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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Journal of the Royal Society of Medicine

JRSM v. 100 (M a y 2 0 0 7)
By Michael Fitzpatrick

In his comprehensive survey of vaccination controversies
past and present, Arthur Allen quotes US vaccine chief
Walter Orenstein’s recollection that ‘for those trained in
pediatrics in the 1970s, Hib (Haemophilus influenzae type b)
was a horror.’ It was indeed. I recall a mother whose infant
died of Hib meningitis, secondary to an apparently trivial
otitis media, within minutes of arriving in hospital. Already
at an advanced stage of her second pregnancy, she promptly
went into labour and had an uncomplicated delivery. The
way her grief at the loss of one child overwhelmed her joy
at the arrival of another is my enduring memory of the
horror of Hib, which was still killing 60 children every year
in Britain in the 1980s.

Thanks to the introduction of routine Hib immunization
in 1992, this disease has now become a rarity. Yet, as
Orenstein points out, when the immunization was
introduced there was much uncertainty about its impact
on the ecology of Haemophilus and the long term
consequences. As he observes, some things are ‘only
knowable in the long run;’ in the meantime, ‘we have to
take our chances and then follow up.’ One of the themes of
Allen’s book is that this courageous and enterprising
approach to vaccination policy—vindicated by its historic
achievements in the conquest of disease—is now threatened
by the contemporary climate of risk aversion.

Allen does not ignore the history of vaccine disasters.
He includes the fiasco in the US military in 1942, when
yellow fever vaccine contaminated with hepatitis B caused
100 deaths, and the mass vaccination against smallpox in
New York in 1947 that caused six deaths (four more than
the outbreak itself). In the Cutter incident in the 1950s,
inadequately inactivated polio vaccine caused 164 cases of
paralysis and 10 deaths. While acknowledging these failures,
Allen pays tribute to immunization authorities—such as
Henry Kempe and Bob Chen—who have campaigned to
improve vaccine safety.

The great irony underlying current vaccination controversies
is that, as vaccines have become more effective
and safer than ever before, an anti-vaccine world view,
reflecting a combination of nostalgia and cultural pessimism,
has become more prevalent. Allen reports how one family
with an autistic child described ‘going down the rabbit hole’
into a ‘spooky realm of herbalists and populist mavericks
and—not to put too fine a point on it—conspiracy kooks,
who view America as a toxic hell.’ Recognizing that
parents’ anger and inclination to blame vaccines reflect
difficulties in coming to terms with their children’s
disabilities, Allen has himself bravely challenged antivaccine
campaigners who have had such a damaging impact
on the world of autism.

Allen concludes with Orenstein’s prescient warning that
a precautionary approach, reflecting corporate concerns
about a low profit, high risk area of investment and
government sensitivities to public anxieties, ‘could
paralyze’ innovation in vaccines.

Competing interests MF is the author of MMR and
Autism: What Parents Need To Know (Routledge, 2004. ISBN-
13: 978-0415321792. £18.99).
Michael Fitzpatrick
Barton House Health Centre, London N16 9JT, UK
E-mail: fitz@easynet.co.uk

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