The Sniping Scientists Whose Work Saved Millions of Lives

https://www.nytimes.com/2018/09/03/books/review/michael-kinch-between-hope-and-fear.html

Version 0 of 1.

BETWEEN HOPE AND FEAR A History of Vaccines and Human Immunity By Michael Kinch 334 pp. Pegasus Books. $27.95.

As Michael Kinch tells us in “Between Hope and Fear: A History of Vaccines and Human Immunity,” vaccinations have saved millions, possibly billions, of lives. Along with antisepsis and anesthesia, they rank as one of the greatest achievements of scientific medicine. It is therefore deeply disturbing that in recent decades a significant minority of people in the world’s wealthier countries has become opposed to them. This anti-vaccination movement has even been given the nod by Donald Trump. To be effective, a vaccine requires that at least 95 percent of a population receive it — a phenomenon known as “herd immunity.” If even a small number of parents decide not to have their child vaccinated because of an alleged (and usually spurious) risk from the vaccine, they are putting enormous numbers of children at risk of contracting the disease the vaccine protects against.

Until the 19th century, human life was dominated by infectious illness. Up to 50 percent of children died before the age of 5, almost all from infections. Long exposure over centuries to some of these pathogens yielded some resistance, but the devastating potential of infectious diseases was demonstrated when Europeans arrived in the so-called New World. In Cuba and its surrounding islands, it is estimated that one-third of the population was killed by smallpox beginning in 1518, and two-thirds of the survivors by measles in 1529.

Kinch, a research scientist, now at Washington University in St. Louis, who has worked on both immunology and cancer and has published a previous book on the crisis in drug development, recounts this history in scholarly detail. Although Edward Jenner is credited with the discovery of vaccination, for using cowpox to inoculate against smallpox, it was already known in his day that survivors of smallpox were immune to further episodes of the disease. The Chinese and the Ottomans had been using “variolation” for centuries, a procedure in which people were deliberately infected with material from smallpox scabs applied inside the nostrils or under the skin. Some of the inoculated patients died, but many fewer than would have had they contracted the disease the conventional way.

Kinch’s tale picks up speed and interest in the second half of the 19th century, when it was finally understood that infections were caused by microorganisms and not by foul vapors, known as “miasma.” As with so much biological science, it’s a complicated story, featuring dozens of scientists, many of them scrabbling for a place on — rather than gratefully ascending — a predecessor’s shoulders, and numerous discoveries that were the result of sheer luck. Robert Koch and Paul Ehrlich in Germany, and Louis Pasteur in France, dominated the early years of microbiology, but their professional relations were often riven by competition and conflict. Koch was famously insulted at a conference when an interpreter mistranslated Pasteur’s phrase “recueil allemand” (a collection of German writing) as “orgueil allemand” (German arrogance). And Pasteur deliberately suppressed — and ordered his colleagues to follow suit — the fact that he had committed fraud during a public demonstration of his anthrax vaccine. (He used a chemical method to attenuate the virus but claimed he had not.) Pasteur succeeded in developing a rabies vaccine, but much of his work was derivative, taken wholesale from the veterinarian Pierre Galtier, whom he failed to credit and who slipped into oblivion.

A similar fate befell other pioneers in the field, such as the Jewish-Ukrainian scientist Waldemar Haffkine, who, working in the British Raj, developed toxoid vaccines for both bubonic plague and cholera. (A toxoid is a weakened version of toxins produced by bacteria, as opposed to a weakened form of the bacterium itself.) When 19 patients in the Punjab died of tetanus contracted from a contaminated bottle of plague vaccine, Haffkine was unjustly held responsible. Although he was eventually shown to be innocent, his treatment — he was effectively exiled from his profession — was compared to that of Alfred Dreyfus.

Kinch has done these early scientists a great service by recounting their contributions. There are some fascinating episodes about the discovery and use of bacteriophages (viruses that attack bacteria) and the way in which they might become important again as antibiotic resistance is increasingly a problem.

The final, and most important, chapters of the book deal with the contemporary anti-vaccination movement and its possibly lethal consequences, including several passages on the British doctor Andrew Wakefield, who falsely claimed that the MMR (measles, mumps and rubella) vaccine was responsible for autism. Kinch shows that public anxiety about vaccines is nearly as old as vaccines themselves. In the 1970s, there was widespread doubt in Britain over the safety of the DTP vaccine for diphtheria, tetanus and pertussis (whooping cough). One prominent opponent, Dr. Gordon Stewart, went on to maintain that AIDS was caused not by H.I.V. but by homosexual behavior. His view had a major influence on the South African president Thabo Mbeki, whose AIDS policies were subsequently estimated in a report by the Harvard School of Public Health to have resulted in 365,000 avoidable deaths.

Despite vigorous campaigns to discredit Wakefield and other vaccine opponents, the anti-vaccination movement shows no signs of weakening. In recent decades, diseases such as measles have reappeared in countries where they had been nearly eradicated, with serious, even fatal sequelae. (The World Health Organization reported 41,000 measles cases in Europe, 37 of them fatal, during the first six months of this year alone, compared with just 5,273 cases in 2016.) With global warming and global travel both increasing, we face many potential infectious threats in the future — from hemorrhagic viruses like Ebola and Lassa fever to Zika and other diseases, not to mention the possibility of a major influenza pandemic. It is vital that there is widespread public understanding of the importance of vaccination and above all of the need for high compliance rates. Kinch has practical suggestions as to how this might be done, and about the critical role governments must play in incentivizing pharmaceutical companies — which currently obtain their greatest profit from cancer drugs — to carry out more vaccine research.

This is an important book, but one marred by the author’s tendency to pad the narrative with historical anecdotes of often marginal relevance. We do not really need to hear, for instance, about Lady Godiva riding naked through the streets of Coventry in the Middle Ages, just because the journalist Brian Deer, who helped expose Wakefield’s false claims, went to college there more than 900 years later. Even had the book been ruthlessly edited, though, I fear that the people who most need to read it — those who have doubts about the value and safety of vaccination — would fail to do so. The stronger our convictions are, the greater our reluctance to expose ourselves to evidence that might contradict them. We may all yet pay a heavy price for that.