On Immunity : An Inoculation (9781555973278) (10 page)

Power, of course, is vampiric. We enjoy it only because someone else does not. Power is what philosophers would call a positional good, meaning that its value is determined by how much of it one has in comparison to other people. Privilege, too, is a positional good, and some have argued that health is as well.

Our vampires, whatever else they are, remain a reminder that our bodies are penetrable. A reminder that we feed off of each other, that we need each other to live. Our vampires reflect both our terrible appetites and our agonized restraint. When our vampires struggle with their need for blood, they give us a way of thinking about what we ask of each other in order to live.

M
Y FATHER HAS A SCAR on his left arm from his smallpox vaccination more than half a century ago. That vaccine is responsible for the worldwide eradication of smallpox, with the last case of natural infection occurring in the year I was born. Three years later, in 1980, the disease that had killed more people in the twentieth century than all that century’s wars was officially declared gone from Earth.

The smallpox virus now exists only in two laboratories, one in the United States and the other in Russia. Beginning shortly after the eradication of smallpox, the World Health Organization set a number of deadlines for the destruction of these stores, but neither country complied. In a 2011 discussion of the matter, the United States argued for more time with the virus so that a better vaccine could be developed, just to be safe. Smallpox has now ceased to be a disease and is only a potential weapon. And even if the last stores are destroyed, it may remain a weapon. There is plenty we do not know about smallpox, including why it is such a virulent disease, but we know enough, in theory, to resurrect it in a laboratory. “Our knowledge,” Carl Zimmer observes, “gives the virus its own kind of immortality.”

Thirty years after routine vaccination for smallpox ceased in the United States, the government asked researchers at the University of Iowa to test the remaining stores of the vaccine for efficacy. This was in the long moment after 9/11 when every potential terrorist attack was anticipated, including the use of smallpox as a biological weapon. The smallpox vaccine proved to be effective even after having been stored for decades and diluted to increase the supply. But the results of the vaccine trial, says Patricia Winokur, director of the university’s Vaccine Research and Education Unit, were “unacceptable by today’s standards.” A third of the people who received the vaccine suffered serious fevers or rashes and were sick, in some cases, for several days.

That vaccine eliminated smallpox, but it remains far more dangerous than any vaccine currently on our childhood schedule. The risk of death after vaccination against smallpox, according to one estimate, is about one in a million. And the risk of hospitalization is about one in a hundred thousand. Many of the children in my father’s generation took that risk. They were the generation of the Polio Pioneers, the 650,000 children from all over the country who were volunteered by their parents to test the first polio vaccine. This was after Jonas Salk had tested the vaccine on himself and his own three boys. I have seen pictures of the Polio Pioneers, schoolchildren just slightly older than my son, standing in lines with their shirtsleeves rolled up, grinning for the camera.

“They were afraid of polio and of the bomb,” Jane Smith writes of their parents, “and they tended to think of them in the same terms, as sudden forces that would attack without warning and destroy their own and their children’s lives.” The Polio Pioneers were born in the wake of Hiroshima, to parents who had, in many cases, been enlisted into wartime service. The forms they signed to give permission for their children to receive the experimental vaccine did not ask for their consent, but allowed them to “request” to be part of the trial. It is hard to imagine parents now making that request. While we routinely call for more vaccine testing, and more human trials, the unspoken assumption is that we do not intend our children to be the subjects of those trials.

Polio is the next disease likely to be eradicated through vaccination, though that project has proved more difficult than smallpox eradication. Unlike people with smallpox, the majority of people who contract polio carry it without symptoms and never develop paralysis, but can pass the disease to others. There is no highly visible rash that can be used to identify and quarantine every case, as with smallpox, so the elimination of polio is more dependent on universal vaccination.

Polio is now endemic only in Pakistan, Afghanistan, and Nigeria. The polio eradication campaign in Nigeria came to a temporary standstill in 2003, when fears that it was a plot by Western powers to sterilize Muslim children were embraced by religious and political leaders there. “We believe that modern-day Hitlers have deliberately adulterated the oral polio vaccines with anti-fertility drugs and contaminated it with certain viruses which are known to cause HIV and AIDS,” the chairman of the Supreme Council for Sharia in Nigeria maintained, urging parents to refuse vaccination.

