Elena Conis, Vaccine Nation: America’s Changing Relationship with Immunization (Chicago: University of Chicago Press, 2014, $27.50, 353 pp.)
On November 8 the on-line magazine Salon published an excerpt from this book, under the heading “Jenny McCarthy’s new war on science: Vaccines, autism and the media’s shame”. The headline, however, bore no resemblance to the actual book, leading one to suspect the editors of Salon had not read it to the end. When they do, they may realize, to their dismay, that in promoting this book, they scored an own goal. For if their objective is to persuade readers to stop asking questions about vaccines, Vaccine Nation will have (happily) the opposite effect.
Elena Conis is a young historian of science at Emory University. Her Vaccine Nation is a remarkably insightful first book, which is already causing a splash. Another excerpt has been published in the Atlantic. In the book review section of Nature magazine, Vaccine Nation was rated one of “the week's best science picks”, and the Times Higher Education Supplement called it “a fine social history of an ongoing story”. Prof. Conis clearly isn’t an “anti-vaxxer”, but she has produced a strikingly honest, fair-minded, and informed chronicle of the vaccine controversy in the United States. She illuminates issues that others have obfuscated, and she opens up discussions that some have tried to shut down. She understands that vaccine policy is determined not solely by objective science, but also by politics, profits, prejudices, and bureaucratic imperatives. She neither endorses nor condemns vaccine resistance: her aim is to understand the larger causes behind this growing movement. But anyone who reads this book with an unprejudiced mind is likely to conclude that the skeptics had good reason to be skeptical.
For those who say there is no scientific debate about vaccination, Prof. Conis shows that there has always been a debate. She scotches the myth, repeatedly reinforced in newspaper stories, that nobody thought to question vaccines before Andrew Wakefield and Jenny McCarthy. Vaccine skepticism was rampant in both America and Britain a century ago, faded out (but never entirely disappeared) in the 1950s and 1960s, and then came surging back owing to a number of converging factors. After Rachel Carson’s Silent Spring (1962) raised public concerns about environmental toxins, first in pesticides and then in a host of consumer products, questions were inevitably asked about toxins in vaccines. Starting with the volume Our Bodies Ourselves (1971), feminists charged that the male medical establishment didn’t listen to female patients and were not honest about the risks associated with many drugs and contraceptives. Not all “Warrior Moms” were radical feminists, but they viewed vaccines and vaccine manufacturers with the same kind of fierce distrust. The “natural childrearing” movement took off with the launch of Mothering magazine (1976), where vaccination was sharply debated in letters to the editor. The wisdom of mass inoculation was seriously challenged in widely-read books by philosopher Ivan Illich (Medical Nemesis, 1976) and physician Robert Mendelsohn (Confessions of a Medical Heretic, 1979). Then there was 1976 swine flu immunization fiasco and, in the 1980s, shocking revelations about tragic reactions to the DPT shot. One FDA bureaucrat frankly dismissed the idea of informed consent to the DPT: “If we told parents there was a risk of brain damage, there’s no question what their response would be.” (121) All that set in motion a broad grassroots movement for what Conis calls “the democratization of vaccine knowledge.” (126) And it all happened long before Dr. Wakefield and Ms. McCarthy got involved.
Throughout the twentieth century, when new vaccines were introduced, scientists and public health officials often questioned whether they were safe or effective – and in fact, often their safety and effectiveness were largely unknown. After the CDC’s Advisory Committee on Immunization Practices recommended that children be vaccinated against mumps, the New England Journal of Medicine and the Lancet both doubted whether it was necessary. A CDC epidemiologist conceded that scientists didn’t really know the prevalence of mumps, or whether it caused male sterility or impotence, or the long-term effectiveness of the vaccine.
Measles, mumps, and HPV were once considered relatively minor diseases: they were only characterized as terrible scourges after vaccines for them were developed. Maurice Hilleman, who invented a vaccine for mumps, repeatedly warned that the disease could be “permanently crippling when it involves the brain,” though Prof. Conis notes that “the relationship between mumps and brain damage or mental retardation was neither proven nor quantified.” (77) In 1978 a federal government brochure claimed that mumps could cause diabetes, though that link has never been confirmed. But by then the transformation was complete: the media’s portrayal of mumps had “morphed from that of a childhood nuisance to that of a deadly crippler.” (82)
Merck’s measles vaccine, available in 1963, didn’t win immediate acceptance in the medical community. In the pages of Pediatrics, one doctor questioned whether measles was “worth worrying about.” A CDC committee worried that mass vaccination of children might confer only temporary immunity, so that “in the not too distant future, many adults…may become once again susceptible to such diseases as diphtheria, pertussis, and measles.” (55) In 1964 ACIP decided that, in the case of measles, “rarely would there appear to be a need in the United States for mass community immunization programs”. (52)
The following year ACIP reversed itself. But though the CDC and Merck launched a hard-sell marketing campaign that rebranded measles as a deadly threat, the general public and many health professionals remained unconvinced. The CDC then revised measles mortality statistics upward by orders of magnitude, from 1 of in 100,000 cases to 1 in 10,000 cases (by 1967) to 1 in 1,000 cases (by 1989). The alleged hundredfold increase looked suspicious to some observers. “Indeed,” writes Prof. Conis, “the calculated representation of measles as a dangerous infection began to seem like a self-fulfilling prophecy.” And, she adds, health officials were not paying much attention to the vaccine’s adverse effects. (57) In 1967 the CDC promised that, in a matter of months, measles would be eradicated in the United States. Of course measles is still with us – as are hubristic assurances that vaccines can totally wipe out diseases.
