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Distributed for Reaktion Books

Immunization

How Vaccines became Controversial

Distributed for Reaktion Books

Immunization

How Vaccines became Controversial

As the world pins its hope for the end of the coronavirus pandemic to the successful rollout of vaccines, this book offers a vital long view of such efforts—and our resistance to them.
 
At a time when vaccines are a vital tool in the fight against COVID-19 in all its various mutations, this hard-hitting book takes a longer historical perspective. It argues that globalization and cuts to healthcare have been eroding faith in the institutions producing and providing vaccines for more than thirty years. It tells the history of immunization from the work of early pioneers such as Louis Pasteur and Robert Koch through the eradication of smallpox in 1980, to the recent introduction of new kinds of genetically engineered vaccines. Immunization exposes the limits of public health authorities while suggesting how they can restore our confidence. Public health experts and all those considering vaccinations should read this timely history.

288 pages | 6 x 9

Medicine


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Reviews

"Blume grapples with the hot-button topic of immunization programs and public resistance to them in this persuasive, challenging chronicle of how vaccines improved human health—and the pharmaceutical industry’s bottom line. . . . Blume’s crucial history illustrates that vaccines have saved countless lives, but they must win the confidence of those who don’t recognize their universal benefit."

Publishers Weekly, Starred Review

“This is a fascinating history of vaccination and its troubles.”

Times Higher Education

"From vaccine hesitancy to virulent anti-vaccine views, parents are questioning what used to be considered a triumph of public health—vaccines. As so often happens with debates on controversial issues, emotion often trumps information. . . . [Immunization] offer[s] refreshingly fact-based alternatives to the vitriol dominating the current conversation on vaccines. . . . From Cold War politics to neoliberal economics, Blume puts policy and advancement into a broader context in which public health sometimes takes a back seat to other, less noble concerns. His central argument, articulated in the final chapter, is that vaccine hesitancy is rooted in mistrust of the institutions that promote them—especially governments and pharmaceutical companies. . . . Readers who wish to be informed of the current debate and issues surrounding it will appreciate the clear, fact-based approach."

Library Journal

"In his thought-provoking book, Blume carefully explains how exactly vaccines protect the human body, before going on to explore the worrying phenomenon that has come to be dubbed ‘vaccine hesitancy’—the reluctance of some parents to have their children vaccinated."

Prospect

"Reaktion is rushing through this paperback on the history of vaccination given its topicality, and the message it can bring to anti-vaxxers. It looks at why growing numbers of parents are becoming opposed to vaccinating their children, and at the multinationals who now dominate vaccine development and production, arguing that globalization and healthcare deficiencies are eroding faith in the institutions producing and providing vaccines." 

Bookseller

"Blume’s latest book is a timely political intervention into the vaccination debate. He expertly summarizes the history of vaccine technology and vaccination policy to explain how and why certain publics have questioned the need to vaccinate themselves or their children. The author outlines the role of public and private institutions, the dynamics between the global north and south, and implores all those with a stake in public health to work to restore trust in vaccination systems. . . . Anyone studying the history of vaccination should read this book. It provides both an excellent summary of the history and a powerful political argument to begin further discussion."

Social History of Medicine

"While the book provides an interesting social history and an attempt to understand why people resist vaccinations, it also serves as a reminder that it’s a privilege of the developed world to be able to approach a matter of public health and saving lives as a philosophical concern."

Health Affairs

"A much-needed historical analysis of the global dynamics in vaccine development and vaccination policies. . . . This is an important book, primarily because of its global perspective on the question how vaccines became controversial."

Isis

“This is an important, comprehensive, and pathbreaking book. Eschewing simplistic, unipolar notions of the planning and delivery of international health, it places the history and contemporary provision of immunization on a truly global scale. This is a study that looks at all facets of a complex subject, where the troubled birth and expansion of the use of vaccines is examined thoroughly and fairly. This is scholarship at its richest, which reminds us all about the dangers of technological determinism in all matters of public health. A must read for academic, government, and international health agency audiences, especially those committed to the equitable introduction of vaccines around the world on the basis of careful and transparent consultations with target societies.”

Sanjoy Bhattacharya, director, Centre for Global Health Histories, University of York, and head, WHO Collaborating Centre for Global Health Histories

“Blume’s Immunization is a clearly written, brilliant, and highly sophisticated look at the roots of the growing phenomenon of ‘vaccine hesitancy.’ He rejects the dominant, and superficial interpretation by public health officials of what is going on, and shows the reader what insights occur when you really stop and listen to what people are saying rather than assuming you already know what motivates them and pigeon-holing their supposed views into various unflattering categories.”

William Muraskin, Queens College, City University of New York

Immunization provides great insight into the vaccination issue precisely because it avoids the easy generalizations made by partisans on either side. Blume more usefully points to the complexities and contradictions in the history and social dynamics of vaccination. He presents vaccination as a technology, and as just one of several approaches to promoting health, and thus to be judged in a wider context than a narrow calculation of benefits and risks. Immunization is essential reading for anyone who wants to get beyond the usual polarized positions in the vaccination debate.”

Brian Martin, University of Wollongong, Australia

Table of Contents

1. What do Vaccines do?
2. Technologies: The First Vaccines
3. Technologies: Viral Challenges
4. Technologies: The Commodification of Vaccines
5. Policies: Hesitant Beginnings
6. Policies: Vaccination and the Cold War
7. Policies: Vaccination in a Globalizing World
8. The Roots of Doubt
References
Additional Reading
Acknowledgements
Index
 

Excerpt

If its films are any kind of guide, the English-speaking world views the prospect of a pandemic with the fascination of a trapped man watching an approaching snake. There is a sense of horror, of inevitability. Films about epidemics show us people in their thousands (or more) dropping in the streets, social disintegration and approaching havoc. However, there is a catharsis. In many of these films there are heroes or heroines, doctors or scientists, who ultimately save what is left of the human race. Some of these movies, such as John Ford’s 1931 film of Sinclair Lewis’s novel Arrowsmith, were made long ago, but most are fairly recent. Think of the 1995 film Outbreak, starring Dustin Hoffman and Morgan Freeman. Or the 2007 film I Am Legend, starring Will Smith. Or the popular TV series The Last Ship. Or Steven Soderbergh’s gripping 2011 version, Contagion. Soderbergh’s film opens with an American business executive, Beth Emhoff, taken ill on her way home from Hong Kong. She’s coughing and sweating. We see others similarly affected, in Hong Kong, London, Tokyo . . . This is turning into a public health emergency though it is totally unclear how it started, or where, or what is causing it. It is a private tragedy as well. Of course it is many private tragedies, but the film focuses on how Beth’s collapse and rapid death affect her family. Her husband Mitch is at first incredulous, then bereft, then put into an isolation ward, and finally discovered to be immune. The public health side of things focuses on the Center for Disease Control (CDC) based in Atlanta, Georgia, and in particular on an epidemiologist named Erin Mears who has to trace and map the spread of the disease, on her boss Ellis Cheever, and on Ally Hexhall, a virologist who’ll be given the job of identifying the causal agent, which proves to be a virus. The action shifts to Geneva, where the World Health Organization (WHO) is based, and where reports are coming in of deaths and millions of cases from some of the world’s most densely populated metropolises. The WHO, which has developed protocols for dealing with this kind of emergency, is going to send Dr Leonora Orontes to investigate. What precautionary measures should governments be advised to take? Should schools be closed? Is there a risk of panicking people needlessly? How does the virus spread? Epidemiological investigation would have to establish how infectious it is. What kind of virus is it? Is there a chance that a known pathogen (anthrax? smallpox? ‘Bird flu’?) has been turned into a weapon and that this epidemic has been started deliberately?

