Until recently, it was easy to scoff at parents who refused to vaccinate their kids. Paranoid, we would say. Most of us were raised on the notion that vaccines represent one of the greatest medical advances of modern times, sparing our families from crippling and often fatal diseases. Cast against that background, claims that vaccines cause everything from asthma to autism have been easy to counter.
But several recent reports promise to give the anti-vaccine movement a boost by pointing out that official immunization policies often have as much to do with politics as they do with science.
The nearly 20-year history of the hepatitis B vaccine is a case in point. Congress appropriated money to vaccinate low-risk infants against the disease but could not muster enough support to provide shots for the people who really needed them—IV drug users and inmates—according to Joshua Sharfstein, writing in The American Prospect (May 8, 2000).
Hepatitis B is a disease that, like AIDS, is caused by a blood-borne virus, but the hepatitis B virus is much more infectious than AIDS. Most people who get it—usually IV drug users and their sexual partners—recover after a nasty bout of jaundice and vomiting. But about 6 to 10 percent can’t shake the virus, which eventually destroys the liver.
In the 1980s, scientists developed a vaccine, and while it was popular with at-risk health care workers, they represent only a small portion of cases. "Other than advise physicians on whom to vaccinate, public health officials in the Reagan era did little to bring the hepatitis B vaccine to those most likely to contract the disease," Sharfstein writes.
In an attempt to address the problem, a Centers for Disease Control committee in 1991 considered a plan to immunize all children at birth and offer the shot to everyone treated for a sexually transmitted disease, according to Sharfstein. Only the shot for babies won approval that year.
Ironically, it was the anti-vaccine movement that brought the issue to light. Most vaccines do cause a small number of severe reactions. And many of the parents testifying before Congress last year blamed the hepatitis B vaccine for problems unlikely to be linked to it, Sharfstein notes. But the session raised questions about vaccination priorities. Eventually, universal infant vaccines will protect the entire country, but targeting high-risk groups as well would have worked much more quickly.
Instead, "nearly 20 years after licensure of a vaccine against the hepatitis B virus, that severe and potentially fatal liver pathogen still infects an estimated 300,000 Americans each year, killing about 5,000 annually," Sharfstein writes. "The story of the hepatitis B vaccine is a lesson in what not to do next time."
The Atlantic Monthly (Feb. 2000) offers another harrowing tale of good intentions gone bad, this time when certain early forms of the polio vaccine—cultured in monkey cells—were inadvertently contaminated with a simian virus called SV40 and given to 98 million Americans. As Debbie Bookchin and Jim Schumacher write, early tests on animals linked the virus to cancer. But a "flurry of quick studies" concluded that SV40 did not cause cancers in humans and the matter was settled.
Now, a growing chorus of researchers say that conclusion may have been wrong. Italian scientist Michele Carbone tested dozens of tumors collected from patients with mesothelioma, a rare cancer of the lining of the chest and lungs, and found that 60 percent contained SV40. His research, along with other evidence, prompted Carbone to theorize that SV40 might be a factor in the growing number of mesothelioma cases. "It was the first time researchers had put forward hard evidence that the all-but-forgotten vaccine contaminant might cause cancer in human beings," Bookchin and Shumacher report.
But Richard Klausner, director of the National Cancer Institute, disagrees. The agency is funding Carbone’s work, but Klausner said that "in the absence of compelling clinical or epidemiological data, it’s very difficult to say this looks like a pressing problem." So the debate goes on.
All in all, it’s been a rough spell for vaccines. Over the past year and a half, concerns have also surfaced about small amounts of a mercury-based preservative in some vaccines and bowel problems associated with the rotavirus vaccine. Hundreds of people in the military risk courts-martial for refusing to take a mandatory but questionable anthrax vaccine.
By letting politics—not science—guide vaccine policy, those who promote their benefits unwittingly support those concerned about the risks of vaccines in general. Sharfstein writes. "If America’s unfortunate experience with hepatitis B yields any lesson, it’s that we must confront public health challenges honestly in order to conquer them decisively."