Deadly Choices: How the Anti-Vaccine Movement Threatens Us All, by Paul A. Offit (Basic, 288 pp., $27.50)
From experience I know that it is best, when reviewing a book about the vaccine question, to declare a financial interest, or in my case, a lack of one. As far as I know I own no shares in vaccine companies, except perhaps through mutual funds whose holdings I havent examined closely. I dont think, therefore, that my economic future depends to any great extent on the sale of vaccines. In view of what I am about to say, conspiracy theorists will have difficulty believing this, but its true.
The worlds children are, taken as a whole, the healthiest who have ever lived, in no small part thanks to immunization against the common infectious diseases of childhood that, not so long ago, caused misery, morbidity, and death. In my own case, I suffered mumps, measles, chicken pox, and whooping cough. I remember them all (and can still feel my painful swollen parotid glands in my minds soma). I came through unscathed, but my best friend, from whom I was inseparable, contracted polio in the months immediately before the introduction of immunization against it. He was paralyzed from the waist down.
No child today need experience these diseases. Surely this is an unequivocal example of progress, but strangely enough, many people are highly suspicious of the triumph of preventive medicine. It is as if they had lost all historical memory and could not imagine that things were ever any different. We are now so safe that all hazard appears anomalous to us, a deviation from natures normal course. It must be someones fault.
In his eloquent and bracing book, Paul Offit, an expert on child immunization, traces the intellectualor perhaps I should say the emotionalhistory of the modern anti-vaccination movement and its consequences. If progress in preventive medicine has been remarkable, so in its own way has been the persistence of prescientific and even anti-scientific thought in modern society.
The author correctly draws attention to the similarities between the anti-vaccination movements in modern America and in Victorian England. The Victorians, however, had the excuse that they were facing a new and unprecedented situation, which the Americans do not. The Victorians knew nothing of bacteriology, virology, and immunology; their epidemiology was rudimentary. Moreover, smallpox vaccination was a crude procedure, sometimes genuinely dangerous; arm-to-arm vaccination, which was eventually abandoned, could spread syphilis.
Offit underestimates the range, both social and intellectual, of the Victorian anti-vaccination movement. While it might have started off as a popular agitation against Parliaments decree of compulsory vaccinationwhich was in practice mainly directed at the poorit quickly spread to the middle and upper classes. It produced an astonishing range of literature, including a mass-circulation magazine that ran for 70 years. Not all of its adherents by any means were willfully ignorant cranks (such as George Bernard Shaw). Converts to the cause included Charles Creighton, an eminent pathologist and the erudite historian of epidemics in Britain, as well as the first person to hold a chair in bacteriology in Britain, E. M. Crookshank. Vast and learned tomes were produced on the noxiousness of vaccination, and while some of the wilder claimssuch as that vaccination had led to a recrudescence of leprosy in Europewere absurd, attempts to prove vaccinations dangers by statistical means helped spur the development of the science of epidemiology.
Still, the Victorian anti-vaccination movement discovered, and maybe even invented, a fundamental principle of modern pressure-group politics: always make lots of noise. It is noise that makes the world go round as much as money, with truth coming in a poor third; and noise is difficult to counteract. Its true that the adventure novelist Henry Rider Haggard produced a good pro-vaccination novel, Doctor Therne, in 1898, after Parliament surrendered to pressure and repealed compulsory vaccination. But it seems that there is a quasi-law of politicking that the noise of opponents is always louder than that of proponents.
As with any medical procedure, things can go wrong with vaccination. But modern vaccine scares are generally not the consequence of genuine problems. They are the result of unproven scientific hypotheses given echo, and magnified and coarsened, by campaigners. The idea, for example, that the MMR (measles, mumps, and rubella) vaccine causes childhood autism gained currency when a British surgeon, Andrew Wakefield, claimed to have found evidence that the vaccine could damage the intestines of those to whom it was giventhus giving a portal to neurotoxic substances.
It was an error of judgment on the part of the medical journal The Lancet to have published this research in the first place. The experimental group was completely without a control group. Even odder, the principal author of the research, Wakefield, held a press conference to announce the findings even before they were published. The most likely explanation of his conduct is that he was a highly ambitious man, desperate for a scientific coup like that of Barry Marshall, who established the bacterial causation of peptic ulceration, which had escaped thousands of previous researchers. The difference, of course, was that Marshalls research was valuable.
Nevertheless, the autism rumor soon swept the world. Many distressed parents thought they had found the explanation for the otherwise inexplicable condition of their child. Some people underwent a quasi-religious conversion, and made Wakefields cause their own. When it was established beyond reasonable doubt that he had feet of clay, they turned him into a martyr, someone condemned for his heresy rather than for his conduct.
Even some of those who did not worship at Wakefields shrine acted on the no-smoke-without-fire principle. They declined to have their children immunized, with the result that measles epidemics returned where they had been almost eliminated. In Britain, the refusal of Prime Minister Tony Blair to reveal whether he was having his own child immunized with the MMR vaccine led to a further fall in the immunization rate and suggested that at least a section of the population does not take its decisions on purely rational grounds. Whooping cough has returned in California, thanks to a reduction in vaccinations.
When scientific research refutes the rumor that started a scare, the scare does not die straightaway. The first response of adherents to the cause is to find a paranoid explanation for the research findingsfor example, that the government is in league with the vaccine manufacturers and the doctors. Thus starts an endless Russian-doll regression of ad hominem arguments, and thus a pseudo-religious faith, which gives meaning to the lives of many, is upheld. Offits book is therefore not only an interesting scientific saga in itself, but a kind of cultural X-ray of our society.
Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute.