Vaccine Nation: America's Changing Relationship with Immunization

With employers offering free flu shots and pharmacies expanding into one-stop shops to prevent everything from shingles to tetanus, vaccines are ubiquitous in contemporary life. The past fifty years have witnessed an enormous upsurge in vaccines and immunization in the United States: American children now receive more vaccines than any previous generation, and laws requiring their immunization against a litany of diseases are standard. Yet, while vaccination rates have soared and cases of preventable infections have plummeted, an increasingly vocal cross section of Americans have questioned the safety and necessity of vaccines. In Vaccine Nation, Elena Conis explores this complicated history and its consequences for personal and public health.

Vaccine Nation opens in the 1960s, when government scientists—triumphant following successes combating polio and smallpox—considered how the country might deploy new vaccines against what they called the “milder” diseases, including measles, mumps, and rubella. In the years that followed, Conis reveals, vaccines fundamentally changed how medical professionals, policy administrators, and ordinary Americans came to perceive the diseases they were designed to prevent. She brings this history up to the present with an insightful look at the past decades controversy over the implementation of the Gardasil vaccine for HPV, which sparked extensive debate because of its focus on adolescent girls and young women. Through this and other examples, Conis demonstrates how the acceptance of vaccines and vaccination policies has been as contingent on political and social concerns as on scientific findings.

By setting the complex story of American vaccination within the countrys broader history, Vaccine Nation goes beyond the simple story of the triumph of science over disease and provides a new and perceptive account of the role of politics and social forces in medicine.

“This comprehensive social history of childhood vaccination in the United States since the 1960s is written in clear, engaging, and always intelligent prose. As Conis wends her way through a field notorious for partisan pleading and other intellectual landmines, she convinces us of both the power of vaccination to save us from disease and the sincerity of the often well-intentioned people who question its adherents tendency to oversell their product.”

“An original and illuminating analysis of the relationship of vaccination, public health, and American society since 1960. Vaccine Nation is especially strong on the vaccine policies of presidential administrations and on the relationship between vaccine politics and social movements such as environmentalism and feminism. Conis's clear and lively writing style makes the book a pleasure to read.”

“This is a fascinating account of how routine childhood immunization came to be both a public health success story and a source of bitter controversy. Conis untangles these seemingly contradictory trends and provides a probing analysis of the ways that American culture and politics have influenced how we think about vaccines. Engagingly written and filled with surprising insights, this book is an invaluable guide to one of the most critically important areas of modern medicine. Everyone with a stake in our immunization system—which is to say, all of us—should care about the story Conis has to tell.”

“In the 1960s afterglow of broad success in defeating polio and smallpox, the US public embraced vaccination. Yet by 2009, debate was raging over its risks, even as some 90% of toddlers were being vaccinated against a raft of diseases. Historian Elena Conis analyses the shifts in official and public thinking on immunization as initiatives by presidents from John F. Kennedy onwards drove waves of mass vaccination. As she reveals, each new vaccine has prompted a radical reevaluation of the disease it targeted.”

“No book on vaccination can ignore the rise of vaccine-safety and anti-vaccination movements. Conis brings out their complexities in the United States with great skill. . . . This is a fine social history of an ongoing story.”

“Conis has produced a strikingly honest, fair-minded, and informed chronicle of the vaccine controversy in the United States.  She illuminates issues that others have obfuscated, and she opens up discussions that some have tried to shut down.  She understands that vaccine policy is determined not solely by objective science, but also by politics, profits, prejudices, and bureaucratic imperatives. . . . Conis provides that historical context in rich and illuminating detail, and in crystal clear prose that any lay reader can follow.”

“How do some people in a country that rejoiced in vaccines for killers like polio wind up wary of them? Emory University historian Elena Conis goes sleuthing in her book, Vaccine Nation: America's Changing Relationship with Immunization, finding answers in science, politics, and shifting cultural standards about how we vaccinate and what our doubts are. At a moment when, as Conis says, children’s participation in public life depends on their immunization status, she favors a nuanced view of our complicated relationship with ‘the jab.’”

