Insights offer a dose of realism on vaccines

O ver the past two decades, the debate on vaccination has become steadily more rancorous, which is puzzling. After all, vaccines have wiped smallpox from the face of the planet and reduced polio to a ghastly memory. Diseases that once struck fear into every parent's heart -- diphtheria, tetanus, whooping cough, measles -- have become, for most Americans, medical asterisks. But, as Arthur Allen shows in "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver," vaccines are not miracles: They are imperfect drugs with risks and benefits. What's more, he argues, vaccination raises fundamental issues about life, death, illness and the individual's duty to society.

Misgivings about vaccines stretch back to 1721, when Cotton Mather, a Boston minister, promoted inoculation (a primitive forerunner to vaccination) to forestall a smallpox epidemic. Opponents denounced Mather as a misguided crackpot who sought to evade God's judgment through unnatural practices. They also articulated the parental dilemma at the heart of every shot: "I should have less distress in burying many children by the absolute acts of God's providence," wrote one opponent, "than in being the means of burying one by my own act and deed."

The smallpox vaccine proved remarkably successful, so successful it hatched a swarm of imitators. It is somewhat unsettling to read about the haphazard development of these early vaccines, many produced by "guts and guesswork," and tested on soldiers or schoolchildren. In 1942, for example, the U.S. Army, acting on intelligence that the Axis powers might wage biological warfare, injected millions of GIs with a vaccine against yellow fever that was contaminated with hepatitis B. Some 100 soldiers died and 50,000 others were hospitalized. (Sadly, their sacrifice was meaningless; the intelligence was wrong.)

In a similar vein, the polio vaccine developed by Jonas Salk in 1952 was heralded as a triumph of American know-how. Salk described it as "safe, and you can't get safer than safe." Unfortunately, shoddy manufacturing and inept federal oversight allowed contaminated shots to reach the marketplace, crippling hundreds of children before the vaccine was withdrawn.

As the last century wound to a close, vaccines were safer and more effective than ever, but the political and moral calculus surrounding them had changed. The diseases they protected against were largely abstract. Cases of severe reaction, though exceedingly unusual, were dramatic and easy to demonize. And the era of trusting experts was long gone. These trends converged in 1982, when NBC aired an expose on the diphtheria-pertussis-tetanus (DPT) vaccine, complete with footage of quadriplegic and brain-damaged children. Overnight, the modern anti-vaccine movement was born.

It turns out that the whole-cell pertussis vaccine used in the old DPT shots did indeed cause brain damage in extremely rare instances, and that drug companies had known this for decades but never bothered to introduce a safer alternative. Although the pertussis vaccine has since been replaced, the revelations inflicted tremendous damage to the public trust. Many parents now oppose vaccination in principle and blame shots for a horde of maladies from autism to asthma.

"Vaccine" is at least 100 pages too long, and some chapters meander. But Allen really shines with his perceptive analysis of the anti-vaccine movement and his calm examination of the evidence linking vaccines and autism (he is a skeptic). His greatest achievement is to inject a dose of reality into a debate that has become distressingly doctrinaire.

Allen reads from "Vaccine" at 7:30 p.m. Friday at Powell's City of Books, 1005 W. Burnside St.

Chris Lydgate is a Portland writer.