Vaccinated (22 page)

Within a few years, measles, which has been virtually eliminated from the United States, would again find a home. Although measles infections are very rare in the United States, they're not rare in the world; every year about thirty million people are infected with the virus. Because international travel is common, people with measles often come into the United States. For example, in May 2006 an unimmunized computer programmer brought measles with him from India. He worked at the John Hancock Tower, Boston's tallest building and home to five thousand other workers. Anita Barry, Boston's public health commissioner, remembered what happened when the city first offered vaccine to company workers: “Only about thirty people showed up at that initial clinic,” she said. “I wish that a lot more people had shown up. And so did the company, given subsequent events.” Soon the virus spread to others in the building. Then it traveled a few blocks, infecting a member of the Christian Science Church, a group that doesn't believe in immunizations. “It's actually more contagious than smallpox,” said Alfred DeMaria, Massachusetts's chief infectious diseases official. When fourteen more people were infected and the media alerted Boston residents of the growing outbreak in the Hancock Tower, thousands of people were vaccinated, and the outbreak subsided. But imagine what would have happened if no one in the John Hancock Tower had been immunized.

When enough people are unimmunized, rubella would again cause birth defects and fetal death. And mumps would be a common cause of deafness. In 2006 a mumps epidemic swept across several Midwestern states. The virus infected four thousand people, mostly young adults, causing seizures, meningitis, and deafness in about thirty people. The strain of mumps virus that was isolated in the United States was the same as the one recently found circulating in England, where seventy thousand people were infected. The outbreak in England was worse because many more people were unimmunized, scared by the false concern that the MMR vaccine caused autism.

Next up would be the bacterium
Haemophilus influenzae
type b (Hib). Before the vaccine, Hib caused meningitis and bloodstream infections in tens of thousands of children every year. And the Hib vaccine wasn't introduced in the United States until the mid-1980s, well after several antibiotics were available to treat the disease. Despite the availability of these antibiotics, Hib caused mental retardation, speech disorders, language delays, hearing deficits, and paralysis in many of those infected. Although antibiotics save lives, they aren't given until after the infection has already started, often too late to prevent permanent harm.

After about ten years in which babies were no longer immunized, polio would return, allowing younger Americans to experience firsthand what their parents and grandparents had experienced in the 1940s and 1950s. Again, parents would be scared to let their children go swimming in the summer or drink from water fountains or congregate in movie theaters or play with neighbors. This scenario isn't so far-fetched. In 1978 and again in 1992, outbreaks of polio occurred among members of a Dutch Reformed Church in the Netherlands who refused vaccines, causing paralysis in several children. Fortunately, the disease didn't spread to neighbors because 98 percent of people who came in contact with these children had been immunized. But if immunization rates had been only 50 percent or 0 percent, the outcome would have been very different.

When there were enough susceptible children, diphtheria would return. In the early 1990s, during the collapse of the Soviet Union, many children there didn't get the vaccines they needed. It wasn't long before diphtheria reappeared, causing disease in fifty-thousand people. The bacterium that causes diphtheria is still out there; if we lower our defenses, the disease will be back. And we will again be able to experience what it was like for our ancestors, who, in the 1920s, feared diphtheria as one of the greatest killers of teenagers.

Given other advances in modern medicine, some might argue that we are better able to handle the onslaught of infectious diseases now than we were fifty years ago. But in some ways we're worse off. Intensive care units in hospitals today care for hundreds of cases of severe infections every year, not tens of thousands. Facilities to handle the sudden increase in infections that would inevitably follow a dramatic decline in immunization rates don't exist. Furthermore, intensive care units today take care of a much more vulnerable group of patients, such as severely premature babies and bone marrow or organ transplant recipients. Also, because of the widespread use of drugs like steroids, which suppress the immune system, many more people in the United States have weakened immune systems today than they did fifty years ago. As a consequence, they are far more susceptible to harm caused by highly contagious infections.

A return to a time before vaccines would also affect the workplace. Fifty years ago, most mothers stayed home to take care of their children. But today women work outside the home. If infectious diseases like measles, mumps, Hib, polio, and diphtheria returned, one parent would be forced to spend at least several more weeks every year staying home to take care of sick children. Day care centers, where spread of these diseases would be rapid, would be particularly vulnerable. The result would be a major disruption of the workforce necessary to provide goods and services, and billions of dollars in lost wages.

