vaccine-preventable diseases. Meanwhile, fewer pharmaceutical companies are now producing vaccines, citing the high cost of testing, diminishing markets and a fear of litigation. For Allen, a reversal of these trends will require something long overdue: a frank national discussion about the risks and benefits of vaccination. His splendid book is a smart place to begin. David Oshinsky, New York Times Book Review View All Reviews
The Institute of Medicine held a workshop this past week to examine research into the "environmental" causes of autism. It was an opportunity for discussion among scientists pursuing possible links, and a chance for some of the autism "advocacy" community to press their research priorities. No less a bigwig than Alan Leshner, president of the AAAS and editor of Science, presided over the meeting, also attended by the directors of two of the National Institutes of Health.
The opinions of the parents of autistics, especially angry parents, occupy pride of place in our Oprah-fied public culture. Ignore them at your own peril. This is not an entirely bad thing. But there's a weird disparity between what's expected of the scientists and advocates in a setting like this.
Among writers there's a phenomenon known as the Rule of Three. It's based on the strange but true fact that threes are more satisfying than twos, or fours, for that matter--in humor, scholarship, and argumentation, at least. There seems to be a natural economy to threes. Three little pigs, three stooges, three Marx brothers. Many titles of books, articles, and scholarly talks have three elements. Such as in this (invented) history of German baseball: Nietzsche, Nazism and Knuckleballers: Three Reichs and You're Out.
Well, the same seems to hold true when it comes to arguments about vaccine mandates, which explains why the HPV mandate is a bad idea at this time.
Cotton Mather’s name has become synonymous with Puritanism and hellfire-and-brimstone religion, but he believed both in the absolute rule of an angry God and in the principles and value of scientific inquiry. And so, when smallpox came to Boston in 1721, Mather mobilized the moral weight of religion against the resistance of the medical establishment and fearful members of the public to implement preventive variolation, an early form of smallpox inoculation.
In 1721, smallpox “treatment” consisted primarily of dangerous and ineffective practices like bleeding and large doses of toxic mercury, which caused vomiting, tooth loss, and other side effects. People rightly feared and mistrusted doctors and went to them only as a last resort. Smallpox killed as many as one in four infected, and child mortality from smallpox and other diseases was high. Mather himself lost 13 children, and once said in a sermon that, “A dead child is a sign no more surprising than a broken pitcher or blasted flower.”
Variolation, in which a patient’s arm was lightly scratched and fluid from a fresh smallpox sore rubbed on the wound, was relatively harmless compared to conventional “treatments.” It had long been used effectively to prevent smallpox infection in Africa, Turkey, and other parts of the world outside Europe. Mather learned of the practice from one of his African slaves, while his English counterpart and political opposite, Lady Mary Wortley Montagu, first saw variolation practiced in Turkey.
Both Mather and Lady Mary met with violent opposition, sometimes literally. The history of vaccination is full of politics, contradictions, and, most of all, fear, and has been marked by furious debate since the beginning. In the introduction to Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver, author Arthur Allen writes, “Without fear, history has shown, it was difficult to get people vaccinated.”
Yet fear has also been a primary reason people have refused vaccines; fear of disease and fear of the vaccines themselves have dominated the debate over vaccination for almost three centuries now. We have moved from a world in which often-lethal and crippling diseases killed millions to a world in which vaccines that prevent those diseases are mistrusted by a vocal and growing minority. Allen comes down firmly on the side of public health, but he doesn’t avoid describing the harsh details of the less-than-shining history of vaccines and the medical profession -- or the harsh realities of the diseases vaccines and sanitation have made into little more than clinical descriptions in textbooks to the average Western citizen.
In the first two sections of Vaccine, Allen describes the history of the development of vaccines in a time when there were no clinical ethics boards or informed consent laws and patients often survived despite their doctors’ “treatments,” the defeat of smallpox and polio, and public resistance to widespread vaccination. The history has both triumphs and tragedies.
Religion often supported the side of the anti-vaccinists, believing that disease was God’s punishment and that the Bible prohibited “polluting the blood.” English eugenicists argued initially against vaccines, believing that they would unfairly save the “poor and unworthy,” harming society, but American eugenicists later argued that mandatory vaccination was as important to society as forced sterilization of the “mentally unfit.” Both pro- and anti-vaccinists have always had their share of morally abhorrent, deliberately dishonest supporters.
Vaccines didn’t gain much public support in the United States until World War I and particularly World War II, when the military implemented a mass immunization program against common battlefield killers like typhoid fever, tetanus, smallpox, cholera, typhus, and plague, with great success. Compared to previous wars and to unimmunized foreign troops, U.S. soldiers suffered far fewer illnesses and only a handful of deaths. Soldiers who returned home wanted their children to have the same protection, and the medical profession was respected and trusted to an unprecedented degree. The United States entered a period of public support for vaccines that lasted for several decades.
Allen devotes the last four chapters to the vaccine controversies of the last few decades: the trend towards alternative health, vaccines and autism, and the moral condemnation by religious conservatives of first the Hepatitis B vaccine and now the HPV vaccine. This relatively brief analysis of the modern political debate is not well connected to the first two sections of the book, and it is not flattering in its portrayal of the anti-vaccine movement.
Vaccine presents a well-researched history of both sides of the vaccine wars, warts and all, with unflinching language (and 52 pages of endnotes and references). There’s a lot here to disturb both proponents and opponents of mandatory vaccination, but Allen does support the scientific viewpoint and treats alternative medicine with skepticism. Readers seeking a comprehensive treatment of the vaccine-autism debate or a history of vaccination outside the United States and Europe should seek elsewhere, but readers seeking a solid history of the first two and a half centuries of vaccination will find a lot to think about in Vaccine.
