On Immunity : An Inoculation (9781555973278) (22 page)

In July of 1999, CDC officials became alarmed by fifteen VAERS reports of babies who had developed an uncommon form of intestinal blockage called intussusception after receiving a new rotavirus vaccine, RotaShield. (This was not the rotavirus vaccine coinvented by Paul Offit.) The CDC had recommended the vaccine for all infants because rotavirus was responsible for 70,000 hospitalizations and sixty deaths in this country every year. When VAERS raised suspicion of a potential problem, the CDC suspended use of the vaccine and launched an investigation. The RotaShield vaccine had been available for less than a year at that point. By October, researchers had concluded that children who received the vaccine were twenty-five times more likely to develop intussusception than those who did not, and the vaccine was taken off the market. The risk of developing intussusception after vaccination had been about 1 in 10,000 and VAERS had served to detect that risk within months.

Page 137

Robbed of their context, some of the components involved in vaccine production—human albumin, protein fragments from human cells, residual DNA—suggest that debris from other bodies is being injected into us:
I drew these particular examples from the many lists of vaccine components in
The Vaccine Book
by Robert Sears.

Page 137

“Is the immune system at the heart of a new incarnation of social Darwinism that allows people of different ‘quality’ to be distinguished from each other?” asks the anthropologist Emily Martin:
Martin does not ask this question in the context of vaccination specifically, but in a wider context of American attitudes toward health and disease in general. This question, which opens the final chapter of her book
Flexible Bodies: Tracking Immunity in American Culture—From the Days of Polio to the Age of AIDS
, is informed by her observations around AIDS and emergent diseases, as well as late capitalism and racism. “It is clear to me,” she writes, “that what is at stake in our understanding of ‘health’ are the broadest issues of the survival and death of the social order itself.”

Page 138

Siddhartha Mukherjee’s history of cancer, in which he argues not only that life causes cancer but that cancer is us:
In
The Emperor of All Maladies: A Biography of Cancer
, Mukherjee suggests, “We tend to think of cancer as a ‘modern’ illness because its metaphors are so modern.” Cancer, he explains, “is an age-related disease—sometimes exponentially so. The risk of breast cancer, for instance, is about 1 in 400 for a thirty-year-old woman and increases to 1 in 9 for a seventy-year-old.” And, “Nineteenth-century doctors often linked cancer to civilization: cancer, they imagined, was caused by the rush and whirl of modern life, which somehow incited pathological growth in the body. The link was correct, but the causality was not: civilization did not cause cancer, but by extending human life spans—civilization
unveiled
it.”

Page 140

The “Vaccine Court” was established by the National Childhood Vaccine Injury Act in 1986, the same legislation that provided for the independent review of vaccine safety by the Institute of Medicine and created a system for reporting vaccine side effects through VAERS.

The chain of events that led to this legislation began in 1981, when a British study suggested that the whole-cell pertussis component of the DTP vaccine (diphtheria, tetanus, and whole-cell pertussis), which has now been replaced by an acellular pertussis component, could cause permanent brain damage. As Paul Offit explains in his book
Deadly Choices
, this finding would be refuted by a number of later studies—an investigation by neuropathologists in England, an epidemiological study in Denmark, and a study of over 200,000 children in the United States—but not before fear of the DTP vaccine spread to the United States. In 1984 a television documentary,
DPT: Vaccine Roulette
, dramatized this fear with footage of severely disabled children and interviews with experts who warned that “the dangers are far greater than any doctors have been willing to admit.” Its national broadcast was followed by a dramatic increase in lawsuits against pharmaceutical companies.

“By 1985,” Arthur Allen writes, “219 pertussis vaccine lawsuits had been filed in U.S. courts, with an average compensation request of $26 million. When the lawsuits began in 1981, the total size of the pertussis vaccine market in the United States was only about $2 million.” One of the three companies making DTP quit distribution and another stopped production because of liability. In 1986, the last company still making the vaccine announced that it would no longer continue production.

