Denialism (9 page)

The history of vaccines, and particularly of smallpox, is filled with similar stories of fear at war with progress. According to Voltaire, the ancient Chinese inhaled dried powder of smallpox crusts through the nose in a manner similar to taking snuff. Thomas Jefferson’s children were vaccinated by a slave who learned how to do it as a traditional aspect of African medicine. “We keep forgetting this stuff over and again,” Juan Enriquez told me. Enriquez, who founded the Life Sciences Project at the Harvard Business School, is one of America’s most insightful genomic entrepreneurs, and has spent many years studying the unusual ebb and flow of knowledge. “People become scared of change,” he said. “They get scared of technology. Something bad happens and they don’t know how to react: it happened with the emperor in China, and with smallpox, and it has happened with autism, too. People want to blame something they can’t understand. So they blame technology. And we never stop forgetting how often this happens. We think of technology and the future as linear. It so clearly is not.”

The controversy surrounding the MMR vaccine and autism is far from the first time the world has recoiled from vaccination, with at least some people convinced it does more harm than good. Smallpox arrived in Boston in 1721, carried by passengers on a ship from the Caribbean. It was the second coming of the epidemic to American soil—the first had landed more than one hundred years earlier. This outbreak was more severe, though, and by the time it had run its course, half of the ten thousand residents of Boston had fallen ill, and more than a thousand had died. Cotton Mather, the fiery, brilliant, and unpleasantly self-righteous preacher, had heard about vaccination several years earlier from an African slave. He then read about the practice in a British scientific journal and became convinced it could provide the answer to the plague that threatened the city (and the entire New World). Mather attempted to interest the town’s residents in what he acknowledged was the genuinely risky “Practice of conveying and suffering the Small-pox by Inoculation,” a practice “never used . . . in our Nation.”

There were few takers. Instead, the majority of the population was awed by the ability of smallpox to wipe out entire nations and wondered whether it was not simply a judgment from God, rather than a disease one could defeat with medicine. Most people condemned inoculation. Perhaps the answer was to turn inward, to pray more fervently. Mather screamed from the pulpit (joined by several others, including his father, Increase Mather—they came to be known as the Inoculation Ministers). They faced opposition from the nation’s first powerful newspaper, known at the time as the
New England Courant
(eventually to become the
Hartford Courant
), which was published by Benjamin Franklin’s brother James—and not just from him. “Cotton Mather, you dog, damn you! I’ll inoculate you with this; with a pox to you,” said a note that was attached to a bomb lobbed into Mather’s house. All because he argued for the adoption of the most important public health measure in the history of colonial America.

Ben Franklin himself opposed the idea of the inoculation—called variolation, in which healthy people would have pus from the scabs of smallpox victims rubbed onto their skin. This usually produced a much milder form of smallpox, although a small percentage of the people vaccinated in this way died as a result. When the final tally was made, however, the salutary effects of vaccinations were impossible to deny. Of the 240 people inoculated during the epidemic in Boston, six died, one in forty. Among the rest of the population the mortality rate was one in six. Even those made sick by the vaccine tended to become less seriously ill than those who acquired the infection in the usual way.

Years later, Franklin’s son died of smallpox, after which he became an ardent supporter of vaccination. He even made a special appeal to parents who might be afraid of the consequences. “In 1736 I lost one of my sons, a fine boy of four years old, by the smallpox taken in the common way,” he wrote in his autobiography. “I long regretted bitterly and still regret that I had not given it to him by inoculation. This I mention for the sake of the parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.” George Washington initially hesitated to vaccinate his Continental Army troops during a smallpox outbreak, writing that “should We inoculate generally, the Enemy, knowing it, will certainly take Advantage of our Situation.” By 1777, however, he ordered mandatory vaccination for every soldier.