We don't have to go back in time to see what life was like before vaccines. If we want to get a peek into a future without vaccines, we could take a trip to sub-Saharan Africa or India or Pakistan and watch children suffer and die of diseases now prevented by vaccines, remembering that about half of these children are actually vaccinated. From measles alone, about five hundred thousand children die every year.

 

“D
ESPITE ALL OF SOCIETY
'
S NEGATIVE PRESSURES, VACCINATION HAS
proven itself beyond the shadow of doubt to be the most logical way to control infectious diseases in a community,” says Adel Mahmoud, the parasitologist mentioned earlier who grew up in Egypt, a country devastated by infectious diseases. “The success story is undeniable. There is no measles, a little bit of mumps, no rubella, a little bit of hepatitis B in many communities. And the reason is vaccination. Vaccination is an unbelievably smart way of changing the environment for pathogens in human populations. It is as ecologically important as anything that we have discovered in our long history in the fight between us and the microbes. But it's not free. It comes with a price, an imperative. And that is that you have to keep using it.”

H
ere was a guy,” said Walter Strauss, senior director of epidemiology research at Merck, “born on some windswept ranch in Montana, practically orphaned at birth, taken in by relatives, and who, but for his talent and drive, might have spent a lifetime working as a clerk at a retail store. Instead he rose to the pinnacle of scientific achievement in the United States, leaving his mark on half the world's children. It is one of the greatest of all Horatio Alger stories.”

Hilleman didn't see his career as improbable, reasoning that his farming background was perfect training for a scientist to create life-saving vaccines. “We had a machine shop, an electrical shop, and a blacksmith shop,” he said. “You learned agronomy. We tore apart irrigation pumps and put them back together. And I had an old 1928 Ford, nothing but a wreck. But I rebuilt [it] and made it a functioning car. When you're brought up on a farm, you have a lot of general knowledge.” At Custer County High School Hilleman had the option of majoring in general farming, mechanics, science, business, or academics. He chose science. So did all of his brothers. And, like Hilleman, all were successful. Howard, a professor of anatomy and physiology at the University of Oregon, wrote a textbook on invertebrate anatomy. “He had a photographic memory,” recalled Hilleman. Victor ran a landscaping unit for FDR's Civilian Conservation Corps and later built ships and airplanes. Harold designed and built propeller planes for Lockheed. Richard supervised the installation of electrical systems in planes, also for Lockheed. Norman was a radar specialist for the federal government. “He liked to memorize all of the radar circuitry,” recalled Hilleman. The only brother who didn't choose a life in science or engineering was Walter, who graduated from Concordia College and was about to be ordained as a Lutheran minister when he died on the operating table of an undiagnosed case of appendicitis; he was nineteen years old.

Although all of his brothers were successful, Maurice's relentless, unending drive was unique. When asked to explain this difference, Hilleman would invariably talk about his father, saying “I wanted to get him to see me.” Hilleman, raised by his aunt and uncle, hated his father for the perceived rejection. “I found [my father's] narrow-minded, domineering opinions and intrusions insufferable and unforgivable,” recalled Hilleman. “The antagonism that I [felt] toward him was taken out on [my] occasional outbursts and his threats of physical harm. There was no resolution.” But nothing ever erased the pain of getting up every day to watch his brothers and sister grow up in a house with their father—his father. Never recognized by his father, each of Hilleman's many accomplishments was just one spade of dirt in a bottomless hole.

 

A
S A CHILD,
H
ILLEMAN
“
CHEATED DEATH
.” N
EITHER HIS MOTHER
nor his twin sister survived his birth. If Hilleman hadn't survived, would we still have the same vaccines that we do today? Most likely all of his vaccines would have been developed eventually by others, with two exceptions: the blood-derived hepatitis B vaccine and the mumps vaccine. Only Maurice Hilleman had the foresight to treat human blood with chemicals, prove that he could kill any possible contaminating organism, and purify Australia antigen from the mix. No one else had the resources, intelligence, and guts to do this. With the appearance of HIV in the blood supply, the task was seen as too dangerous. But for the five years when Hilleman's blood-derived hepatitis B vaccine was the only one available to prevent hepatitis B virus infections, millions of doses were sold, and thousands of lives were saved. Also, no one has ever developed a better mumps vaccine than the one Hilleman made from the virus that infected his daughter. And it wasn't for lack of trying. In the 1960s a mumps vaccine made in Russia, called the Leningrad strain, and one made in Japan, called the Urabe strain, were licensed and sold. Both of these vaccines worked well to eliminate mumps infections and were on the market for decades. But both also came with a price: they occasionally caused meningitis. The Jeryl Lynn strain of mumps vaccine didn't cause this dangerous side effect.

