The Vaccine Narrative

Introduction

[ 1 ] Vaccines in Context vaccines have been part of Western medicine and public health for more than two hundred years.They have become more than just a way to stay healthy: they have become a metaphor for protection and a cultural story that transcends social divides. We simultaneously understand vaccines as a shield against disease, a right of passage for children and parents, and an expression of our science, civilization, modernity, and morality. We want to make sure our children get all the necessary “shots” to grow up healthy and to have a fair chance at life’s opportunities; we want children throughout the world to benefit from this simple, elegant intervention that eradicates unnecessary suffering. vaccines have taken on important meanings far beyond the realm of medicine and public health. New vaccines still manage to excite our imagination and allay our fears about disease, even though controversies sometimes develop about their use, their cost, and their consequences. Pharmaceutical giant Merck & Co. recently came out with two new vaccines: one against human papilloma virus (hPv), to prevent and eventually eradicate cervical cancer (Blumenthal 2007), and another that promises protection against rotavirus , a debilitating and potentially deadly diarrhea-causing infection among children, particularly the poorest of the poor (harris 2006). Both have been certified as highly effective, but both have also raised issues of cost, access, the nature of the target population, and whether these vaccines are necessary and appropriate for the american population. Recent scientific discoveries and sizable investments promise further vaccine triumphs : against the much-feared but still uncertain avian flu pandemic (Davis 2005),against hiv/aiDs (altman 2006),or even against smoking Introduction The vaccine was a folk victory, an occasion for pride and jubilation. —Richard Carter Breakthrough: The Saga of Jonas Salk t h e v a c c i n e n a r r a t i v e [ 2 ] (Tuller 2006). With a stable of established vaccines and promising new ones in development, vaccines appear to be simple and versatile tools for contending with all kinds of as-yet-unforeseen problems.as new diseases arise, we have faith that scientists will study the problem, develop and test vaccines that, with widespread use, will protect us, and put the new diseases on the road to extinction. every vaccine has costs and benefits that sometimes seem unfair. health professionals and women’s health advocates have, for example, raised concerns about the target population for the new hPv vaccine and how to achieve high levels of compliance with recommended use. since most girls and women only contract hPv from boys and men, some women’s health advocates have asked why the vaccine has not been designed to target the entire hPv-carrying population—boys as well as girls, men as well as young women. Moreover, widespread use of Pap smears has already drastically reduced the consequences of hPv infection for american women, and this has raised questions about whether americans really need an hPv vaccine at all (Rabin 2006). Others have raised questions about mandating a vaccine to protect young women from a sexually transmitted virus (Daitz 2006; Uribarri 2007). Public and heated controversies like those surrounding hPv vaccine , however, rarely concern the vaccine itself, which typically receives high and hopeful praise once it has passed scientific muster.1 instead, conflicts seem to arise around the context: the laws regarding vaccine use, the role of corporate lobbying, or the politics of a vaccine designed to protect against a controversial disease. There is also the cost issue. We understand vaccines as such a good bargain for society as a whole that out-of-pocket costs to vaccine recipients often become a side issue: our belief in the efficacy, necessity, and wisdom of vaccines sometimes overrides more mundane aspects like the price at the point of use. Yet the cumulative costs of the full course of vaccines for children, none of which is free, has made a surprising number of doctors reluctant to administer them (Pollack 2007). Understanding these changes, tracing them over time, and imagining what the future may hold for vaccines is not, however, as straightforward as the vaccines themselves seem to be. individual vaccines or diseases may not change much from year to year or even decade to decade, but their context undergoes slow and continuous variation that subtly influences how we view, understand, and use vaccines. since edward Jenner discovered the first vaccine (against smallpox) in the 1790s, vaccines have enjoyed a widely varied career in...