Vaccines work primarily by stimulating the immune system to produce a defensive response; there is a small risk that the response won’t be good enough and the vaccine will cause the disease it has been designed to prevent. Unless you compare those risks with the alternative—that is, of not having the vaccine at all—there is no way to properly judge any vaccine’s value to society. It has been three hundred years since Tony Blair’s distant predecessor, Robert Walpole, Britain’s first prime minister, purchased vaccines for the children of King George I. “Here is the tradition that Tony Blair is fighting against,” Enriquez said. We were sitting in the parlor of his house outside Boston—which had once served as a stop along the Underground Railroad. Enriquez is a collector of medical records, scientific charts, and many types of maps. On the table before us he had spread his “smallpox collection,” letters relating to the history of the disease. He produced a yellowed parchment that looked more like an eighteenth-century proclamation than a bill. “This is from a guy called Charles Maitland, a surgeon,” he said. “It’s a bill of sale for vaccinating the king’s children in 1724, signed by Walpole. So here is the British royalty in 1724 understanding that it is really important to vaccinate your children. It is just amazing to me that you can take this . . . and move to where we are today.”

At that, Enriquez stood up to fetch another armful of documents. “These are Jenner’s notebooks on vaccination,” he explained. Edward Jenner is generally credited with having invented the smallpox vaccine, after noting that milkmaids rarely got the disease. He theorized, correctly as it would turn out, that the pus in the blisters that milkmaids received from cowpox (a disease similar to smallpox, but much less virulent) protected them from smallpox. “Here are the letters to the public health department in 1804 donating the skins that Jenner had tested. And here are the enclosed tests.” It was all there: the data, the evidence, sitting irrefutably three centuries later on a table in a suburb of Boston. “We have this science,” Enriquez said, pointing respectfully at the notebooks. “Look at the data, it’s so clear. Here is the result of the first twenty tests. It’s a pile of stuff telling us something the king and his circle knew instinctively in 1724: vaccinations are essential.”

Instincts evolve. We have become inherently suspicious of science, so when a drug company or a researcher does something wrong, fails to show data that could be harmful, for example, or when there’s an issue having to do with the safety of a particular product, it feeds into the underlying suspicion and permits people to say, “Ah! All of science is bad.” When people encounter something that isn’t immediately explicable—autism, for example—it plays into this sense of doubt, and even when the scientific evidence is overwhelming people don’t always believe it. It is a climate that has created people like Tony Blair’s wife, Cherie, who has long been known for her skepticism toward many aspects of conventional medicine. She recently acknowledged that while she had been highly suspicious, she did eventually vaccinate her son Leo. Blair had been influenced by, among others, a half sister who had criticized the bonus payments doctors in England received for administering MMR shots, and publicly declared that she would never vaccinate her own daughter. “A number of people around me, whose views I respected, were vociferously against all forms of vaccination,” Blair said in 2008. “Over the years I had listened to their side of the argument and, it’s fair to say, I was in two minds.”

INCREASINGLY STYMIED in their quest to blame autism on the mercury contained in thimerosal, or on vaccines in general, unconvinced by mounting evidence that genetics and the environment play significant roles in the development of autism, activists began to hunt for a new approach to bolster their vaccine theory. On March 6, 2008, they found what they were looking for. On that day, the parents of Hannah Poling, a nine-year-old girl from Athens, Georgia, held a press conference to announce that the Department of Health and Human Services had issued what Jon Poling, the girl’s father, referred to as a ruling that may “signify a landmark decision with children developing autism following vaccines.” He said he made the public statement to provide “hope and awareness to other families.” His lawyer, Clifford Shoemaker, who has turned the vaccine plaintiff industry into a lucrative career, was by his side. They both nodded when a reporter asked whether the case was the first in which “the court has conceded that vaccines can cause autism.”

