April 2007

Melissa A. Barton

nonfiction

Vaccine: The Controversial Story of Medicine's Greatest Lifesaver by Arthur Allen

Cotton Mather’s name has become synonymous with Puritanism and hellfire-and-brimstone religion, but he believed both in the absolute rule of an angry God and in the principles and value of scientific inquiry. And so, when smallpox came to Boston in 1721, Mather mobilized the moral weight of religion against the resistance of the medical establishment and fearful members of the public to implement preventive variolation, an early form of smallpox inoculation.

In 1721, smallpox “treatment” consisted primarily of dangerous and ineffective practices like bleeding and large doses of toxic mercury, which caused vomiting, tooth loss, and other side effects. People rightly feared and mistrusted doctors and went to them only as a last resort. Smallpox killed as many as one in four infected, and child mortality from smallpox and other diseases was high. Mather himself lost 13 children, and once said in a sermon that, “A dead child is a sign no more surprising than a broken pitcher or blasted flower.”

Variolation, in which a patient’s arm was lightly scratched and fluid from a fresh smallpox sore rubbed on the wound, was relatively harmless compared to conventional “treatments.” It had long been used effectively to prevent smallpox infection in Africa, Turkey, and other parts of the world outside Europe. Mather learned of the practice from one of his African slaves, while his English counterpart and political opposite, Lady Mary Wortley Montagu, first saw variolation practiced in Turkey.

Both Mather and Lady Mary met with violent opposition, sometimes literally. The history of vaccination is full of politics, contradictions, and, most of all, fear, and has been marked by furious debate since the beginning. In the introduction to Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver, author Arthur Allen writes, “Without fear, history has shown, it was difficult to get people vaccinated.”

Yet fear has also been a primary reason people have refused vaccines; fear of disease and fear of the vaccines themselves have dominated the debate over vaccination for almost three centuries now. We have moved from a world in which often-lethal and crippling diseases killed millions to a world in which vaccines that prevent those diseases are mistrusted by a vocal and growing minority. Allen comes down firmly on the side of public health, but he doesn’t avoid describing the harsh details of the less-than-shining history of vaccines and the medical profession -- or the harsh realities of the diseases vaccines and sanitation have made into little more than clinical descriptions in textbooks to the average Western citizen.

In the first two sections of Vaccine, Allen describes the history of the development of vaccines in a time when there were no clinical ethics boards or informed consent laws and patients often survived despite their doctors’ “treatments,” the defeat of smallpox and polio, and public resistance to widespread vaccination. The history has both triumphs and tragedies.

Religion often supported the side of the anti-vaccinists, believing that disease was God’s punishment and that the Bible prohibited “polluting the blood.” English eugenicists argued initially against vaccines, believing that they would unfairly save the “poor and unworthy,” harming society, but American eugenicists later argued that mandatory vaccination was as important to society as forced sterilization of the “mentally unfit.” Both pro- and anti-vaccinists have always had their share of morally abhorrent, deliberately dishonest supporters.

Vaccines didn’t gain much public support in the United States until World War I and particularly World War II, when the military implemented a mass immunization program against common battlefield killers like typhoid fever, tetanus, smallpox, cholera, typhus, and plague, with great success. Compared to previous wars and to unimmunized foreign troops, U.S. soldiers suffered far fewer illnesses and only a handful of deaths. Soldiers who returned home wanted their children to have the same protection, and the medical profession was respected and trusted to an unprecedented degree. The United States entered a period of public support for vaccines that lasted for several decades.

Allen devotes the last four chapters to the vaccine controversies of the last few decades: the trend towards alternative health, vaccines and autism, and the moral condemnation by religious conservatives of first the Hepatitis B vaccine and now the HPV vaccine. This relatively brief analysis of the modern political debate is not well connected to the first two sections of the book, and it is not flattering in its portrayal of the anti-vaccine movement.

Vaccine presents a well-researched history of both sides of the vaccine wars, warts and all, with unflinching language (and 52 pages of endnotes and references). There’s a lot here to disturb both proponents and opponents of mandatory vaccination, but Allen does support the scientific viewpoint and treats alternative medicine with skepticism. Readers seeking a comprehensive treatment of the vaccine-autism debate or a history of vaccination outside the United States and Europe should seek elsewhere, but readers seeking a solid history of the first two and a half centuries of vaccination will find a lot to think about in Vaccine.

Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver by Arthur Allen
W.W. Norton
ISBN: 0393059111
523 Pages