Review of The Vaccine Race: Science, Politics, and the Human Costs of Defeating Disease by Meredith Wadman

This is what I knew about vaccines prior to reading this book:

• Vaccines work by delivering a killed or live, but weakened, version of a virus into the body, stimulating the body’s immune system into producing antibodies without actually causing an infection.
• Edward Jenner gets a lot of credit for using cowpox to vaccinate against smallpox, though he wasn’t the first to think about this.
• Vaccines are responsible for preventing death, disability, and disfigurement due to such diseases as smallpox, polio, measles, and even the flu. Indeed, we’ve eradicated smallpox and almost completely eradicated polio!
• Vaccines do not cause autism.

I love reading books like The Vaccine Race, because they make me realize how much I didn’t know that I don’t know about things! In this case, while I knew what vaccines were, I realized that I didn’t actually know how we make vaccines, the process used to kill or weaken the virus. Meredith Wadman explains this, along with all sorts of related developments in the science of vaccination. The title of this book is somewhat inaccurate, or at least too narrow: The Vaccine Race is really the story of virology and immunology in the 20th century. After all, the central character of this story is Leonard Hayflick, who does not himself develop vaccines but rather a critical line of “normal” human tissue cells that become integral to many vaccine efforts. This story goes far beyond the creation of vaccines, touching broadly on issues of biological research and human health.

This is a story, albeit one supported heavily by research. Wadman begins from Hayflick’s earliest days as a scientist, chronicling his studies and start at the Wistar Institute. Along the way, she takes us on digressions to talk about other important figures and the vaccines they worked on. I love the amount of detail that Wadman goes into with regards to the science being done; equally, though, this is not just a book about science but a book about history. Wadman sets out to examine how social conditions and politics in the United States influenced vaccine development, and vice versa.

The history herein is a mixed bag, and Wadman tries to celebrate the progressive aspects while acknowledging the shameful, harmful parts. She does not ignore the fact that vaccines were often tested on poor children and orphans, intellectually disabled people, prisoners, and military personnel. In so doing, she doesn’t just highlight the ethical problems with this, but the way they were embedded within the society of the time:

In 1950 Koprowski began testing his vaccine on intellectually disabled children at Letchworth Village, a filthy, overcrowded institution for people with physical and mental disabilities in the tiny town of Thiells, New York.

Wadman makes it clear here that Dr. Hilary Koprowski didn’t just happen along some intellectually disabled children—they were warehoused, making them ideal for his experiment. Of course, it’s difficult for me to say that things have gotten any better in the present day, considering we incarcerate our mentally ill when we should be helping them…. Anyway, I think the way that Wadman presents these dubious aspects of vaccine development is an important reminder that science is a human endeavour and therefore vulnerable to human flaws.

It is impossible, in fact, to separate science and politics. We must push back against people who insist this is possible, people who think that scientists have no business commenting on public policy, that the existence of global warming has no bearing on how we conduct our lives. The Vaccine Race is a potent primer on science, but it’s an even better look into the political framework in which science was done in the 20th century United States. The scientists in this book lived and died by funding, which often came in the form of grants from government institutions like the National Institute of Health. Moreover, scientists in positions of power were not above using their influence to spin things their way:

Koprowski had minimized the SV40 monkey virus problem only four months earlier, when his own monkey kidney–based polio vaccine was still in the running for U.S. approval. Now, with Sabin’s vaccine rolling quickly toward being licensed, he sounded more alarmed.

The scientific facts were that the SV40 virus existed and that it could potentially survive the vaccine-making progress—but the potential for harm that this posed was still up in the air, and as you can see, Koprowski was willing to change his tune if he thought he could benefit. Someone who was a brilliant scientist—or, more notably perhaps, had a talent for recognizing, grooming, and enabling the brilliance of other scientists—nevertheless keenly acted in his own self-interests when he should have been safeguarding the public good.