Nearly five thousand families have similar suits before the court, so any judgment that applied broadly would have had profound implications. Paul Offit has described Hannah Poling’s case in the
New England Journal of Medicine
: “Hannah Poling received five vaccines when she was nineteen months old—diphtheria- tetanus-acellular pertussis,
Haemophilus influenzae
type b (Hib), measles-mumps-rubella (MMR), varicella, and inactivated polio. At the time, she was a typically playful and communicative girl. Within two days she had become lethargic, irritable, and febrile. Ten days after vaccination, she developed a rash consistent with vaccine-induced varicella. Months later, with delays in neurologic and psychological development, Hannah was diagnosed with encephalopathy,” a syndrome characterized by altered brain function, “caused by a mitochondrial enzyme deficit,” which left her weak and often confused. Hannah’s symptoms included problems with language, communication, and behavior—all features of autism spectrum disorder. Although it is not unusual for children with cellular disorders like mitochondrial enzyme deficiencies to develop neurologic symptoms between their first and second years of life, Hannah’s parents believed that vaccines had triggered her encephalopathy. That’s why they sued the Department of Health and Human Services for compensation under the National Vaccine Injury Compensation Program. When a federal court awarded damages to their daughter, the vaccine scare was ignited anew.

The vaccine court is unlike any other in the United States, however, and the suit can only be examined in the context of the way it works. In the late 1970s and early 1980s, American lawyers successfully sued pharmaceutical companies, claiming that vaccines for pertussis caused a variety of illnesses, including unexplained coma, sudden infant death syndrome, Reye’s syndrome, mental retardation, and epilepsy. As a result, by 1986 all but one manufacturer of the diphtheria-tetanus-pertussis vaccine had abandoned the American market. The risk of lawsuits became far greater than the potential for profits. The federal government, increasingly concerned that no company would be willing to manufacture essential vaccines, passed the National Childhood Vaccine Injury Act, which included the creation of the VICP.

Funded by a federal excise tax on each dose of vaccine, the VICP compiled a list of compensable injuries. If scientific studies supported the notion that vaccines caused an adverse event—such as thrombocytopenia (the dangerous depletion of platelets) after receipt of measles vaccine, or paralysis following an oral polio vaccine—children and their families were compensated, and usually quite generously. The average family received nearly $1 million. Health officials developed a table of injuries that would apply, and the number of lawsuits against vaccine manufacturers fell dramatically. One of those “table injuries,” encephalopathy following a measles vaccine, is the cellular disorder for which Hannah Poling was awarded money.

Because some of the court records are sealed, it is impossible to know with certainty how the decision was made. Nonetheless, Hannah’s father, Jon Poling, and Shoemaker, the lawyer, were wrong: neither the court nor the federal government conceded that vaccines cause autism. They conceded that in that specific case vaccines may have been responsible for exacerbating a condition with symptoms that are similar to those of many autistic disorders. Hannah had a mitochondrial enzyme deficiency, which consisted of a metabolic disorder called encephalopathy. (Mitochondria are responsible for producing 90 percent of the energy we need to stay alive. Many defects can prevent them from functioning properly or at all—and without enough energy, cells, like any other factory, stop working.)

The court was compelled to address a difficult question: could the fever that Hannah developed following those vaccines (one of which was a measles vaccine) worsen her encephalopathy? “This is a particularly complex issue,” Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, told me. “And it’s even more complicated by the fact that it is likely that there are a minute fraction of kids who have an underlying defect—clearly, mitochondrial defects are the one that stands out—where at a certain time of their life, when they get confronted with an influenza, with an [environmental toxin] or a vaccine, it’s going to accelerate what already was going to happen anyway. Then some people will say that every autistic kid became autistic because of a vaccine. And we know absolutely that that’s not the case.”

In early 2009, the vaccine court agreed. After ten years of bitter scientific and legal battles, the court rejected any relationship between autism and vaccines. “Petitioners’ theories of causation were speculative and unpersuasive,” wrote Special Master Denise Vowell in the case of
Colten Snyder v. HHS.
“To conclude that Colten’s condition was the result of his MMR vaccine, an objective observer would have to emulate Lewis Carroll’s White Queen and be able to believe six impossible (or at least highly improbable) things before breakfast.”