At a Senate hearing in 1984, a group of parents who would eventually call their organization the National Vaccine Information Center (see note to page 75) had asked the government to expand research on vaccine side effects, to require physicians to report side effects to a central database, and to create a compensation program for children who had been seriously injured by vaccines. Hoping to address not just the vaccine shortage, but also the concerns that had led to the litigation that contributed to it, legislators passed a bill that met these parents’ requests. This bill was designed to protect the interests of both vaccine manufacturers and parents—predictably, neither liked it.

The National Childhood Vaccine Injury Act provided for the federal government, not vaccine makers, to be sued in cases of vaccine injury. Parents did not like this because they worried that manufacturers would not be held liable for the safety of their products. The act also provided for the parents of injured children to be compensated without definitively proving that the injury had been caused by a vaccine. Manufacturers did not like this because they were concerned that their products would become associated with side effects those products did not actually cause.

Page 142

as the medical researcher John Ioannidis has observed, “most published research findings are false”:
Described in the
Boston Globe
as an “instant cult classic,” Ioannidis’s 2005 paper “Why Most Published Research Findings Are False” has been downloaded more times than any other technical paper published by the journal
PLOS Medicine.
Both of the scientists who read a draft of this book for me expressed concern that my quote of Ioannidis’s bold title could be misleading. In many cases, as one of the scientists pointed out, the data in published research is correct, even when the conclusions drawn from that data are not. “Most published research needs refinement,” would be more accurate than “most published research findings are false,” he suggested.

In his 2007 study “Most Published Research Findings Are False—But a Little Replication Goes a Long Way,” the CDC researcher Ramal Moonesinghe and his colleagues find that the likelihood of a research finding being true increases significantly after it has been replicated in several other studies. Or, as Carl Sagan puts it, “Science thrives on errors, cutting them away one by one.”

Page 145

“A scientist is never certain,” the scientist Richard Feynman reminds us:
Having contributed to the invention of the atomic bomb, Feynman had considerable occasion for uncertainty.

Page 145

Keats: “’Beauty is truth, truth beauty,’—that is all / ye know on earth, and all ye need to know.”

Page 146

Children with egg allergies can react to this particular vaccine, which is grown in eggs:
I have since learned that many children with egg allergies can safely receive the flu vaccine. My son was ultimately vaccinated despite his allergy.

Page 151

The seasonal flu vaccine is unlike other vaccines in a number of ways, the most obvious being that it tends to be less effective. This is because influenza viruses change rapidly and different strains of influenza cause the flu each year. In order to prepare a vaccine in advance of flu season, researchers must make an educated guess about which strains of the virus are going to be active in the coming year. The match is usually good. But vaccinated people can be infected with other strains of influenza not covered by the vaccine. This leads some people to conclude that the vaccine does not work. It does work. Even in years when the vaccine is not a good match for the strains of the virus that are actually in circulation, it can still reduce the severity of the disease in vaccinated people and reduce the incidence of disease across the population as a whole. And people who have been vaccinated against the flu many times can carry a cumulative immunity to many strains of the flu.

Both the efficacy of the flu vaccine and the severity of the flu virus fluctuate from year to year, making individual risk assessments difficult. The virus may be weak for many years in a row, producing mostly mild cases of influenza, and then a much more dangerous strain may suddenly emerge.

Page 153

I introduced my son to the rules of baseball one spring day when we were playing on the beach with a Wiffle ball and a plastic bat. After his first “out” he began to understand that we were not on the same team. “You’re the bad guy,” he said with a sly smile. He had recently discovered super-heroes and the easy opposition between bad and good. He gravitated toward this opposition, but he was also drawn to the word
renegade
, which I defined for him as someone who breaks the rules for reasons that person believes are good. “Sometimes I’m a renegade,” he confessed to me.

“I’m not a bad guy or a good guy,” I told him. “I’m just on the other team.” He laughed at this weak reasoning. I threw a pitch and he struck out. “Nice try, bad guy,” he said to me amicably as he handed over the bat. He may not have fully understood the game, but he understood that I wanted him to hit the ball as much as he wanted to hit it. We were not really on different teams—we were playing together.