“With Vaccine Nation, Conis explores the history of vaccines in our country, exploring the many reasons (medical, societal, political, financial) why their use has become so widespread. Conis also spends a fair amount of time discussing the many legitimate reasons why people from all walks of life are sometimes skeptical of vaccines, covering heavy metals in the ingredient lists, safety concerns over testing, and vaccine injuries. With its extensive list of sources, Vaccine Nation is a surprisingly balanced history of this controversial topic.”

andldquo;How did risk reduction become the mantra of modern medicine? Risky Medicine tells the important story of how disease and the risk of it have become collapsed to the point that itandrsquo;s no longer always clear which one weandrsquo;re actually treating. A physician and historian of medicine, Aronowitz surprises the reader with his counterintuitive arguments but never oversimplifies debates or caricatures the doctors, researchers, patients, and policy makers who figure in this compelling and incisive account. He shows us how medicineandrsquo;s risk revolution matters, both for individuals who must manage their fears in the face of uncertainty and for societies intent on improving health outcomes while controlling costs.andrdquo;

“Conis presents a detailed, step-by-step historical account, beginning in the 1960s, based on an extensive literature review of all the events.  This includes social, economic, political, and commercial aspects as well as issues such as poverty, sex, government, drug companies, the women’s movement, society’s perception of disease, and more.  These all contributed to the still-current controversy over the safety and medical value of vaccination, which started with the introduction of the polio vaccine. . . . Highly recommended.”

Vaccine Nation tells the recent history of how and why vaccines became such a prized but polemical part of American health care, politics, and culture. In the sixties, American children began to receive more vaccines than any previous generation, and laws requiring their immunization against a litany of diseases became common. In the decades that followed, vaccination rates soared, preventable infections plummeted, and popular acceptance of vaccines remained strong—even as an increasingly vocal cross-section of Americans questioned the safety and necessity of vaccines and the wisdom of related policies. Vaccine Nation examines the origins of some of todays most salient sources of vaccine skepticism. It describes how and why presidents from JFK to Clinton championed childhood vaccination from the White House. And it reveals that new vaccines fundamentally changed the ways health experts and lay Americans perceived the diseases they were designed to prevent. Chapters in the book examine how and why we vaccinate against specific infections—including measles, mumps, hepatitis B, and HPV—and how social movements of the late twentieth century posed profound, but previously overlooked, implications for how Americans today have come to think about vaccination and vaccines.

In medicine today, public health and medical interventions are largely risk reducing and risk controlling rather than treating symptoms or curing disease. In several cases risk factors have almost become diseases in themselves. As Robert Aronowitz vividly depicts, we are experiencing a convergence of risk and disease, and a market-driven expansion of risk interventions. We increasingly understand and accept that many medical interventions are efficacious because they reduce risk. It is often the case, however, that little science supports risk interventions that have become commonplace. Risky Medicine wrestles with the problems associated with the conflation of risk and traditional notions of disease. It explores not only how we got to this point but what the implications are for our health care system and our personal dealings with doctors. The subject is hugely important for patients and doctors, and it matters enormously in health care policy going forward.

Will ever-more sensitive screening tests for cancer lead to longer, better lives?and#160; Will anticipating and trying to prevent the future complications of chronic disease lead to better health?and#160; Not always, says Robert Aronowitz in Risky Medicine. In fact, it often is hurting us.and#160;and#160;

Exploring the transformation of health care over the last several decades that has led doctors to become more attentive to treating risk than treating symptoms or curing disease, Aronowitz shows how many aspects of the health system and clinical practice are now aimed at risk reduction and risk control. He argues that this transformation has been driven in part by the pharmaceutical industry, which benefits by promoting its products to the larger percentage of the population at risk for a particular illness, rather than the smaller percentage who are actually affected by it. Meanwhile, for those suffering from chronic illness, the experience of risk and disease has been conflated by medical practitioners who focus on anticipatory treatment as much if not more than on relieving suffering caused by disease. Drawing on such controversial examples as HPV vaccines, cancer screening programs, and the cancer survivorship movement, Aronowitz argues that patients and their doctors have come to believe, perilously, that far too many medical interventions are worthwhile because they promise to control our fears and reduce uncertainty.and#160; and#160;

and#160;

Risky Medicine is a timely call for a skeptical response to medicineandrsquo;s obsession with risk, as well as for higher standards of evidence for risk-reducing interventions and a rebalancing of health care to restore an emphasis on the actual curing of and caring for people suffering from disease.and#160;and#160;and#160; and#160;and#160;

Robert Aronowitz is professor and chair of the history and sociology of science at the University of Pennsylvania; he earned his medical degree from Yale University. His books include Making Sense of Illness: Science, Society, and Disease and Unnatural History: Breast Cancer and American Society. He lives in Merion Station, Pennsylvania.

Introduction

Part I

1. Kennedys Vaccination Assistance Act

2. Polio, Measles, and the “Dirty Disease Gang”

3. How Serious Is Mumps?

Part II

4. Carters Childhood Immunization Initiative

5. A Mothers Responsibility

6. Tampering with Nature

Part III

7. Clintons Vaccines for Children Program

8. Sex, Drugs, and Hepatitis B

9. Vaccine Risks and the New Media

10. Sex, Girls, and HPV

Conclusion

Appendix: The Science and Regulation of Vaccines

Acknowledgments

Notes

Selected Bibliography

Index