The officials in charge of government institutions could also play a huge role in aiding or standing in the way of progress. Wadman discusses how the Department of Biological Standards dragged its feet on allowing vaccines made with WI-38 cells to be licensed in the US, but the rest of the world wasn’t so conservative:

If the WI-38 cells were ignored in the United States, abroad they were increasingly embraced.… It was a sign of the esteem in which Hayflick’s WI-38 cells were held that the British vaccine authorities … decided, perhaps as a matter of national pride, to derive their own analogous normal, noncancerous human diploid cells.

I appreciate that, although largely about the US vaccine industry, the book acknowledges the global scope of medical research. In many cases, crucial advances in vaccines happened because of testing in other countries, or the participation of scientists from other countries—as is the case of Mrs. X and her aborted fetus shipped from Sweden to Hayflick to donate the cells that would become WI-38. Similarly, Wadman reminded me of the importance of scientific conferences—what might seem like a social occasion is really a chance for scientists to recombine ideas and find new, interesting avenues of exploration. If it weren’t for a meeting at a conference, Elizabeth Blackburn might not have heard of Alexei Olovnikov’s little-known theory of cellular aging and connected them to her work on telomeres. Crazy.

Much of The Vaccine Race’s political treatment emphasizes the ways in which scientific and medical research’s evolution into an industry has shaped that research, for better or for worse. The pressure on scientists to secure lucrative grants, make big discoveries, and then patent those discoveries is intense. Post-secondary institutions have essentially turned into patent machines, in a sense, and this can often have an adverse effect on the quality of teaching and learning at that institution, not to mention the actual science being done and the mental health of the scientists doing it.

Still, while I have been and remain critical of the pharmaceutical industry’s power, influence, and actions, I appreciate how Wadman shows the positive effects of nascent Big Pharma’s embrace of vaccines. At the risk of arguing counterfactually, I’m not sure how effective vaccination would be if it were not for the vaccine production industry. And I have no doubts that vaccines are good. At 27, I am old enough not to have been vaccinated with chicken pox (I have vivid memories of that itch when I was a kid, and then three occurrences of what might have been shingles in my early 20s). But I am too young to remember any kind of developed world scarred by polio, rubella, and measles:

In the end, the rubella epidemic that swept the United States in 1964 and 1965 infected an estimated 12.5 million people, or 1 in 15 Americans. More than 159,000 of these infections included joint pain or arthritis, typically in women. Roughly 2,100 people developed encephalitis, a brain inflammation with a 20 percent mortality rate.

Some 6,250 pregnancies ended in miscarriages or stillbirths. An estimated 5,000 women chose to get abortions. Still another 2,100 babies were born, and survived, with congenital rubella syndrome. Of these, more than 8,000 were deaf; nearly 4,000 were both deaf and blind; and 1,800 were intellectually disabled. About 6,600 babies had other manifestations of congenital rubella, most typically heart defects. Often babies were born with several of these disabilities.

These numbers are, at the very best, approximations. They come from a 1969 CDC report whose authors stressed that it was not until 1966 that physicians were required to report rubella cases to authorities.

Just think about that. It boggles my mind, those numbers—they are approximate, because physicians weren’t keeping track! And that was for one epidemic among a recurring cycle of epidemics every 5 years or so! Vaccines have saved literally millions of people from death or needless suffering, and The Vaccine Race is an up-front reminder of how fortunate we are for these discoveries.

The Vaccine Race is a first-rate example of science communication. Wadman is detailed but clear in her writing. I could have done without some of that detail, I think—she loves to tell me all about the backstories of every minor character in the book, and at points my eyes glazed over—but I love this blending of science and history. Moreover, this book is meticulously research, and it shows! In addition to numerous primary and secondary print sources, Wadman interviewed any key players who were still alive (a benefit to writing about recent history!). As a result, she can provide a comprehensive and intimate look at the topic, while remaining somewhat more journalistic than a book written by someone directly involved, such as Hayflick himself. I learned so many interesting things in here. I am quite thankful for NetGalley and Viking making a copy of this book available to me to review.