In the 1950s McCarthyites applied the label “Commie” to everyone to the left of Dwight Eisenhower (and sometimes to Ike as well). Today the epithet “anti-vaxxer” is likewise hurled at just about anybody who expresses any doubts about any vaccine – even at Elena Conis herself (check out the online comments on her Atlantic article). Conis is careful to avoid that crude stereotyping. She reserves the term “antivaccinationist” for those “who rejected all vaccines for religious or safety reasons,” while emphasizing that “the ranks of vaccine resisters also included those who discerned among vaccines, accepting some and forgoing others they deemed too risky or just unnecessary.” (11) If you accept that definition, then the majority of Americans – including everyone who declines the flu or HPV shots, and all parents who don’t immunize their children according to the full mandated schedule – are “vaccine resisters”.
As the twentieth century drew to a close, the vaccine debate was louder than ever and still wide open. “The Lethal Dangers of the Billion-Dollar Vaccine Business” headlined Money magazine, which charged (writes Prof. Conis) that “health officials were systematically downplaying vaccine risks, medical experts with industry ties were setting policies that padded drug companies’ bottom lines, and parents were in the dark about all of it.” (203) In 1999 a congressional committee conducted a public investigation into the hazards of the hepatitis B shot. As Conis notes, the fact that, “in the hearings, scientists and citizens were given equal time and attention by the assembled lawmakers…is just one illustration of the degree to which scientific authority had been eroded over the previous quarter century.” (199-200)
When authorities feel seriously threatened, they often fight back by shutting down debate, rooting out heretics, and dogmatically proclaiming their own infallibility. The Counter Reformation, the Soviet purges of the 1930s, and McCarthyite hysteria are a few of many examples. Andrew Wakefield was certainly not the first to suggest a possible link between vaccines and autism, but his 1998 Lancet paper and the publicity surrounding it challenged at least four powerful authorities – the medical profession, public health agencies, the pharmaceutical industry, and vaccine scientists – and all of these establishments were already feeling beleaguered in the face of mounting vaccine skepticism.
In her chapter on vaccines and autism, Elena Conis begins to waffle a bit – forgivably so, given that she is an untenured professor entering a minefield. Elsewhere in the book she subjects the pronouncements of scientists and bureaucrats to sharp critical analysis, but here she reports the charges against Wakefield without asking questions. She writes (on p. 204) that the autism-vaccine link was “disproven”, but then (on p. 211) she says that the eight epidemiological studies that “showed no association between MMR and autism…didn’t definitively disprove a causal relationship.” She grants (on p. 212) that a few other studies “endorsed the plausibility of a link”, and mentions (in an endnote) that a 2001 Institute of Medicine report conceded that the MMR might cause autism “in a small number of children”. When she portrays (on p. 218) arguments between scientists and autism parents as a “battle between allegedly rational and irrational actors”, the reader can’t help but notice the word “allegedly”. And Conis clearly says that media depictions of nonvaccinating mothers as “selfish” affluent cranks are the stuff of “caricature”.
This chapter leaves out a lot: it doesn’t mention the Gates Foundation or the Simpsonwood transcript or Hannah Poling, and David Kirby’s Evidence of Harm appears only in the bibliography. Vaccine Nation leaves the impression that parents based their belief in a vaccine-autism link solely on what they observed in their own children, when in fact quite a few published scientific articles suggested such a connection, as Helen Ratajczak has documented. But even if Conis doesn’t necessarily agree with Jenny McCarthy and her supporters, neither does she dismiss or ridicule them. Contrary to what Salon suggests, they come across in this book as sincere and passionate advocates who have raised important questions about “the nature of evidence and expertise”. (218)
Post-Wakefield, this debate was almost entirely shut down in the old media, but the reaction to Gardasil (licensed in 2006) suggests that public distrust of vaccines was stronger than ever, especially among the youngest generation. Merck promoted the drug with a blizzard of ads targeted at teenage girls, who responded with their own fierce debate on Facebook, YouTube, blogs, and discussion groups. Carrying on the feminist insurgency of Our Bodies Ourselves, many of those girls charged that once again an unsafe drug was being foisted on women in violation of their bodily autonomy. Amidst the controversy Jenny McCarthy’s Louder than Words went to first place on the New York Times bestseller list. And the popular outcry ultimately halted the campaign to mandate Gardasil for girls.
If you believe journalists who tell you that a Playboy bunny and a doctor struck off the register inspired (all by themselves) the rising tide of vaccine resistance, then the trend will seem crazy. But it looks far more plausible if you know the long history behind this movement, which arose in reaction to vaccine failures, not-entirely-honest vaccine propaganda, and exposures of corruption on the part of vaccine manufacturers. Elena Conis provides that historical context in rich and illuminating detail, and in crystal clear prose that any lay reader can follow. Even if coping with autism takes up most of your life, set aside time to read this book. It will equip you well to discuss vaccines with friends, relatives, and doctors. And give it to folks who have questions about vaccination: there are a lot of them out there.
Jonathan Rose is a professor of history at Drew University. His most recent book is The Literary Churchill: Author, Reader, Actor.
 Helen Ratajczak, “Theoretical Aspects of Autism: Causes—A Review,” Journal of Immunotoxicology, 2011; 8(1): 68–79.