Under the Skin: A History of the Vaccine Debate Goes Deep but Misses the Drama

Vaccine: The Controversial Story of Medicine's Greatest Lifesaver by Arthur Allen.
January 1, 2007

At this point, it’s safe to say, most people in the United States have not been on the receiving end of midnight vaccination raids, with doctors breaking into their homes and jabbing their families with needles. It’s been a long time since we saw entire cities flattened by disease. So long, in fact, that lessons from those days seem to have been lost on a few generations.

We’re in the midst of a confused national debate over vaccines, with some fearing immunization side effects more than the diseases they fight, and others pushing for more vaccines, at younger ages, and being baffled when parents object. Newspapers report that vaccines may or may not cause autism, autoimmune diseases, and allergies; at the same time, they warn of viral pandemics that can (and do) kill millions, and call for new vaccines to save us (from, say, AIDS, or avian flu). But when those new vaccines arrive and officials say we must give them to our children, we balk. This is nothing new: the vaccine debate has been raging for hundreds of years, because immunizations have a long and complicated history of both saving our lives and hurting us. We needed a book that laid out the history and made sense of it.

There have been at least twenty books on smallpox and polio alone. But until Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver, by the science journalist Arthur Allen, no book had so carefully and clearly catalogued the history of immunization. And, as Allen writes, “the best way to gain an understanding of why our children [are] vaccinated against particular diseases—and why some people [are] challenging these choices—[is] to delve into the history.”

We’ve seen viruses threaten to wipe out millions (and succeed). Parents have refused immunization, then found themselves with sick and dying children, while those doing the immunizing had to pay large sums for damages caused by vaccines that were not properly made or tested. And here’s something ironic: when vaccines do their job best, people doubt them most. They start thinking, Who gets whooping cough anymore? Why should I expose my children to even the slightest risk of vaccine side effects to protect them from a disease no one gets? Anyone who’s ever asked that question should read this book. So should anyone who thinks vaccine doubters are crazy. Because Allen shows that those fears come from real stories of vaccines causing everything from brain damage to tetanus to polio. But more than that, he shows why we have vaccines in the first place, and why it’s a bad idea to shun them.

Allen’s book starts in the 1700s, with smallpox and the first immunizations, and ends with the nearly 10,000 lawsuits filed in 2006 claiming vaccine damages. Along the way, he raises important ethical issues (like the role vaccines played in eugenics), and highlights the many ways children bore the burden of that history: their bodies were used to develop and test vaccines (not always ethically); they suffered the injection side effects, and got the diseases when parents refused to immunize them. Allen traces the legal history of vaccine production, from the first lawsuit for damaging side effects to a litigation free-for-all, with companies paying large sums for problems their shots didn’t cause. (Covering their losses by raising vaccination costs was easier than fighting in court.)

Much of the material devoted to smallpox and polio has been explored elsewhere. Allen’s truly original contributions come with more recent issues that haven’t been widely covered. Whooping cough, for example, lingers in the United States in part because many parents refuse to vaccinate against it. The story that feels largely missing is the new vaccine for strains of the HPV virus, which can cause cervical cancer. HPV is rapidly headed toward as much controversy as any vaccine before it. More, perhaps, since this one—like the vaccine for hepatitis B, which faced similar problems—is a sexually transmitted disease. But Allen makes up for that omission with his detailed coverage of the autism controversy.

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He is one of the first authors to really delve into the science behind the do-immunizations-cause-autism debate. “No one could deny,” he writes, “that autism diagnoses had gone up during a period in which vaccine use was going up.” What caused that increase is still unknown. In 1997, a study found that the hepatitis B vaccine contained as much mercury as a can of tuna. That alone may not be toxic, but because of multiple vaccinations, by the age of six months, kids were getting “doses up to 87 times higher than FDA guidelines for the maximum consumption of mercury from fish.” Mercury is known to cause brain damage, so no one was wrong to ask what it was (and still is) doing in vaccines. Allen doesn’t deny that. But by documenting the science behind the debate, he makes a convincing case against the vaccine-autism theory.

The way Allen sees it, one reason the autism debate still exists, despite evidence against it, is “pseudo-investigative, sensationalist news reporting.” He says a “chunk of the news media” continues to hype the story, and he criticizes them sharply for this. (He might well criticize cjr. See “Drug Test,” November/December 2005.) The vaccine-autism theory was, Allen says, “the Pamela Anderson of news stories—dumb, maybe, but oh, so sexy.” Not that the media must always agree with science, but it’s irresponsible to ignore scientific evidence in favor of a sexy headline, something Allen clearly has not done.

