The whole cell pertussis vaccine, media malpractice, and the long-term effects of avoiding difficult conversations

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Seventy years-ago, a pioneering American scientist named Pearl Kendrick combined killed, whole cell pertussis bacterium with weakened diphtheria and tetanus toxins to create the first combination diphtheria-pertussis-tetanus vaccine. It was an almost instantaneous success: In 1934, six out of every 100,000 Americans died of whooping cough. By 1948, that figure was less than one in 100,000; by 1960, there were fewer than ten cases of the disease per 100,000 residents.

In the coming decades, there were reports about complications from the whole-cell pertussis vaccine. This was not surprising: while whole-cell vaccines can be both effective and safe, their use of the actual contagion as opposed to an isolated component mean they are among the crudest of all vaccines. The whole-cell pertussis vaccine could cause febrile seizures, high fevers, and even fainting — reactions which are understandably scary for parents but which typically have no long-term effects. (My younger sister ran an extremely high fever after her first DPT injection, which she received in the late 1970s.) There were also unconfirmed reports — of brain damage, comas, even paralysis — which to this day have never been verified.

Fast-forward to April 19, 1982, when  WRC-TV, the local NBC affiliate in Washington, DC, aired a special titled “Vaccine Roulette.” The report, hosted by Lea Thompson, was an example of scare-mongering at it’s worst: Throughout the hour-long show, Thompson featured heart-breaking interviews with parents  who described how their children had been left in near-comatose states after receiving a vaccine that was mandatory for public-school children in the vast majority of states. These were augmented by what turned out to be inaccurate statistics, cherry-picked quotes, and risible falsehoods about some of the “experts” Thompson used to support her thesis that the “medical establishment” was “aggressively promot[ing]” a vaccine while willfully ignoring “the consequences.” It also presented parents’ recollections as fact — and, as we know from countless studies, memory is imminently fallible.  Those doctors and public health officials who disagreed with Thompson, on the other hand, were subjected to hours of grilling. (One AAP official said that over the course of a five-hour interview, Thompson asked the same question, “repeatedly in slightly different ways, apparently to develop or obtain an answer that fitted with the general tone of the program.”) When Thompson, who won an Emmy for the show, was asked about her errors, she said the grousing was simply coming from “doctors [who] are miffed because they have to talk to their patients now.”

In the days after “Vaccine Roulette” aired, Thompson’s employer provided callers with the phone numbers of other people who’d also called looking for more information about negative information regarding vaccines — and in doing so, helped create the modern-day anti-vaccine movement. Among the parents who met in the days after the airing of “Vaccine Roulette” was Barbara Loe Fisher, who soon formed a group with the Orwellian moniker the National Vaccine Information Center.

At the time, Fisher was a former PR professional who’d become a full-time housewife after she’d given birth to her son Chris four years earlier. When “Vaccine Roulette” aired, it had been more than a year since Chris had started displaying symptoms of what would eventually be diagnosed as a range of developmental disorders. I wrote about Fisher’s reaction to Thompson’s broadcast in my book:

It wasn’t until she saw Thompson’s broadcast that the pieces fell into place. The reactions that Thompson described—convulsions, loss of affect, permanent brain damage—were, Fisher realized, identical to those experienced by her son. Suddenly, Fisher remembered in meticulous detail what had happened one day eighteen months earlier, when Chris had received the final dose of his DPT vaccine:

When we got home, Chris seemed quieter than usual. Several hours later I walked into his bedroom to find him sitting in a rocking chair staring straight ahead as if he couldn’t see me standing in the doorway. His face was white and his lips slightly blue, and when I called out his name, his eyes rolled back in his head, his head fell to his shoulder and it was like he had suddenly fallen asleep sitting up. I tried, but could not wake him. When I picked him up, he was like a dead weight and I carried him to his bed, where he stayed without moving for more than six hours, through dinnertime, until I called my Mom, who told me to immediately try to wake him, which I finally did with great difficulty. But he didn’t know where he was, could not speak coherently and couldn’t walk. I had to carry him to the bathroom and he fell asleep again in my arms and then slept for twelve more hours.

