One Nation Under Vaccines (I wish): My Review of Vaccine Nation

The relationship the general public has had with vaccines over the past several decades has is not simple. The trajectory of vaccination began with just a single vaccine protecting against a single disease--that of Jenner's for smallpox in the late 1700s--and now every American child is protected against 16, if up-to-date on recommended vaccines (which I hope they all become). When I was a child, I was able to be protected against only 7 of what became routine in 2015.

There are, of course, more vaccines that are not routinely administered though easily available. These include vaccines against smallpox, anthrax, rabies, yellow fever, Japanese encephalitis, typhoid, and adenovirus.

What may be puzzling to many is how diseases get specifically targeted for control via vaccination and how members of the "sweet 16" came to be. A new book by Emory historian Elena Conis entitled Vaccine Nation: America's Changing Relationship with Immunization provides a lot of context and history that is not well appreciated. 

The most important aspect of the book, to me, is the theme that as society matures and medicine progresses what is a tolerable risk changes. New contexts condition how risk is objectively evaluated by individuals. Thus when there was no measles vaccines, measles was an accepted risk. However, when a safe and effective vaccine was available the risk became unacceptable.

Not all diseases are as a straightforward as measles, but the general conceptual model is the same. In many cases, the ability to live a life devoid of a "nuisance" infection may have played a role. For example, mumps--in which complications occur at a low rate--the convenience of living a life free of mumps and the ensuing need to be cared for by parents who must stay home from work (not to mention the national security implications of having soldiers sidelined by the virus which is more severe in adults). This point is moot in the current context when the mumps vaccine is exclusively (and conveniently) bundled with measles and rubella.

Risk goes the other way as well. When smallpox was nearly eradicated from the planet, the US stopped vaccinating against it (1972) because the scientifically-established risk from the vaccine outweighed the risk of contracting the illness for the general public. Similarly, when polio was nearly eliminated from the Americas there was a switch in the US from the Sabin live vaccine to the Salk inactivated vaccine to remove the risk of vaccine-derived polio from the vaccine strain.

Professor Conis provides much vivid material surrounding the debates and decisions that played a role in the rise of such vaccines as ones against measles, mumps, rubella, hepatitis B and HPV.

She also, in a very clinical way, looks at the various facets of the anti-vaccine movement finding its roots in other social movements which espoused certain philosophies that derided the scientific method, logic, and objective evidence in favor of some other "method".

The book also usefully immerses the reader in the politics that followed the introduction of the polio vaccine in the 1950s. This political atmosphere led to a growing government role in specifically funding vaccination activities of the states through various laws that developed new programs beginning in the Eisenhower administration and culminating in the Clinton administration's Vaccines for Children program.

With this book, Professor Conis has made a great contribution to the literature on the social aspects of vaccination and as a dyed-in-the-wool unapologetic vaccine advocate I think it is required reading.

P.S. Get your flu shot