Vaccine, by Arthur Allen

Friday, 16 March 2007

http://www.independent.co.uk/arts-entertainment/books/reviews/vaccine-by-arthur-allen-440363.html

What is the most important medical advance of the last 160 years? When the British Medical Journal put that question to its readers recently they responded in their thousands. Sanitation topped the poll, followed closely by antibiotics and anaesthesia. In fourth place came vaccines. While a similar poll of lay people might have agreed on the first three, would they have ranked vaccines similarly highly?

It seems doubtful. Vaccines have never had the kind of uncritical support that, say, antibiotics enjoy. Although vaccination has saved hundreds of millions of lives it remains controversial, subject to scares, driven by political imperatives, testing our faith in medical authority and our own judgement.

One of the enduring puzzles of the great MMR scare that gripped Britain for much of the last decade is not how it started - the 1998 Lancet paper linking the triple jab with bowel disease and autism is well known - but how it was sustained. Why did parents - predominantly well-educated, professional people - continue for years to doubt the safety of the vaccine in the face of repeated reassurances from medical authorities and in the almost complete absence of evidence to support claims to the contrary?

At least part of the answer is to be found in this enthralling book. Though it does not discuss the MMR controversy in detail, it demonstrates in case after case how, through its 300-year history, the benefits of vaccination have been oversold and the risks underplayed. The eagerness of the authorities to protect the public health has, too often, blinded them to the true scale of the threat, or to the risks of the vaccine.

In April 1947, New York registered its first death from smallpox in 35 years. A rug importer from Mexico had carried the virus to the city and caused panic. In three weeks more than six million New Yorkers were immunised against smallpox, jamming hospital clinics and queuing for hours - all entirely voluntarily - after the city's health commissioner announced his intention to vaccinate the city.

Yet by isolating and vaccinating each contact the outbreak was contained within days and the disease ultimately infected just 12 people. Meanwhile, six people died from brain inflammation caused by the vaccine and 100 others suffered serious injuries such as encephalitis.

In 1954, huge excitement greeted the launch of the Salk polio vaccine against one of the most feared childhood diseases. But within months it became clear that the version manufactured by Cutter Laboratories was crippling children. The vaccine had become contaminated by live virus which infected up to 220,000 people, made 70,000 ill, and was linked to 164 cases of severe paralysis and 10 deaths.

The Cutter incident inspired major reforms. But while these improved safety they could not prevent vaccination's use as a political weapon. In December 2002, President George Bush rolled up his sleeve to be vaccinated against smallpox - a disease eradicated in 1980. He was launching what was supposed to be a campaign to immunise 10 million police and health workers against the threat of biological warfare.

Yet by 2005, fewer than 40,000 had come forward. Just as the Bush administration had failed to find weapons of mass destruction in Iraq, health workers saw the smallpox campaign as an unjustified attempt to build national consensus by stoking fear.

This is a fascinating, meticulously researched history of vaccination which is admirable for its even-handedness. In this fevered debate it is rare to find an author prepared to examine the arguments without taking sides. Yet the moral of Arthur Allen's story is clear. By eliminating many diseases of childhood, vaccines have become a victim of their own success. Vaccination is no longer seen as a necessary rite of passage but a matter of individual choice, even though each person who vaccinates their child helps protect every other child.

Risks must be set out, but individuals must recognise that complete personal responsibility is unattainable. By accepting vaccination, we all help look after one another, as we must. That, as Allen says, is our social contract.

Jeremy Laurance is health editor of 'The Independent'