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.


The (London) Guardian

A jab in the right direction

Arthur Allen shows how inoculation's successes have led to recent concerns in Vaccine, while Robert Bud charts a very different story in Penicillin, says Mark Honigsbaum

Mark Honigsbaum
Saturday May 5, 2007


Vaccine: The Controversial Story of Medicine's Greatest Lifesaver, by Arthur Allen. 512pp, WW Norton, £17.99
Penicillin: Triumph and Tragedy, by Robert Bud. 340pp, Oxford, £30

In March 1947, Eugene LaBar, a rug importer returning from Mexico to Maine by Greyhound bus, collapsed in Manhattan complaining of a fever, rash and headache. Within days LaBar and 11 other New Yorkers had been diagnosed with smallpox, sparking the largest mass vaccination in the city's history. During the following three weeks, six million people were inoculated with the vaccina virus, then as now the only protection. Indeed such was New Yorkers' faith in medical technology and the power of vaccination that clerks and Broadway showgirls queued through the night outside doctors' surgeries in their eagerness to join what newspapers dubbed "the Order of the Itching Arm".

Fast-forward to our own MMR-challenged times, however, and it's a very different story. As the threat of smallpox, measles and other disfiguring childhood diseases has receded, so the balance of power between doctors and patients has shifted. In an era when a list of potential vaccine side-effects is just a mouse click away, few of us itch to have itching arms any longer. Nor do we automatically regard vaccination as a duty to the community, particularly if, as in the case of the HPV vaccine, the disease is sexually transmitted and thus complicated by moralising judgments about "degenerate lifestyles".

According to Arthur Allen, a former AP foreign correspondent with a decade-long interest in the subject, this state of affairs is largely a reflection of vaccination's success. Only a generation of parents that has never experienced the horrors of smallpox - a disease that Macaulay described as "the most terrible of all the ministers of death" and which was thankfully deemed to have been eradicated by the World Health Organization in 1980 - can enjoy the luxury of worrying about autism, a condition that didn't blip on to most GPs' radar screens until 1980. But it also reflects the fact that the question of whether or not to inoculate has always been as much a political as a personal question, and has always attracted zealots on either side.

One of the joys of reading Allen's well-researched but never boring 500-page history is that he pricks both camps, taking a critical look at both the anti-vaccinists' championing of pseudo-science and the medical establishment's repeated tendency to downplay the genuine dangers of vaccine side-effects.

Allen also has a keen eye for the counter-intuitive. For instance, one of the most vocal early American advocates of variolation, as the early 18th-century practice of inoculation was known, was Cotton Mather, the Bible-thumping Massachusetts Puritan and supporter of the Salem witch trials. Despite regarding the pustules of smallpox as evidence of man's innate sinfulness, Mather apparently also regarded smallpox as the "devil's work" and variolation as both a religious and a social duty. Interestingly, his opponents, starting from the same Christian premise, reached exactly the opposite conclusion: it was precisely because smallpox was "God's work" that they argued doctors should let the disease runs its course. Hence the argument of the Swedenborgians that vaccinating a child was "introducing the foul corruptions of hell into innocent life" - a position not that far removed from certain newspaper columnists' rants against the MMR programme today.

In fact, Mather's progressive attitude to vaccination was probably motivated as much by self-interest - he lost several children to smallpox and other diseases - as science. Unfortunately, these days self-interest all too often leads people to ignore the scientific evidence in support of treatment that might serve a greater good, but there was a period when the two happily coincided. Before reading Allen's book, for instance, I hadn't realised that the French superlative "c'est vache" - meaning "excellent" - dates from the early 19th-century Parisian medical practice of corralling cattle on street corners the better to extract fresh vaccine direct from the animals' lymph glands. Nor had I known that such was the enthusiasm for Edward Jenner's cowpox vaccine that Thomas Jefferson personally took charge of its distribution in America, using it to inoculate the last members of the Mohican tribe in 1801.

Present day conservative religious opponents of the HPV vaccine should also note that the reason Jenner's vaccine proved so popular was that it was a lot safer than earlier efforts at variolation in which physicians harvested smallpox directly from patients, many of them infected with syphilis and other sexual diseases. On occasion, however, people have been right to question the prevailing medical orthodoxy, as in 1901 when several children in Philadelphia and other eastern US cities were infected with tetanus as a result of contamination during a smallpox vaccination drive and died agonising deaths from lockjaw despite repeated government assurances that the vaccine was safe.

Allen subtitles his book "the controversial story of medicine's greatest lifesaver", but that is an accolade that Robert Bud, the author of Penicillin, could well dispute, for few drugs can claim to have saved as many lives as Alexander Fleming's "miracle" antibiotic.

Indeed, so closely is penicillin associated with "strong medicine" that Bud, the head of information and research at the Science Museum, argues it could almost be considered a brand, such that "the very writing of a prescription gives hope to the patient and a sense of power to the doctor".

Unfortunately, thanks to the spread of drug-resistant bacteria, the power of penicillin, like that of vaccines, is much diminished these days. The difference is that in the case of penicillin and other antibiotics, this diminution in effectiveness is the result of overuse, not underuse; hence the attempt by doctors to persuade patients to put their faith in vaccination and other medical interventions that have a greater certainty of protecting the health of all of us.

· Mark Honigsbaum's The Fever Trail: The Hunt for the Cure for Malaria is published by Pan


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