Review & Tidbits: The Vaccine Narrative
Joseph Heller’s “The Vaccine Narrative” examines both the history of and the stories we tell about vaccines in the United States, focusing on diphtheria, rubella, pertussis, and HIV. A number of aspects of this book held my interest. In the process of outlining the history of vaccination, Heller also traces the progression of science, from an early focus on stories and guesswork to the later, more familiar study designs and scientific method. The author also contrasts messages about miraculous vaccines, freedom from disease, and individual health with a historical tendency to ignore social problems contributing to disease in favor of magic bullets in the form of vaccines. Heller describes the stories that were told to promote widespread adoption of these vaccines, and the resulting cultural narrative that tells us that vaccines are always worth having and those who question their safety or utility are always deviants.
I found the section on the rubella vaccine particularly interesting, as I was completely uninformed about both this disease and the history of the rubella vaccine, having only encountered it when receiving the routine MMR vaccination. Heller explains that rubella was not a disease that people were dying from, with most cases being mild or even undetectable. The infection was of highest concern when a woman was exposed to it in early pregnancy, as it could lead to miscarriage or deafness or blindness in the offspring. As a result, rubella exposure was one reason a woman could give to obtain a legal, therapeutic abortion at a time when the procedure was illegal. There was no test for exposure to the infection, so concern developed that women might be lying to their physicians to obtain abortions that would otherwise be illegal. Development of a vaccine (and a test for exposure) was seen as a way to eliminate this potential for deceit, although it was not clear how widespread these events might be or even how often fetal effects of rubella exposure occurred.
Therefore, the rubella vaccine was developed not to protect the young boys and girls who currently receive it as a routine injection, but to prevent their potential future offspring from some small chance of being affected, and to prevent women from obtaining abortions. In other words, the rubella vaccine seems to have never been intended primarily to protect those receiving the vaccination or as a response to an overwhelming public health need.
Likewise, the chapter on the search for an HIV/AIDS vaccine is intriguing as it explains ethical challenges posed by the quest for such a vaccine. For example, U.S. ethics standards that would require researchers to provide behavioral counseling on HIV prevention to both test (vaccine) and control (placebo) subjects, which could reduce infection rates in both groups and make measuring the vaccine’s effectiveness for difficult. Heller writes that when this and other barriers to vaccine testing in the U.S. became apparent, researchers began to turn to other nations (primarily in Africa) as potential test sites, with weakened ethical and scientific standards. Somewhat parallel to the purpose of rubella vaccine, some researchers tested strains of HIV prominent in America in test populations in other nations where different strains dominated, making it unlikely that those subjects would actually benefit either individually or as a population from the injections.
“The Vaccine Narrative” will make an interesting read for anyone with an interest in the history of medicine, ethics in medical experimentation, social/cultural aspects of medical policy and research, or current vaccine controversies.
Whew, that was a long review. There really is a ton of material to digest in this book – I may just read it again.