It’s the work of epidemiologist Mears (out in the field) and of the virologists manipulating samples in their laboratories that forms the core of the movie. Because Mears is able to establish that Beth was ‘patient number 1’, and that she became sick as a result of eating some infected poultry, and because the virologists succeed in identifying and then growing the virus, a vaccine can be made and mankind saved. But this isn’t a documentary, so it’s embellished by a number of dramatic flourishes, some of which point neatly to real-life complications, dilemmas and concerns. Orontes, who is dispatched to Hong Kong, suspects that that is where it all started, but discovers that the authorities are anxious to prevent any such announcement being made. Moreover, plenty of people think there is money to be made. We are introduced to Alan Krumwiede, an influential (but shady) blogger, who claims that there’s a simple, cheap ‘natural’ cure for the disease, which the public health ‘establishment’ and the pharmaceutical industry are keeping secret. They want to develop and profit from an expensive vaccine. We subsequently learn that he is hoping to make money himself from this plant extract. Demand becomes insatiable, and riots break out at drugstores across the USA as people try to get hold of it. There are roadblocks and looting. The impression we are given is that the social disruption caused by the epidemic is at least as serious, and certainly as frightening, as the virus. An epidemiology of fear is evoked. As one of the characters points out, in order to get sick you have to be in contact with an infected person or something that they’ve touched. In order to get scared you just have to get in contact with TV or the Internet.

If this dramatic rendering is compared with the histories of real epidemics—comparisons that characters in the movie often make—it is clear that the film-makers did a great deal of preparatory research. (I wasn’t surprised to be told that that they’d visited the World Health Organization to learn how epidemics are dealt with.) Though the likelihood of an epidemic leading to social breakdown surely varies from one society to another, a documentary about a real-life global epidemic could draw on this account of a fictional one. It is not just that the story is a distillation from real-life happenings. It is also that it provides a script: a resource for writing about epidemics. Nearly thirty years ago the eminent historian of medicine Charles Rosenberg offered a dramaturgical way of writing about epidemics. Inspired by Albert Camus’ novel The Plague (1947), Rosenberg suggests that in the past epidemics tended to evolve in a well-structured narrative sequence. Act I of the imaginary play is a community’s reluctant acceptance and public acknowledgement that disease has struck. Act II, which he calls ‘Managing Randomness’, involves the search for some explanatory framework: a way of making sense of the fact that some die while others survive. It is this framework that can provide a guide to action and to control. In earlier times this framework tended to be rooted in widely held assumptions about proper and responsible behaviour. Then, in Act III, a ‘public response’ is negotiated: a set of ‘collective rites integrating cognitive and emotional elements’. Whether these rites emphasize collective fasting and prayer, or quarantine, they represent an enactment of community solidarity. Finally, in the last act of Charles Rosenberg’s narrative, the number of cases has declined. The epidemic is under control. Some have died and others have recovered. Now there is time for remembering and reflecting, though this can probably be entrusted to the historians. ‘Has a heedless society reverted to its accustomed ways of doing things as soon as denial became once more a plausible option?’ ‘Epidemics’, Rosenberg notes, ‘have always provided occasion for retrospective moral judgment’.² If this was a reflection on an era when there were no virologists, written for an age when time and space hadn’t been compressed to the extent they are today, then Contagion provides us with an update. It offers a way of imagining and writing about epidemics as they evolve, as they spread, and as the desperate search for control—today centred more on the laboratory than on the house of prayer—gathers pace.

Fear

When we are told that some horrific pandemic is in prospect—something like the 1918 Spanish flu that killed tens of millions of people (an estimated 3 to 5 per cent of the world’s population), or that a previously unknown virus has emerged from its remote jungle home (as in Contagion)—we now turn expectantly to virologists like Ally Hexhall and the high-security labs in which they go about their business. An example that hit the news in the first weeks of 2016, and that almost no one who wasn’t a virologist had heard of up till then, is the Zika virus. It was discovered in the Zika forest, in Uganda, by researchers who were actually investigating yellow fever. Both viruses, and that responsible for dengue, are spread by the same species of mosquito, Aedes aegypti. Infection with the Zika virus was nothing to panic about. Although the virus had been found in 1947, the first reported case of someone becoming sick from it was only in 1964. After three days of fever and some aches and pains, the victim had fully recovered. Studies showed that many cases of infection were totally without symptoms. But as the virus was carried further afield its effects appeared to change. Epidemics in various Pacific islands in the early 2000s showed more serious symptoms, in particular Guillain-Barré syndrome. And then it found its way to Central and South America. Evidence began to accumulate that if a pregnant woman became infected her baby might be born with an abnormally small head (a condition known as microcephaly). A significantly higher than usual number of babies have been born with microcephaly in Brazil, where the virus has spread rapidly. Researchers are discovering that it is not only mosquitoes that spread it. Some women seem to have picked it up from infected semen and possibly even from sweat. . . .

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