During a time of mounting aggression against Muslim nations by the West, the anthropologist Maryam Yahya observes, Muslims in Nigeria were drawing a connection between the invasion of Iraq and Afghanistan and the invasion of their homes by door-to-door vaccinators. And because polio was endemic in a largely Muslim region of the country, the polio campaign seemed to be disproportionately targeting Muslims. There was also the uncertainty created by the fracture of the Nigerian state itself. When competing political groups tested the oral polio vaccine for the presence of an estrogen that might affect fertility, they produced different results—one found none, the other found traces. And then there was the lack of primary health care across the country. “The Nigerian people are astonished that the federal government, with the support of the international community,” Yahya writes, “is spending huge resources on ‘free’ polio vaccines when basic medicines to treat even minor ailments are beyond the reach of the average person.” In the push to eradicate polio, other preventable diseases like measles did not receive the same attention, even while they killed more children.

“What becomes increasingly apparent in these conversations,” Yahya writes of her fieldwork in Nigeria, “is a lack of trust in the government and the West, portrayed by many as ‘partners in crime.’” This mistrust, she warns, should not be dismissed, and vaccination rumors must be understood as “an idiom crystallizing valid commentary on broader political experience in colonial and post-colonial settings.” By 2004, less than a year after the boycott began, Nigeria had become the center of polio transmission for the world. The disease spread into seventeen other countries including Benin, Botswana, Burkina Faso, Cameroon, the Central African Republic, Chad, Côte d’Ivoire, Ethiopia, Ghana, Guinea, Mali, Sudan, and Togo. The boycott ended after Nigerian officials approved the use of polio vaccine produced by a company based in a Muslim country.

In 2012, a Taliban leader in northern Pakistan banned polio vaccination in his region until the United States ceased drone strikes there. Vaccination campaigns, he claimed, were a form of American espionage. While resembling the rumors of secret plots in Nigeria, this was, unfortunately, more easily verifiable. In pursuit of Osama bin Laden, the CIA had used a fake vaccination campaign—administering real hep B vaccine, but not the three doses necessary for immunity—to gather DNA evidence to help verify bin Laden’s location. This deception, like other acts of war, would cost the lives of women and children. The Lady Health Workers of Pakistan, a team of over 110,000 women trained to deliver health care door-to-door, had already endured years of brutal intimidation by the Taliban and hardly needed association with the CIA. Not long after the Taliban banned immunization, nine polio vaccinators, five of them women, were murdered in a coordinated series of attacks.

Pakistan’s polio campaign was suspended after the murders, but when it resumed the murders resumed in both Pakistan and Nigeria. Nine polio vaccinators were shot in Nigeria in 2013 and, as of this writing, twenty-two health care workers have been killed in Pakistan. During the suspension of the vaccination campaign, polio virus from Pakistan was discovered in sewage samples in Egypt, which had been free of polio for nearly a decade. Polio was subsequently found in Israel, Gaza, and the West Bank, and it paralyzed thirteen children in Syria. Polio’s ability to spread across national borders is part of what makes vaccine refusal a viable weapon in international warfare.

In a scene from
Apocalypse Now
more frightening than anything Francis Ford Coppola conjured for his adaptation of
Dracula
, Colonel Kurtz tells the story of returning to a camp where he had helped vaccinate children against polio to find that the children’s arms had been cut off. “They were there in a pile,” he said, “a pile of little arms.” This was the pile of little arms that was the Vietnam War, which recalled, by way of
Heart of Darkness
, the piles of human hands that were the Belgian Congo.