 

M
AURICE
H
ILLEMAN DIED ON APRIL
11, 2005. T
HE DAY AFTER HIS
death his obituary appeared on the front page of the
New York Times
. Lawrence Altman wrote it. While writing his story, Altman asked prominent scientists and doctors why Hilleman wasn't better known to the public. Shock-jock Howard Stern read Altman's article and asked his listeners why they knew about Britney Spears's pregnancy but didn't know about Hilleman. That same day, public health officials, epidemiologists, clinicians, and members of the media gathered at the University of Pittsburgh's Alumni Hall to celebrate the fiftieth anniversary of Jonas Salk's polio vaccine. At a party following the ceremony, one of the participants told a group of pediatric infectious disease specialists that Maurice Hilleman had died. No single group of doctors was better positioned to appreciate the impact of Hilleman's work, but after hearing the news, all looked up with blank expressions, unmoved. Not one of them had ever heard his name.

Hilleman's relative anonymity can be explained in several ways. Despite his self-confidence; profane, confrontational style; and domineering, occasionally frightening manner, Maurice Hilleman was a humble man.

When Anton Schwarz made his measles vaccine in the mid-1960s—one designed to compete with Hilleman's—he called it the Schwarz strain. When Jennifer Alexander took liver cells from a man dying from liver cancer, and later found that they produced Australia antigen, she called them Alexander cells. And when D. S. Dane looked through an electron microscope and saw hepatitis B virus particles circulating in human blood, he called them Dane particles. Hilleman was different; not one of his discoveries bears his name. He named his measles vaccine the Moraten strain (
Mor
e
At
tenuated
En
ders), in recognition of the work of John Enders. He named his rubella vaccine the HPV77-duck strain, in recognition of the
High Passage Virus
originally developed by Harry Meyer and Paul Parkman. He named his two hepatitis B vaccines the plasma-derived and recombinant vaccines, noting the starting material and scientific process used to make them. After being the first to identify hepatitis A virus, he called the strain CR326. After finding that a previously unknown strain of monkey virus had contaminated early lots of polio vaccines, he called it simian virus-40. Hilleman allowed himself only one conceit: he named his mumps vaccine the Jeryl Lynn strain. But he didn't name it the Jeryl Lynn Hilleman or JLH strain. And few people today reading the package insert know that Jeryl Lynn was Maurice Hilleman's daughter.

“He was interested in the result and the product, not in taking credit for [it],” recalled Tony Fauci, director of the National Institute of Allergy and Infectious Diseases within NIH. “When he had a vaccine or a discovery, his attitude was more, ‘Isn't this an interesting discovery,' rather than, ‘I, Maurice Hilleman, did this.' It's almost like it never crossed his mind. He didn't really care about that. He just did [the work] and he let his accomplishments do the talking. So people know an incredible amount about what he did, but they don't know that it was he who did it. And when the obituaries and the eulogies came out, that's when people said, ‘Oh, my God, this one guy did all of this?'”

“Despite his astounding accomplishments,” recalled Walter Strauss, “Maurice carried himself with great humility. [We all] know many scientists with enormous egos that rest upon the smallest achievements. Maurice was different. Coming from a hardscrabble childhood in the Depression, he realized how much he had to be thankful for. Many of his childhood friends no doubt spent their adult lives working Montana cattle farms, wearing their bodies down for little reward. Maurice looked back on that alternative and considered himself tremendously lucky to be able to devote himself to something that was so much fun.”

Because most people view industry researchers as being different from academic researchers, Hilleman's choice to work for a pharmaceutical company also contributed to his anonymity. Scientists, teachers, and researchers in academia believe that they are pursuing a higher calling, free from the bonds of commercialism. The public believes it too: people want scientists to be so dedicated and idealistic that they can live on air. In 1902 Wilhem Conrad Röntgen won the first Nobel Prize in physics for his discovery of X-rays. Röntgen believed that scientific knowledge was “to be freely shared for the good of humanity,” not rewarded with something as base and common as money. Röntgen gave the Nobel Prize money—seventy thousand gold francs—to charity. Twenty years later he died, penniless.

