Vaccine Nation: America’s Changing Relationship with Immunization by Elena Conis (review)

Given extensive news reports about parents refusing to vaccinate their children, it might seem surprising that American children actually receive more vaccinations than ever before. Less than 0.5 percent of children receive no vaccines at all. In this smart and balanced book, Conis argues that widespread adherence to vaccination is at least as worthy of study as vaccine resistance. She turns her lens on the proliferation of vaccines in the postwar era when new vaccines targeted the “milder” diseases of childhood such as measles, mumps, and whopping cough. More recently, vaccines have been developed and promoted that protect against diseases that largely affect adults (hpv and Hepatitis B), but are given predominantly to children. Through a careful examination of vaccine development, federal vaccine policies, and the public debate over vaccination, Conis demonstrates why health policy-makers have promoted vaccination and why children receive most of the vaccinations. In doing so, she helps us to understand the growing resistance to vaccination.

Conis argues that vaccines came to be seen as an important public good in the wake of the polio epidemics of the middle decades of the twentieth century. The timing of this might be slightly off: toxoid had already had a dramatic impact on reducing deaths from diphtheria. She argues that the rise of pediatrics as a medical specialty and the array of public health services provided to children ensured that children were more easily accessed than other segments of the population and that as a result, children became the primary focus of vaccination. Public funding for vaccinations increased in the post-war era not only because policy-makers realized that the vaccines could dramatically reduce disease but also because after the introduction of the polio and measles vaccines, it became clear that these diseases were increasingly concentrated in poorer neighbourhoods and among African American and Hispanic populations. Vaccines were a relatively cheap option for reducing health disparities.

At the same time, new vaccines changed perceptions of childhood illnesses. Measles had once been dismissed as an inconvenience, but vaccine promoters emphasized that measles could have dangerous side-effects including encephalitis, deafness, and brain damage. Mumps was similarly transformed from a mild disease of childhood to one with frightening complications including male sterility and mental retardation. Conis argues that the introduction of the mumps, measles, and rubella (mmr) vaccine by Merck in 1971 ensured that American children would be vaccinated against the mumps, but she does not believe that a profit-seeking pharmaceutical company duped Americans into vaccinating their children. Instead, she argues that concern about the declining birth rate made the possible complications of the mumps seem more serious. At the same time, alarm about rubella-induced birth defects increased support for the mmr vaccine. What was interesting about both mumps and rubella vaccination is that the people at risk (adolescent boys and pregnant women) were not the groups targeted for vaccination: younger children were vaccinated because they were easier to reach and because universal childhood vaccination could eventually protect the entire population.

The middle chapters of the book trace the beginnings of vaccine resistance. In 1977, the Carter administration promoted a major vaccine initiative in the hopes of reducing health care costs and increasing vaccination rates among the poor. As a result, numerous states strengthened their mandatory immunization legislation. At the same time, a predicated swine flu epidemic never materialized, and the vaccine used had a high rate of complications. By the 1980s, the group Dissatisfied Parents Together drew attention to vaccine-injured children and urged parents to fully educate themselves about vaccine risks. She argues that vaccine resistance drew from the feminist health movement, which had demanded the full disclosure of the risks and benefits of any medical procedure, and from the environmental movement, which was raising awareness of the many unintended consequences of industrial and technological progress, and helped to promote the idea that natural approaches to building...