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.


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.

Another guest on the show was James Colgrove, a Columbia University profesor in public health and author of the interesting-sounding State of Immunity: The Politics of Vaccination in Twentieth-Century America. It wasn't much of a debate, since Colgrove and I, as historians of vaccination, have generated similar perspectives on the HPV controversy. Namely that it looks like a good vaccine, might be worth mandating for junior high school entry at some point, but that it's too early to do so and Merck blew it by pushing too hard.

Moira Gaul of the Family Research Council later joined in with the tired arguments about how mandating such a vaccine would be taking decisions away from the family and encouraging sinful behavior by making it less risky. Not that she's anti-vaccine of course, but this is different because HPV doesn't spread like measles, but rather through behavior that parents should be in control of. This is a religious perspective, not a public health viewpoint. Twaddle from my perspective but then I'm a secular humanist.

Colgrove and I pointed out that hepatitis B is even more of a disease of sin, in that the overwhelming majority of cases in this country are spread through sex, especially homosexual sex, and intravenous drug use. But Moira argued that as a matter of principle, HPV was different because it spread only through sex. I pointed out that sex is something that nearly all humans have eventually and that you don't have to be a woman in scarlet to contract HPV. You can even get it from your prayerful husband, if he happened to have bitten the apple with some shameless hussy earlier in his trial-filled life.

Over the past 15 years, according to a study that appeared yesterday in the CDC's Morbidity and Mortality Weekly Report, rates of hepatitis A and B have declined to their lowest level since the CDC started counting. Some of this is due to the vaccines. Hepatitis B became mandatory for school-age kids starting in 1991. Not much controversy at the time, but the vaccine has prevented thousands of cases of chronic hepatitis, liver cancer, cirrhosis. A 98 percent reduction in cases occurred in the birth-to-15-year-old cohort. A small, virtually uncelebrated triumph. Didn't see it in any of the newspapers.

Another report reminds us of how religious feeling in its most unalloyed gangster state is another obstacle to vaccination. The Taliban are warning vaccinators to stay way from the villages they've taken hold of in southern Afghanistan. The UN-hired polio vaccinators earn $50 a month. Nice work if you can get it, but they'd prefer to live. So the polio endgame continues, seemingly endlessly, with the failure to reach 125,000 benighted Afghan chidlren.

One other item in the news: the CDC has apparently cleared Rotateq, Merck's rotavirus vaccine, of any linkage to intussusception. The FDA raised the alarm last month about a possible linkage. Rotashield, an earlier rotavirus vaccine, was pulled off the market in 1999 because it caused this rare bowel obstruction in approximately 1/20,000 kids. FDA issued a letter after some reports of intussusception after Rotateq came in through VAERS. But a careful review of the case reports indicates that intussusceptions after Rotateq are not higher than you would expect based on the background rate of the disorder, which is about 1/25,000.


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While that is certainly good news about Rotateq, I'd still be very careful about the vaccine. My hunch is that it is possible (note I'm not saying probable) that some mechanism that prevents rotavirus may have the unfortunate side effect of causing intussception in a small number of receipients.


Why is that, anonimouse? They are very different vaccines. And from what I recall of the numbers so far released, it looks as if RotaTeq actually has a significant protective effect. (I'm not asking to be snarky. I would like to understand.)

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