Book Review: Vaccine, The Controversial Story of Medicine’s Greatest Lifesaver, by Arthur Allen

The claim that vaccines are linked to autism has really bruised the vaccine industry. Pharmaceutical companies are quitting (more because vaccines aren’t profitable than because of fears of liability), parents are refusing to vaccinate, and vaccinologists are getting death threats. Allen wrote Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver to put today’s debate into a historical context.

The historical context is that vaccines have always attracted controversy. The smallpox vaccine (which was the only vaccine from the 1700s to the 1900s), did save lives, but it also killed and maimed people. In 1901, hundreds of children were vaccinated against smallpox, and scores of them died of lockjaw because the vaccine was contaminated. Every smallpox vaccination of the early 1900s contained the threat of lockjaw, sepsis, painful swelling and fever. After all that, sometimes the vaccine didn’t “take” and the patient was not immune anyway. People literally ran and hid from the vaccination squads that roamed cities during smallpox epidemics.

Besides medical complications, vaccines were challenged on moral, religious, and health grounds. Disease is something God has decreed, and mankind has no business thwarting God’s will. It’s healthier for the immune system to suffer natural disease than to be unnaturally provoked by vaccines. It’s better to let the weaker children die of disease so the human race remains strong. Threads of the reasoning from the 1700s are still traceable in the protests against vaccines in 2008.

Like any medical procedure, vaccines do carry some risk, and always will. In 1986, the Vaccine Adverse Events Reporting System and the Vaccine Court were established to compensate the parents of children who have been injured by vaccines. In the war against infectious disease, the government finally formalized a process to recognize the injuries inflicted on the child soldiers. The most common compensable injuries are brain inflammation, seizures, and death. Such serious side effects are very rare. Perhaps one in every 250,000 children suffers such a terrible fate. But they do exist and it is right to formally recognize the injury.

Do vaccines cause autism? The main culprit fingered in this debate has been a mercury preservative – thimerosal. Every vaccine has to have a preservative to keep the vaccine effective and uncontaminated. Different vaccines work better with different preservatives. Thimerosal worked well in DTP, Hib, and hepatitis B vaccines.

To make a long story short, the government told the pharmaceutical companies to take thimerosal out of vaccines in 1999, even though there was no conclusive evidence that thimerosal caused autism. The appearance of possible harm was enough to undercut confidence in vaccines, and vaccines rely on confidence and trust.

Since 1999, scientific studies show that the type of thimerosal used in vaccines does not stay in the body long enough to get into the brain. Statistics also show that autism diagnoses have increased since 1999. If thimerosal was truly to blame for autism, diagnoses should have decreased after thimerosal was removed.

The debate about thimerosal continues, and some anti-vaccinationists switched their accusations to vaccines in general. Their broad and shifting claims are hard to prove or disprove. Allen ended his book by noting that the vaccine and autism debate is still an open chapter.

The discussion about the risks of vaccination tends to obscure the risks we don’t see anymore – the diseases themselves. We don’t see children with measles, mumps, polio, diphtheria or pertussis anymore. In the early 1700s, Cotton Mather, a well-known preacher, taught that, “a dead child is a sign no more surprising than a broken pitcher or a blasted flower,” though he felt that seeing his own children die was like “having a limb torn away.” Now we expect all our children to reach adulthood, and a dead child is the greatest tragedy most of us can imagine. Vaccines are “medicine’s greatest lifesaver” for children.

Vaccinology is not a flashy area of study. It attracts scientists who want to stop suffering before it starts. As one vaccinologist noted, “if a vaccine works, nothing happens.” It’s hard to measure the value of “nothing happening,” but no disease and no side effects are the goals of a vaccinologist.

Vaccinology is not without its problems. Market forces do not encourage vaccines, and so the government steps in to mandate vaccinations (by making vaccines necessary before a child can attend public school) and even prop up pharmaceutical companies that want to leave the industry because there is so little profit to be made in manufacturing vaccines. Pharmaceutical irresponsibility in the past has caused cases of disease and serious side-effects. Vaccinology should not be put on a pedestal any more than it should be painted as the villain.

Learning the historical context of vaccines is an excellent way to frame today’s debate about vaccines. This book contains enough history and information to put things in perspective. It’s 450 pages of 8-point font, though. You’ve got to be pretty motivated to plow through it, although it is written very well. Allen does a good job of making the technical details about manufacturing vaccines readable. The technical details are necessary to understand some of the risks of vaccines, and he explains the science well. Maybe you could skip the first 250 pages and just read the last 200 pages that cover the time since the 1960s.

All that, and I didn’t even get to talk about how some of the issues vaccines are solving were caused by medicine and hygiene in the first place. One quick example: polio virus used to be so common that everyone was immune to it. Once we started cleaning up our drinking water, we were no longer constantly exposed to polio and it became a serious disease. Now we need a vaccine to immunize us against a disease that everyone used to be immune to. We’re not going back to drinking dirty water, though.

If I had to sum it up in one line, I’d say that vaccines raise complex issues, and it’s impossible to answer them in one line. Keep that in mind when you hear people try to sum up vaccines in inflammatory slogans.