Page 155

The poem “Poetry” by Marianne Moore begins, “I, too, dislike it: there are things that are important beyond/all this fiddle. / Reading it, however, with a perfect contempt for it, one / discovers in / it after all, a place for the genuine.”

Author’s note: Hundreds of newspaper articles, countless scholarly articles, dozens of books, many blog posts, some poems, several novels, one immunology textbook, a handful of transcripts, piles of magazine clippings, and many essays fed my investigation of immunity. A full list of all the sources I consulted would be unwieldy, but I would like to acknowledge those that were essential to my work. Listed below are the texts from which I have quoted without full attribution and the texts to which I am most indebted for information or ideas.

Page 8

That fall, the
New Yorker
ran an article … it did not acknowledge any good reason for doubt:
“The Fear Factor,” Michael Specter,
New Yorker
, October 12, 2009.

Page 12

The ability to make and understand basic metaphors … “our metaphors prime how we think and act”:
James Geary,
I Is an Other: The Secret Life of Metaphor and How It Shapes the Way We See the World
(New York: Harper, 2011), 155, 19, 100.

Page 13

“inappropriate for girls of such a young age”:
Brian Brady, “Parents Block Plans to Vaccinate Nine-Year-Olds against Sex Virus,”
Scotland on Sunday
, January 7, 2007.

Pages 13–14

Throughout the nineteenth century … bacterial contamination remained a problem:
Nadja Durbach,
Bodily Matters: The Anti-Vaccine Movement in England, 1853–1907
(Durham, NC: Duke University Press, 2005), 132, 118, 138–39.

Pages 19–21

herd immunity:
Paul Fine, “Herd Immunity: History, Theory, Practice,”
Epidemiologic Reviews
, July 1993; Paul Fine, “’Herd Immunity’: A Rough Guide,”
Clinical Infectious Diseases
, April 2011.

Page 24

In an article for
Mothering
magazine … “she had no chance of catching”:
Jennifer Margulis, “The Vaccine Debate,”
Mothering
, July 2009.

Pages 24–25

hep B:
Paul Offit,
Deadly Choices
(New York: Basic Books, 2011), 64–67; Stanley Plotkin et al.,
Vaccines
, 6th ed. (New York: Elsevier, 2012), 205–34; Gregory Armstrong et al., “Childhood Hepatitis B Virus Infections in the United States before Hepatitis B Immunization,”
Pediatrics
, November 2001.

Pages 25–26

When the last nationwide smallpox epidemic … poor were enlisted in the protection of the privileged:
Michael Willrich,
Pox: An American History
(New York: Penguin, 2011), 41, 5, 58.

Pages 26–27

Debates over vaccination … it fell to the poor to articulate their vulnerability:
Nadja Durbach,
Bodily Matters: The Anti-Vaccine Movement in England, 1853–1907
(Durham, NC: Duke University Press, 2005), 83.

Page 27

a 2004 analysis of CDC data:
P. J. Smith et al., “Children Who Have Received No Vaccines: Who Are They and Where Do They Live?”
Pediatrics
, July 2004.

Pages 29–30

We need germs … one particular childhood disease that might prevent allergies:
David Strachan, “Family Size, Infection, and Atopy: The First Decade of the Hygiene Hypothesis,”
Thorax
, August 2000.

Page 30

the overall diversity of germs in our environment … the bacteria that colonize our skin, lungs, nose, throat, and gut:
Graham Rook, “A Darwinian View of the Hygiene or ‘Old Friends’ Hypothesis,”
Microbe
, April 2012.

Pages 30–32

a million different viruses in a teaspoon of seawater … “There is no us and them”:
Carl Zimmer,
A Planet of Viruses
(Chicago: University of Chicago Press, 2011), 47–52.

Pages 34–35

triclosan:
Alliance for the Prudent Use of Antibiotics, “Triclosan,” January 2011; Jia-Long Fang et al., “Occurrence, Efficacy, Metabolism, and Toxicity of Triclosan,”
Journal of Environmental Science and Health
, September 20, 2010.