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Bulletin of the History of Medicine 74.3 (2000) 650-651



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Book Review

The Politics of International Health: The Children's Vaccine Initiative and the Struggle to Develop Vaccines for the Third World


William Muraskin. The Politics of International Health: The Children's Vaccine Initiative and the Struggle to Develop Vaccines for the Third World. Albany: State University of New York Press, 1998. xiv + 258 pp. $21.95 (paperbound).

At a sushi bar in Hokkaido I once feasted on "dancing shrimp," scooped live from the tank, dressed, and served still twitching. The taste was exquisite and the sensation unique, but my enjoyment was vaguely uncivilized and discomfiting. So it is with this marvelous but unsettling new book, in which William Muraskin, a sociologist/historian, vivisects and serves up to the reader the living story of a noble experiment called the Children's Vaccine Initiative (CVI).

The CVI's founders had great hopes that the revolution in biotechnology could be channeled into the development of new effective and affordable vaccines that could save the lives of millions of children worldwide. The original idea--a "Children's Vaccine"--was that a single-dose, orally administered, combination vaccine could be developed against all the important infectious disease killers of children. When it became clear that this was a utopian fantasy, the focus of the Initiative gradually shifted to the more achievable goal of developing vaccines more stable and less reactogenic than those currently available. With increasing donor demands for immediate and tangible success, the Initiative was further forced to morph into a quality-control agency for vaccine production facilities in developing countries. Eventually the radical new concept became absorbed into and extinguished by the WHO. Although the CVI "failed" to develop any new vaccines, it proved to be an incredibly successful catalyst for important changes in the international system for vaccine development, procurement, and supply.

Muraskin first reviews the intellectual and political background of the 1990 Declaration of New York that established the CVI, and then tracks the Initiative's turbulent scientific, financial, and administrative course. Within six years the utopian dream was all but dead. Muraskin brilliantly reveals the institutional fissures that almost inexorably led to this outcome: European-American rivalries, WHO-UNICEF tensions, intra-WHO turf wars, and the public sector's inability to productively engage private-sector vaccine companies in mutually beneficial relationships. He also exposes several crucial lapses in human behavior--sometimes risk-avoidance, other times power seeking--that accentuated these institutional fissures.

Politics is a concise, meticulously researched and documented history of the determined efforts of a small group of biomedical scientists to speed the development and distribution of new and improved vaccines to millions of poor children worldwide. Muraskin, who interviewed all the central figures in the drama and reviewed all the key documents, provides the reader with hundreds of direct quotations from them. His sources are exceptionally candid, occasionally brutally so, in their uncensored views of the events--and of each other. Some readers may prefer a more processed, analytical approach, but I find Muraskin's reportage a [End Page 650] highly effective style to evoke the nuances of the institutional and personal rivalries that ultimately led to the downfall of the CVI.

Who should read this book? I have already purchased and sent gift copies to many of my friends in vaccine development, and it is required reading for my graduate course in Vaccine Policy. Anyone concerned about international health--government officials from both south and north, industry managers, scientists, trade representatives--should read it. Indeed, the most important use of Politics may be as a field manual for the leaders of the highly encouraging post-CVI explosion in global vaccine initiatives supported by the Gates Foundation, such as the Children's Vaccine Program and the International AIDS Vaccine Initiative. Perhaps by close attention to the lessons offered by the CVI we--the human race--may someday just get it right.

Donald S. Burke
Johns Hopkins School of Public...

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