Vaccine: The Debate in Modern America by Mark A. Largent (review)

One of the most prominent vaccine-safety concerns in the United States today is the distinctly modern worry that vaccines may cause or contribute to autism. Debate about the existence of this link has dominated media, policy, and scientific reports about vaccination for the better part of a decade. To Mark Largent, however, the debate is both a “proxy” and a calculated distraction. Beneath the surface, Americans are debating something more complex and troubling than the relationship between vaccines and autism—but the debate’s tight focus on this relationship has allowed “serious real problems with the current vaccine regime [to] remain unresolved” (p. 1).

According to Largent, public health and medical officials have kept today’s vaccine debate focused on autism because it “allows them to engage in the debate on the basis of their authority in the realm of science” (p. 157). This focus has also allowed them to ignore the litany of issues at the root of parents’ vaccine worries: the astounding growth of the vaccine schedule, the increasingly commonplace status of vaccines as “enhancement technologies,” inadequate surveillance of vaccine risks, gendered ideas about disease eradicability, corporate influence on vaccine safety testing and use, and the lack of a long-term vision for our nation’s vaccination enterprise as a whole. “Individually, any of these problems can be addressed,” writes Largent. “Combined, the problems represent a serious threat to U.S. parents’ willingness to allow their pediatricians to vaccinate their children” (p. 171).

In addition to excavating the true causes of contemporary vaccination resistance, Largent attempts to complicate dominant explanations of how and why this resistance emerged. Chapter 2 describes what he sees as the major sources of vaccination doubts that emerged in the 1990s: the vaccine critiques of alternative medical practitioners (notably chiropractors), the theory linking HIV’s emergence to the polio vaccine, and critics’ claims of a connection between military vaccinations and Gulf War Syndrome. Chapter 3 situates the controversy over the safety of the mercury-based vaccine preservative thimerosal within the context of broader vaccine safety worries, ongoing measures to reduce exposures to toxic environmental chemicals, and rising autism rates. Chapter 4 attempts to contextualize the work of British researcher Andrew Wakefield, who alleged to have unearthed a mechanistic link between the MMR vaccine and autism in a highly controversial 1998 report. But as Largent points out, Wakefield didn’t cause parents’ vaccine worries any more than celebrity turned vaccine critic Jenny McCarthy did. Such outspoken vaccine critics “are, in short, not the cause of the problem,” he argues in chapter 5. “They are merely a symptom” (p. 151).

Largent’s book is a swift read; it’s compact, well organized, and thought-provoking. Its target audience is clearly broader than historians of science, medicine, and public health. Largent speaks directly to parents, recounting the vaccination decisions he has made as a father. He speaks directly to medical and public health professionals, suggesting, for instance, that they acquire a deeper understanding of parental notions of vaccine risks and benefits. He’s sometimes quite critical of such professionals, arguing, for instance, that their ideas about parental vaccine worries are “overly informed by historical memory” (p. 25). This critique (and others like it) also makes the book a good starting point for discussion among students in the classroom.

But beware the book’s omissions. Largent’s focus is the past two decades, but many events spelled trouble for the nation’s vaccination enterprise well before the 1990s: lawsuits against vaccine makers in the 1960s and 1970s, the emergence of a consumer rights movement in the 1970s, and the creation of an organized vaccine safety movement and establishment of a federal vaccine injury compensation program in the 1980s, to name a few. Of course, no book can be comprehensive, but chapter 2’s emphasis on the long history of chiropractic beliefs, for example, makes some of the omissions mentioned here stand out.

On the whole, however...