Dr Hervé Bazin, author of Vaccination: A History and Professor Emeritus of the Faculty of Medicine at the University of Louvain, says that for as long as there have been vaccines there have been a small minority which has been staunchly opposed to their use.
In his book, which has just been translated into English and is currently rolling off the printing presses, Dr Bazin traces the ups and downs of vaccination. While it may ultimately be framed as a success story, it’s a tale not without its share of drama and setbacks. Progress came in bursts, and opponents drew succor from problems encountered in developing or testing vaccines.
New media, old problems
The modern debate on vaccination has been shaped in part by the new media revolution, says Dr Bazin, adding that anti-vaccination voices have been quick to get their message out through online channels.
“Anti-vaccine activists have found in Internet a powerful media. News stories are very often pessimistic. By comparison, there are few positive stories on vaccines. The anti-vaccine campaigners are active,” he says.
The market for books on vaccines is also dominated by a disproportionate volume of anti-vaccine titles, according to Dr Bazin, a trend he has worked to help reverse by publishing several books on the subject.
Public trust in vaccines may not be what most experts would wish, but vaccination is not the only field suffering from a crisis of confidence, he says. “There is a strong anti-science movement – against vaccines, nuclear energy, genetically modified organisms, etc. – which is against novelty, at least in Europe.”
Plus ça change, plus c’est la même chose
From history, says Dr Bazin, come lessons for the present. The tension between science and its critics are familiar, although high standards of public safety have bred a degree of complacency in the current generation.
“The [controversies of today] are not so different from the past, except for the contemporary absence of fears about infectious diseases – at least in developed countries where antibiotics and anti-retrovirals seem to be enough to fight infectious diseases. There is now a complete ignorance of the risk of return of the infectious diseases.”
Full interview transcript
Vaccines Today: You have written about the history of vaccination, including the history of vaccine refusal dating back to the 17th century. This continues to be an issue today. In your opinion, has this problem grown in recent decades?
Dr Hervé Bazin: I do not know if there is really growth of the anti-vaccine movement in our Western countries right now. It would be interesting to get a clear view of the problem with precise data provided by an enquiry. But, at the same time, such an inquiry can be source of problems!
The decreased prevalence of infectious diseases in developed countries has contributed to a sense of security in the general population. Also, there is a strong anti-science movement – against vaccines, nuclear energy, genetically modified organisms, etc. – which is against novelty, at least in Europe.
Probably the main reason is the new media and their exceptional audience: TV programs, but the Internet in particular, and the rumors which are disclosed and amplified. News stories are very often pessimistic. By comparison, there are few positive stories on vaccines. The anti-vaccine campaigners are active. For example, if you are going on eBay and sites like that, you will find people selling a lot of anti-vaccine books which are perfectly new. On the contrary, books which are positive for vaccine are few, if not exceptional. Anti-vaccine activists have found in Internet a powerful media.
The most important anti-vaccine problems are national, generally limited by language. The MMR and autism association is most important in Great Britain; Hepatatis B vaccine and multiple sclerosis is very crucial in France. This, in my opinion, is proof of the importance of the national media.
Direct preventive medicine is always difficult to adopt, if there is no clear interest for patients:
At least in France, there was a perception that the H1N1 vaccination campaign was badly organized by the authorities. Also, medical professions are not always interested in vaccines and some are not sufficiently aware of them.
The Nobel Prize in medicine and physiology has been awarded every year since 1900. Just one Nobel Prize was given for vaccines: Max Theiler and the 17D Yellow Fever vaccine and, in fact, the prize was given for the work in Yellow Fever prevention of Max Theiler, not just for the 17D vaccine alone.
Vaccines Today: Historically, what are the main drivers of anti-vaccine sentiment?
Dr Hervé Bazin: The main drivers are doubt about the balance of benefits and risks, with an addition of false (and sometimes true) rumors, often via Internet and books.
Vaccines Today: How do today’s controversies compare with those seen in the past?
Dr Hervé Bazin: They are not so different from the past, except for the contemporary absence of fears about infectious diseases – at least in developed countries where antibiotics and anti-retroviral seem to be enough to fight the Infectious diseases. There is now a complete ignorance of the risk of return of the infectious diseases.
Vaccines Today: Can any lessons be learned from the past in terms of how to communicate and address public concerns about immunisation?
Dr Hervé Bazin: The eradication of smallpox and polio are both extremely interesting. Smallpox was a terrible disease, killing and disabling many people, susceptible to reappear easily, even in developed countries. Different factors were in favor of the eradication and it worked, mainly, because the vaccine was inexpensive and efficient and the human species was the only one susceptible. But smallpox was highly contagious, and the risk for the developed countries of getting smallpox from less developed countries was high.
Vaccines Today: You’re written a book about Louis Pasteur. Was he the most influential figure in the history of vaccination, in your view? What about Jenner, Lady Wortley Montagu and others?
Dr Hervé Bazin: I previously wrote a book on Jenner (Ce bon docteur Jenner, éditions Josette Lyon, 1997, Paris and translated in The eradication of smallpox, Academic Press, 2000, London) before the one on Pasteur! In my opinion, Jenner and Pasteur were the most influential figures in the history of vaccination. They both created an enormous movement on vaccines, Jenner for smallpox and Pasteur for many different diseases. They were at the beginning of a network of vaccinologists that I hope is well described in the English version of my book on vaccines.
Lady Montagu used her influence on variolation, but in my opinion, she did much less than the doctors (like, for example, Jurin) of that time. However, she was an interesting lady, but her role was modest, being in too high a position in the society to fight on such a subject. Worse still, if I may say, variolation was very positive for individuals but not for people in general and especially for the poor people. Mortality statistics for London make that rather clear.
There were other major influences. By that I essentially mean the results of genetic engineering. The first “second generation” Pastorian vaccine is the hepatitis B vaccine of Professor Pierre Tiollais, made using CHO [Chinese Hamster Ovary] cells. It was an economic failure, unable to compete with the production in yeast but it was the first new vaccine of the Pastorian second generation. Another valuable vaccine was the ‘rabies-vaccine’ distributed to wild foxes by helicopter which eliminated rabies in a number of European countries. I describe these vaccines in the new English version of my book.
Vaccines Today: How has modern genetics and molecular biology helped to accelerate the pace of scientific progress in immunology?
Dr Hervé Bazin: Up to the development of molecular biology and the monoclonal antibodies, nothing really new appeared between Pasteur’s works and the 1950s or 1960s. Most of the new vaccines were empirically developed. Great improvements in immunology appeared in recent years with a new approach to the natural as well as the induced immune responses. Genetic engineering can solve the very difficult problem of the production of antigens from virus and parasites.
Vaccines Today: What can understanding the history of vaccination teach us about the future?
Dr Hervé Bazin: It is always difficult to answer such a question, but, unfortunately, many examples of incidents (important or minor) have been used to improve the safety regulation of vaccine. It is often the mistakes that teach us the most and allow us to continually make vaccines safer.
The development of international vaccination programmes is extremely important. Globalization of the problems of infectious diseases and the fight against them is crucial. We should highlight hygiene, treatment and prevention.
Looking to history, Jennerian vaccination was diffused extremely rapidly, in Europe, America and even in Macao and China, with the support of the King of Spain. The problems are still the same: research and discoveries, production of the vaccine and its diffusion, and financial supports. Organisations like the Bill Gates Foundation and the Rotary Club can help with the latter.