In the late 1950s Samuel Katz was part of John Enders's research team at Boston Children's Hospital, involved in the quest to make the first measles vaccine. The Enders group never patented its vaccine. In 2005, Robert Kennedy Jr., in his article for
Rolling Stone
magazine, accused Sam Katz of having profited from a patent on the original measles vaccine. Katz was incensed: “I am cited personally as having a patent for a measles vaccine. That is just a total lie. I was part of the group of three who developed measles vaccine and brought it to licensure in 1963. However, our leader and mentor, John Enders, was a scientist who believed fully that the more people who are able to work on a problem, the more rapidly and likely it will be solved. Therefore, throughout our more than seven years of research we gave freely to any legitimate investigator who came to our laboratories. Dr. Enders was firmly opposed to patenting a biological product such as a vaccine, and we absolutely did not.” Katz wanted Kennedy to know that the Boston researchers would never have debased themselves by financially profiting from their work; they were academicians, guardians of the public good, not industrialists out for profit.

Jonas Salk also made it clear to the press and the public that he would not profit from his polio vaccine. In April 1955, on the television program
See It Now
, Edward R. Murrow asked Salk, “Who owns the patent on this vaccine?” Salk thought for a moment and said, “Well, the people, I would say. There is no patent. Could you patent the sun?”

As reflected in popular culture, today's press and public share the disdain of Röntgen, Katz, and Salk for scientists interested in financial gain. A 1996 movie,
Twister
, subtly mirrors this belief.
Twister
is the story of two rival research groups trying to understand the physics of tornadoes. Each hopes that by placing small robotic measuring devices in the center of tornadoes it can better predict when and where the next one will appear. One research team is from academia, the other from industry. The academia group, led by Bill Paxton and Helen Hunt, consists of men and women of European, African, and Asian descent; all wear bright, colorful clothing that collectively looks like an entertaining patchwork quilt. The industry group, led by actor Cary Elwes, consists of white men in dark clothing; they look like a platoon from Darth Vader's home ship. The academia group is funny, childlike, and irreverent. The industry group is serious, formal, and humorless. The implications are clear. Academic research is fun, pursued by those with the curiosity of children who are naïve and pure at heart; they seek knowledge because knowledge alone is rewarding. Industry research, on the other hand, is serious, pursued by grim, faceless adults; knowledge is obtained solely for the money it can bring. We are much more comfortable touting the accomplishments of scientists in academia than of those in industry. “[Maurice] got enormous peer recognition,” said Robert Gallo, codiscoverer of HIV. “But do we know anyone as a scientist in the corporate world who became well known? I don't think so.”

“When Maurice came to work at Merck, it was wonderful,” recalled Maurice's wife, Lorraine. “You had people to wash your pipettes and to wash your glassware. You didn't have to do any of that yourself. He couldn't believe that. And there was money to spend to do what you needed to do. Money wasn't an object. You could do your research.” But Hilleman understood that most people saw pharmaceutical company scientists as inferior to those who worked in academia. He sarcastically referred to his working for “dirty industry.” But he also knew that with the resources provided by industry he could have an impact on human health that would never be matched by the greatest academic centers. And that was a trade he was perfectly willing to make.

Hilleman's choice to get a doctorate in microbiology, not a medical degree, also contributed to his lack of recognition. When Hilleman finished weakening his daughter's mumps virus in the laboratory, he asked Robert Weibel and Joseph Stokes Jr. to test it. After Weibel and Stokes published their findings, and children in the United States began to receive the vaccine, Merck distributed a heart-warming picture to help physicians understand the vaccine's origins. In the center of the picture is two-year-old Kirsten Hilleman, getting a shot of the new vaccine. Tears are coursing down her face, and her mouth is open in a wide circle, screaming. Her sister, Jeryl Lynn, stands to her right. “I was telling her that everything was going to be all right,” remembers Jeryl. To Kirsten's left—giving the vaccine—is Robert Weibel. Merck made thousands of copies of this photograph and distributed it to media outlets throughout the United States and the world. Although both of his daughters were in the photograph, Hilleman was nowhere to be found. Many people interpreted this photograph to mean that Robert Weibel had developed the mumps vaccine. Because Hilleman was a PhD working behind the scenes—not an MD on the front lines, giving vaccines and explaining them to the press and the public—few knew his name or his contributions.