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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Vaccines and the Rule of Three

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.

For example, let's say that you deeply mistrust vaccines and are opposed to them, consciously or unconsciously, on principle. Let's say this springs from a fundamental fear of vaccines, a sense that they interfere with the natural order of things by artificially tinkering with your child's perfect body. After all, vaccines are really the first form of biotechnology. Eating and taking medicines also alter biochemistry, but food and medicine are primordial. Eat when you're hungry, take a remedy when you're sick -- whether it's willow bark or risperidol, it doesn't seem unnatural to fix something that's broken. With vaccines, however, there's nothing wrong and the point is to reshape the body's immune response to a future, potential challenge.

Anyway. So let's face it -- people are generally leery of vaccines. That's strike one against them.

Strike two, for many religious conservatives, is the sense that providing HPV will lower the barrier to moral peril and thereby encourage the little devil sitting ont he shoulders of teen-age girls telling them it's OK to have premarital sex. Well, that argument has been countered in a variety of ways, among them the fact that you don't have to be promiscuous to be infected with a deadly strain of HPV. Even health leaders of the religious right have been quoted as saying they'd like the vaccine for their own daughters, for the simple reason that it prevents cancer.

Strike two for certain Americans of libertarian bent is the idea that any mandate that coerces a parent to give his or her child any medication is inherently a trampling of personal liberties. This argument, however, has also been effectively countered in states that are considering a mandate by including a prominent "opt-out" clause for those who don't want the vaccine for their daughters.

With those two points effectively dispatched, it might have been possible to push a mandate for HPV were it not for a third point, which is that the vaccine is simply not ready to be mandated. Public health agencies can't afford to buy it, and it hasn't been tested enough to be absolutely certain that it has no side effect profile.

Strike three. The mandate idea loses. I predict that few states will mandate HPV at this time, although the city council of my own "state," the District of Columbia, approved one this past week. 

The other problem with pushing a questionable mandate is that by engaging opponents of vaccination it inevitably brings extraneous arguments to the fore. (Thanks to the Jewish Light of St. Louis for the following item). For example, Republican Rep. Rob Schaaf of the Missouri house of delegates recently introduced a bill that would prohibit the state from paying for any vaccine produced from a cell culture derived from an aborted fetus--unless no other vaccine is available. Beginning in 2010, the state could not buy such a vaccine even if no alternative were available. Schaaf says he's merely trying to encourage vaccine makers to come up with new vaccines against chickenpox and rubella. The current vaccines were developed with cell lines from fetuses aborted 40 years ago.

This is a tired old argument; the Vatican's Pontifical Academy for Life issued a paper two years ago saying that while the Church supported a person's decision not to take such a vaccine, it absolved those who are vaccinated because the moral justification of "cooperation with evil" done four decades ago pales by comparison to the potential harm to public health of stopping vaccination. Rubella, for example, caused tens of thousands of birth defects (including autism) during the last great U.S. epidemic of Congenital Rubella Syndrome, in the mid-1960s. 

Schaaf's bill isn't going anywhere anyway, and was probably just a political maneuver. But when vaccines are in the news, they tend to attract muddled thinking. Controversy completes the rule of three.

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