When it comes to modern medicine, there are few topics more dramatic than vaccination. It’s a story full of politics, big-business, desperate parents, sick and dying children, conflicts of interest, national security—it even has abortion controversy, since many vaccines are created using cells from aborted fetuses. The subject should be a narrative goldmine.

But unfortunately, for the most part, that drama doesn’t come through in Vaccine. Its reporting is impressive; there are countless wonderful and often surprising facts that drive the book forward (like companies trying to cover up toxicity problems by spreading out distribution of vaccines, to avoid noticeable clusters of side effects). It’s all interesting; it’s just hard to wade through.

Vaccine is traditional historic nonfiction writing that lays out the facts. But as I read it, I couldn’t help asking myself, Why write a nonfiction science book like this? Why wouldn’t you incorporate narrative into any story that’s so potentially rich with it? Narrative is one of the best tools science writers have for conveying complicated and important information to the general public.

It would be great if all readers loved science for science’s sake, but they don’t. There’s a limited audience for a string of facts about vaccines. But there’s no limit to the number of people who want to read a good story. As long as there are characters to latch onto, as long as there are scenes with action and dialogue, readers will do the work required to understand the science.

How many readers come to John McPhee’s writing interested in geology and ecology? Not a lot. But they read, say, his essay “Travels in Georgia” because he follows two wonderful and complex characters who talk funny and collect road kill and sleep next to poisonous snakes and want nothing more than to save Georgia’s wilderness from bulldozers. People might pick up Oliver Sacks’s An Anthropologist on Mars to learn about neurology, but what gets them through the book is an autistic scientist who communicates with animals, and a top neurosurgeon with Tourette’s who screams obscenities while ticking his way through delicate brain surgeries without a single slip of the scalpel. Such stories aren’t just about keeping readers entertained: they’re about showing instead of telling—they illustrate science at work.

People already interested in vaccination will get a lot out of Allen’s book. It will educate parents seeking answers. Scientists will enjoy it. But the general public—who may be the audience that needs Allen’s book the most—may have a hard time getting beyond the early chapters, which tend toward a blur of information, like this: “A survey of 9,000 American families conducted from 1928 to 1931 found that 26 percent of five-year-olds had been vaccinated. The number jumped to 59 percent by age 7 . . . in cities, where vaccination was a more heavily enforced annoyance, the percentages were 37 and 75 percent, respectively. The last major epidemic, in 1921, brought 102,787 cases and 563 deaths.” The outbreaks and deaths blur because they don’t happen to characters. They’re just numbers.

Which didn’t have to be the case. Allen himself proves this late in the book, when he takes a sharp narrative turn and appears as a character. Suddenly, his voice becomes absorbing and personal as he tells the story of driving through the hills of Colorado, visiting towns filled with antivaccinators, trying to understand why they resist even though they’re some of the only Americans who actually get whooping cough. This is, by far, the book’s strongest section.

We meet people like Dawn Winkler, a full-fledged character who believes only inoculated kids throw temper tantrums. We hear her explain her neighbor’s child by saying, “she must be vaccinated because every time I see her she has a huge amount of snot on her face.” We see her convince many parents not to vaccinate their children though they live in an area with high whooping cough rates (which are largely blamed on not vaccinating). We hear a mother describing her children’s infection as “a loud cough that goes down to their toes . . . they cough and cough until they throw up, then they sleep for an hour or two, then they wake up and start all over.” But she’s glad she didn’t vaccinate them, she tells Allen, because she believes shots weaken the immune system.

These stories speak volumes about the vaccination debate. Allen doesn’t step in and tell readers, This is crazy. He doesn’t have to. Readers can decide what they think, because they’ve seen it for themselves. (In the epilogue, Allen comes across firmly pro-vaccine, but with this caveat: “The history of vaccines has shown that unexpected results are the rule rather than the exception.”) The Colorado episode is no less scientific or accurate than earlier parts of the book—and it’s clearer because the stories illustrate the science. If Allen had written the whole book with that same voice, and with the same narrative touch guiding us through the thickest of science lessons, it would have helped make his important work accessible to a wider audience.

Rebecca Skloot is a freelance writer. Her first book, The Immortal Life of Henrietta Lacks, is forthcoming from Crown.