 It’s an incredibly moving story, and one that Fisher has told to congressional panels, federal committees, and state legislatures, and at national press conferences for more than twenty-five years. In all that time, she’s almost never been questioned about the specifics of her narrative—and there are parts that, if nothing else, certainly are confounding.~ Fisher, as she told an Institute of Medicine (IOM) Immunization Safety Committee in 2001, is “the daughter of a nurse, the granddaughter of a doctor, and a former writer at a teaching hospital” who viewed herself as “an especially well-educated woman when it came to science and medicine.” How was it that her only response to finding her unresponsive son displaying symptoms associated with heart attacks, strokes, and suffocation was to carry him to bed and leave him alone for six more hours? And if Chris’s reaction to his fourth DPT shot was so severe that it transformed an ebullient boy into a sluggish shell of his former self, why had he been fine after receiving the first three doses?

Shortly after the formation of Dissatisfied Parents Together, Fisher founded the National Vaccine Information Center. Since then, she’s played an essential role in organizing a movement that’s targeted the press, politicians, and the public in equal measures. The result has been a steady erosion of vaccine requirements and a steady increase in the percent of the population skeptical of vaccine efficacy. 

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The vaccine wars of the 1980′s were nowhere near as pitched or as prolonged as those of today, but the focus on the P in the DPT shot was one factor that helped spur the development and eventual adoption of an acellular pertussis vaccine, which was first introduced in the United States in the early 1990′s. (By the end of that decade, the acellular formulation was used for all five recommended doses of what is now called the DTaP vaccine.) Because of the near-impossibility of having an honest discourse about vaccine side effects, there were few conversations about whether the advantages of the acellular pertussis vaccine outweighed its disadvantages — or even what those disadvantages were.

It’s looking increasingly like we’re in the midst of learning the consequences of failing to have those tough conversations two decades ago. For the past several years, the United States has had a series of unusually robust pertussis outbreaks. (Typically, outbreaks go in multi-year cycles, with peaks and troughs. That hasn’t been happening as of late: There were 27,550 cases in 2010, and there have already been 26,146 so far this year.) One theory has been that the acellular vaccine doesn’t confer as lengthy immunity as the whole-cell vaccine did — and a new study published in The New England Journal of Medicine (abstract, PDF) provides strong evidence that that is, indeed, the case. “[O]ur evaluation of data from a large pertussis outbreak in California [in 2010],” the authors write, “showed that protection from disease after a fifth dose of DTaP among children who had received only DTaP vaccines was relatively short-lived and waned substantially each year. Our findings highlight the need to develop new pertussis-containing vaccines that will provide long-lasting immunity.”

There are those who would point out that we actually know of a pertussis-containing vaccine that provides long-lasting immunity — but the chances of returning to the whole-cell DPT vaccine are next to nil. In the future, hopefully we, as a society, will have the courage and fortitude to have these difficult discussions — but for that to happen, the media needs to use the privilege of communicating with the public responsibly and judiciously. “Vaccine Roulette” might have been good for Lea Thompson’s career, but it was awful for public health.

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One final note: The conclusions of the NEJM study also illustraste why the current pertussis outbreaks are occurring not only in unvaccinated children but also in children and adults with waning immunity. (Contrast this with the measles outbreaks which gripped the country last year, which were almost entirely initiated and propagated by deliberately unvaccinated individuals.) As Amanda Schaffer recently pointed out in Slate, this does not mean that unvaccinated children are not presenting an increased risk for the rest of us:

Now here’s how parents who don’t give it to their kids, quite apart from those flaws, are making things worse for all of us. Unimmunized children are simply more likely to get the disease than their vaccinated peers, even with the limitations of the current formulation. And when they do, they are more apt to develop severe symptoms that last longer. This means they’re more likely to pass the disease on to others, including infants, who are at greater risk of dying. Nationally, the anti-vaxers may not be responsible for most of the cases in the spate of recent outbreaks. But that’s mainly because they make up a small fraction of the population.

In addition to making sure their children are vaccinated, parents should make sure they have their pertussis boosters up to date. My mother caught whooping cough while I was working on my book, and I can tell you with confidence that it can be a nasty, nasty disease regardless of how old you are.

 

~ I tried to interview Fisher several times over a period of more than a year. She refused, explaining that my association with Conde Nast — I am a contributing editor at Vanity Fair — meant that I was untrustworthy.

NOTE: Portions of this post previously appeared in the chapters “Fluoride scares and swine flu scandals” and “Vaccine Roulette” of my book The Panic Virus.

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