Vaccine: The Controversial Story of Medicine's Greatest Lifesaver (review)

In 1954, an eleven-year-old boy in a Massachusetts boarding school, David Edmonston, came down with the measles. His case was to acquire a kind of immortality: an investigator associated with famed virologist John Enders swabbed his throat and derived the strain that would become the foundation for the vast majority of measles vaccines used today. But the story is not without irony. When Edmonston himself faced the decision in the late 1970s over whether to vaccinate his own son, he declined to do so. In company with a growing number of parents, he feared that the product in which he had played such a germinal role interfered with natural immunity.

Edmonston's saga is but one of many poignant anecdotes uncovered by Arthur Allen in Vaccine, a fascinating and intensely readable history of childhood immunizations in the United States. Allen, a reporter and freelance writer who has published articles on vaccine controversies in the New York Times and Atlantic Monthly, has labored for the past several years on this project, interviewed dozens of subjects, and read extensively in both primary and secondary sources. The result is a fine work of popular history, brimming with colorful figures ranging from the brilliant but arrogant Albert Sabin (who to his dying day denied that his live polio vaccine had ever induced the disease in a child) to the plain-spoken Henry Kempe, the pediatric child-abuse pioneer who offended many of his colleagues by calling for the discontinuation of smallpox vaccine in the 1960s.

Allen walks a tightrope in telling his story, relating both the successes and unexpected consequences of immunizations. He revisits not only the familiar Cutter polio incident and swine flu debacle but other stories as well, such as how a massive hepatitis outbreak swept American troops vaccinated by a contaminated yellow fever vaccine during WWII. His analysis of more recent vaccine safety controversies is fair and reflective. Although he is ultimately skeptical of the current debate linking vaccines and autism, Allen concludes that the whole-cell pertussis vaccine controversy that set off the modern vaccine safety movement was grounded at least in a measure of truth.

At the same time, Allen argues that these tragedies do not negate the social benefits of vaccination. His final chapters sketch an unflattering portrait of the fringe of today's populist safety movement. Building on his earlier journalistic work, Allen's interviews with families in Boulder and the Colorado Western Slope reveal a complex web of emotions and convictions ranging from a passion for alternative medicine, to expressive individualism, to enthusiasm for modern parenting's obsession with risk.

The fact that skepticism about the efficacy and safety of vaccines today runs so deep among the educated classes highlights the need for a thoughtful and accessible book of this sort. For its genre, Allen's book is exceedingly well done. It does concentrate on personality and narrative rather than policy analysis, and some important themes of twentieth-century vaccination (i.e., the increasing pre-occupation with disease eradication rather than control) do not come through as clearly as they might. The author acknowledges a great debt to secondary historical works. But he has contributed considerable original research, most notably with respect to antivaccinationism in early 1900s Philadelphia, yellow fever vaccine in World War II, and current vaccine resistance. Allen's extensive oral histories are perhaps his most important contribution to the history of immunization. I suspect that, while passionate readers on either side of the contested world of vaccines will find reasons to challenge the author, those who are willing to open their minds will find a book in the best tradition of popular medical history.