I was interviewed by CBS Sunday Morning a few weeks ago for a program on vaccination that aired today, April 1st. They did a nice job unearthing historical footage about vaccines, including some film of Salk vaccinating kids against polio. Unfortunately, they didn't handle the autism question very well. I wrote the following letter to one of their producers:
Cincinnati native investigates the history of vaccination
By Stephen Paul Lansky
Cincinnati native Arthur Allen now lives in Washington, D.C. He has become a widely published and respected journalist who covered the war in El Salvador in the 1980s and spent time in Paris and later Germany in the '90s. He has followed stories about ideological and political conflict, including a powerful op-ed piece for The New York Times about Cincinnati's civil unrest in 2001. Since then he's written about public health for Salon and The Atlantic Monthly. His first book, a history of vaccination, Vaccine, is a vast, meticulous exploration of this topical and vital public health policy issue. As an authoritative history, it might serve as a resource to medical professionals while also shaping the public policy debate.
The shades of meaning employed by both sides of a public health controversy chime and wave, as if bells are tolling and flags are being hoisted. Most pointed are the comments concerning how Western political structures interact with the public when military interests shape disease control.
Once the narrative reaches mid-20th century postwar New York, Allen's prose on voluntary mass inoculation rings with patriotism: "Neither parade attendance nor vaccination were duties that could be shirked." Allen's control works behind the reader's eyes, tugging at the bones of the face, pulling muscles long dormant.
Early in the history Allen shares a country rhyme about milkmaids' clear complexions, which seems to contain a powerful grain of wisdom. Edward Jenner's discovery of cowpox and subsequent invention of the smallpox vaccine might have evolved from folklore. In detailing Jenner's 18th-century discovery, Allen's terse, direct delivery puts opposing positions fairly: "Vaccination was unnatural. It was progress."
Yet it's the ongoing saga of compulsory applications of medical science that is discussed recursively. He shares layers of pointed rhetoric, piling up medical officialdom's frustration in contrast with the stamina of the opposing less logical, less persuasive presentations of a strange coalition that has its own reasons for fearing and shunning science at its most compassionate fringe -- a fringe that by stages takes the mainstream -- as the history progresses.
Allen describes the early 20th-century laws swinging back and forth with lives and morality at stake, then he seems to vilify the health food movement, the New Age Luddites and the homeopaths, because the alternative here is better. Allen sees government by majority as a safety valve where compulsory vaccination is concerned.
His views on court decisions are nuanced -- circular logic is unveiled and named. A person cannot always be fully expected to understand medical advancement but can know that sickness is not weakness. Further, sickness does happen to individuals despite their relation to God or even to those who disdain belief.
The development of medical science from the earlier understanding of illness stands in stark relief to this reflection on Cotton Mather's early 18th-century Boston: "Disease, like a spiritual journey, was a passive experience. Disease states, like visions, were visited upon people."
CityBeat recently spoke to Allen about his illuminating new book.
CityBeat: Is there anything good about disease? Arthur Allen:
A lot of natural medicine folks talk about a "healing crisis," and I think I understand that. Sometimes when my son Ike and daughter Lucy got sick as babies, after they recovered they seemed to make a leap in their development. That's purely "anecdotal" and when I've talked about it with some friends they haven't experienced the same thing. But it stands to reason that our immune systems are designed to deal with germs and that the immune system develops, and probably kicks off other developmental processes, as part of the process of illness.
When I asked scientists whether they thought it would be bad if all exposures to germs were avoided, they generally agreed. But that won't happen, they hasten to add. The question is, which is the germ that you need? Smallpox? No. Measles? I don't think so. Polio? No. Haemophilus influenzae type B, which causes meningitis? I don't think so.
Yet every day we are bombarded with dozens of types of microorganisms against which there is no vaccine protection. They continue to prime our immune systems. There's no way that medicine can totally prevent infections, so the question of whether it would be good to avoid all disease is theoretical only. There's no real absolutism here except as a really fascinating philosophical exercise.
CB:When the military and the "military industrial complex" provides a mobilization that is a means to quarantine and inoculate against disease, isn't that a sort of ridiculous paradigm? Saving lives so that killing for some political, economic or religious purpose can be carried out more effectively? AA:
It's another paradox. That's why the chapter title is "War Is Good for Babies." Obviously it's not meant literally. Yet there are ways in which military technology drives improvements in society, vaccines being an example -- not only in that these vaccines were tried out successfully on soldiers, but that the nation's consciousness about trust in medicine was altered by this successful encounter.
CB:When doctors deny and hide their failures, they invite opposition. And when they
Arthur Allen kicked off his book tour in January 2007 by debating David Kirby in San Diego on the theory that vaccines cause autism. He has appeared at bookstores in Portland, Cincinnati and Washington, DC, and has spoken before scientific and lay audiences at George Washington University and the Wistar Institute in Philadelphia. He is giving the annual Bioethics Lecture at Woods Hole on July 26 and will speak to public health officials in Broward County, Fla., on Oct. 26. Allen has appeared on NPR's "Science Friday" to discuss Merck's Gardasil human papilloma virus vaccine, and on numerous NPR affiliate station programs in Minnesota, Illinois, Texas, North Carolina, Florida, Washington, Oregon and Washington DC. His op-ed columns on vaccines have appeared in the Dallas Morning News, Baltimore Sun, Washington Post Outlook section, The New Republic Online, HuffingtonPost and The New York Times. He has also been interviewed on VOA programs aimed at Latin America, China and Indonesia, on Judy Warner's XM Satellite Radio program and for numerous other radio stations in the United States and Canada. Please contact him at artnews@earthlink.net if you are interested in arranging a speaking engagement.
Yes. Do what your pediatrician says. Vaccines don’t cause autism. To read more about how to think about vaccination,
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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. 
