The Vaccine Narrative

Notes

[ 157 ] Notes Introduction 1. even findings about weaker protection from vaccines usually fail to generate much general interest, as when the news broke that the new chickenpox vaccine is, in fact, much less effective than originally believed (Chaves, Gargiullo, et al. 2007). 2. as this sentence makes obvious, i use the terms vaccine[s] and vaccination almost interchangably. This is intentional. On a stylistic level, it is too cumbersome always to write,“vaccines and vaccination” for every instance that involves either or both. in fact, the two words are different sides of the same phenomenon—the vaccine is the thing, while vaccination is the practice of administering vaccines. They are different, but neither exists entirely independent of the other. i try to use the better term in the particular context, but it should never be forgotten that they are interdependent concepts, if not always interchangeable ones. 3. steeper declines in polio mortality had been recorded in the years leading up to 1920 (McKinlay and McKinlay 1977). 4. like my use of “vaccines” and “vaccination,” i use hiv/aiDs to refer to the virus (hiv), testing positive for hiv, and full-blown aiDs, though when a reference requires more specificity, i will use the other forms individually. 5. smallpox was highly infectious, often deadly, easily identifiable and appeared in a pattern of epidemics. almost alone among human infectious disease, smallpox has no non-human vectors (it can only be passed from person to person), is easily identified because of a very specific set of symptoms, and, perhaps most importantly for vaccination, surviving a case of smallpox confers lifelong immunity to it. 6. Perhaps the most succinct characterization of heroic medicine is Martin Kaufman’s inventory: “Treatment consisted of bleeding, blistering, vomiting, sweating, purging, and administering massive doses of calomel, often until the patient was at the threshold of acute mercurial poisoning” (Kaufman 1967, 468). 7. enthusiasm for vaccines as a technology led some researchers, like the immunological pioneer almoth Wright, to believe that active immunization could be effective not only as a preventive, but as a therapy that would cure a patient even after the disease had been contracted (Worboys 1992, 84). The idea of a “therapeutic vaccine”— of stimulating the immune system after infection—became discredited in the 1930s. in the 1980s and ’90s hiv/aiDs vaccine researchers, des- [ 158 ] perate to produce some kind of vaccine, resurrected the idea (see Chapter 4). 8. That is not to say that the anti-polio campaign was only or even primarily about publicity. Because polio is caused by a virus, it is not amenable to antibiotic treatment. Chapter 1 1. historians who have tried to understand the success of smallpox vaccine in the context of the germ theory of disease discovered that there was little evidence of what Jenner’s vaccine contained—it may even have been a form of inoculation (attenuated smallpox), rather than anything new (or related to cowpox) at all (Razzell 1977a, 1977b). 2. Diphtheria antitoxin conferred “passive” immunity, because immunity to the disease relied directly upon and lasted only as long as antitoxin remained in the body—no more than three or four weeks. “active” immunity is a term that health professionals used to describe immunity that resulted from infection—immunity that derived from the body’s “active” response to disease (or, in the case of diphtheria, “toxin”). immunity in the modern (early twenty-first century) sense usually means “active” immunity. 3. This was also part of the movement among regular (allopathic) medicine practitioners to reorganize medical education, change the standards of the profession and out-compete all the other health practitioners—homeopaths, eclectics, midwives, etc. (see Friedson 1973; Markowitz and Rosner 1973; Brown 1979; starr 1982). 4. This is important for understanding attitudes within the health professions literature. There was, of course, also a moral imperative to eradicating germs in the popular culture; see Nancy Tomes (1998) for an excellent elboration of this popular phenomenon. 5. Out of the more than 50 diphtheria articles directly related to diphtheria prevention, immunity, and vaccine recorded in the Index Medicus between 1903 and 1930, people associated with the New York City laboratory authored more than a third. 6. The closing quotation by Goler is from a story included in the article about a German immigrant family, persuaded by the effectiveness of the anti-pertussis campaign. 7. The idea of a therapeutic vaccine lost credibility by the 1940s, and was not revived until in the 1990s by hiv/aiDs researchers desperate...