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In his comprehensive survey of vaccination controversies past and present, Arthur Allen quotes US vaccine chief Walter Orenstein's recollection that ‘for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.’ It was indeed. I recall a mother whose infant died of Hib meningitis, secondary to an apparently trivial otitis media, within minutes of arriving in hospital. Already at an advanced stage of her second pregnancy, she promptly went into labour and had an uncomplicated delivery. The way her grief at the loss of one child overwhelmed her joy at the arrival of another is my enduring memory of the horror of Hib, which was still killing 60 children every year in Britain in the 1980s.
Thanks to the introduction of routine Hib immunization in 1992, this disease has now become a rarity. Yet, as Orenstein points out, when the immunization was introduced there was much uncertainty about its impact on the ecology of Haemophilus and the long term consequences. As he observes, some things are ‘only knowable in the long run;’ in the meantime, ‘we have to take our chances and then follow up.’ One of the themes of Allen's book is that this courageous and enterprising approach to vaccination policy—vindicated by its historic achievements in the conquest of disease—is now threatened by the contemporary climate of risk aversion.
Allen does not ignore the history of vaccine disasters. He includes the fiasco in the US military in 1942, when yellow fever vaccine contaminated with hepatitis B caused 100 deaths, and the mass vaccination against smallpox in New York in 1947 that caused six deaths (four more than the outbreak itself). In the Cutter incident in the 1950s, inadequately inactivated polio vaccine caused 164 cases of paralysis and 10 deaths. While acknowledging these failures, Allen pays tribute to immunization authorities—such as Henry Kempe and Bob Chen—who have campaigned to improve vaccine safety.
The great irony underlying current vaccination controversies is that, as vaccines have become more effective and safer than ever before, an anti-vaccine world view, reflecting a combination of nostalgia and cultural pessimism, has become more prevalent. Allen reports how one family with an autistic child described ‘going down the rabbit hole’ into a ‘spooky realm of herbalists and populist mavericks and—not to put too fine a point on it—conspiracy kooks, who view America as a toxic hell.’ Recognizing that parents' anger and inclination to blame vaccines reflect difficulties in coming to terms with their children's disabilities, Allen has himself bravely challenged anti-vaccine campaigners who have had such a damaging impact on the world of autism.
Allen concludes with Orenstein's prescient warning that a precautionary approach, reflecting corporate concerns about a low profit, high risk area of investment and government sensitivities to public anxieties, ‘could paralyze’ innovation in vaccines.
Competing interests MF is the author of MMR and Autism: What Parents Need To Know (Routledge, 2004. ISBN-13: 978-0415321792. £18.99).