I would think of those little arms and those human hands when a friend of mine who was born in Vietnam during the war told me that she was exposed to Agent Orange in the womb. After coming to this country, she did not vaccinate her children as infants, for a number of reasons, including her sense that it was not safe. I disagreed with her uneasily, knowing that my understanding of safety had been forged in a life more protected than hers. I could not ask her to risk her children for the benefit of the citizens of the country that had put her in danger. The best I could do, I determined, was hope that my own child’s body might help shield them from disease. If vaccination can be conscripted into acts of war, it can still be instrumental in works of love.

I
N THE SPRING OF 1956, a five-year-old girl was hospitalized in Minamata, Japan, with difficulty walking, difficulty talking, and convulsions. Her younger sister was admitted to the hospital two days later with the same symptoms, and eight more people were soon hospitalized. In their investigation of the mysterious epidemic, health officials found that cats were having convulsions and going mad, crows were dropping out of the sky, and fish were floating in the bay. The chemical factory in Minamata was dumping wastewater contaminated with methyl mercury into the bay, where it was accumulating in the fish and shellfish people were eating. Healthy mothers were giving birth to babies with neurological damage, and thousands of people would eventually suffer mercury poisoning.

In 2013, a global treaty banning mercury was named for Minamata. The treaty ensured that mercury mines would be phased out by 2020, emissions from power plants would be controlled, and many products containing mercury—including batteries, lamps, cosmetics, and pesticides—would no longer be manufactured, imported, or exported. Everyone in the world, the director of the United Nations Environmental Program observed, stood to benefit.

One of the most noted exemptions from the ban was thimerosal, the ethyl mercury preservative used in some vaccines. The World Health Organization recommended that thimerosal be excluded from the ban in the interest of global health, and the American Academy of Pediatricians supported the recommendation. This was, as two members of the AAP would observe, a “significant reversal” of their position in 1999, when they called for the removal of thimerosal from childhood vaccines in this country. This reversal would trigger accusations that the United States was comfortable with mercury in other people’s vaccines, but not its own. The implication was that the United States was subjecting the rest of the world to its hazardous waste, which was easy to believe because it was true in other contexts.

The AAP’s 1999 statement recommended suspending the use of thimerosal while its safety was evaluated, but the statement did not express much concern about the preservative. Thimerosal, as the AAP noted, had been used in vaccines since the 1930s. There was little evidence to suggest that thimerosal was dangerous, but there was also little evidence, at the time, to suggest that it was safe. A broader review of mercury exposure was under way, and the AAP made its statement shortly after the FDA found that a child’s total ethyl mercury exposure from the full vaccination schedule could potentially exceed a federal limit for methyl mercury, the kind of mercury that had caused poisonings in Minamata. Subsequent research revealed “profound differences” between ethyl and methyl mercury, one of the most significant being that ethyl mercury is not associated with the neurotoxic effects of methyl mercury. Reflecting on the research that had been conducted in the thirteen years since the AAP’s statement on thimerosal, a 2012 article in
Pediatrics
concluded, “There is no credible scientific evidence that the use of thimerosal in vaccines presents any risk to human health.”

In 120 countries, vaccines containing thimerosal are currently used to save an estimated 1.4 million lives every year. Thimerosal is essential for multidose vaccines, which are less expensive to produce, store, and ship than single-dose vaccines. Some countries rely on multidose vaccines, not just because they are more cost effective and produce less waste than single-dose vaccines, but also because they do not require refrigeration. There are places, mostly in poorer countries, where a ban on thimerosal would effectively be a ban on vaccination against diphtheria, pertussis, hep B, and tetanus.

If we knew then what we know now, the former president of the AAP has suggested, the 1999 policy on thimerosal would never have been written. Maybe so, though the AAP statement was made in response not just to a lack of data on thimerosal, but also to the social climate at the time. Andrew Wakefield’s 1998 study linking the MMR vaccine to autism was causing a cascade of panic, adding to the alarm that had already been raised by a 1981 study that suggested the diphtheria-tetanus-pertussis vaccine caused brain damage. Subsequent studies in England, Denmark, and the United States had refuted that conclusion, but no new findings could unring the bell. The AAP statement, an effort to preserve confidence in vaccines, would eventually be used to export American anxieties.