Throughout many established nations, outraged parents, particularly those with the financial means and passion to back their words with action, began organizing anti-vaccine crusades and pushed their pediatricians to suspend vaccination. As attention on the subject grew, more and more parents refused to allow their children to be jabbed with the DTP vaccine. Immunization rates plummeted throughout England, Japan, and the rest of the world. Consequently, the rates of pertussis rebounded to more than 100,000 per year in England alone in 1978 and 1979.28 Despite the opportunities afforded by antibiotic intervention (a luxury not available to physicians before the Second World War), dozens of children again began to succumb to the whooping cough each year.
The firestorm that had engulfed Japan and the United Kingdom worked its way across the oceans on April 19, 1982, when the Washington, D.C., television station WRC-TV broadcast a special report with the title DTP: Vaccine Roulette.29 The documentary was masterminded by local consumer reporter, Lea Thompson. Thompson conveyed a heart-wrenching tale featuring countless scenes of sincerely agonized parents whose children had suffered very real hardships. The sensationalized and widely hyped documentary aired during a period known as “sweeps week.” This is a key time when ratings services such as Nielsen determine audience size and thus influence the advertising rates that local television stations can charge. The gamble by WRC-TV to produce DTP: Vaccine Roulette paid off, as ratings were very high. Immediately after the report aired, the company’s switchboard lit up with parents concerned—some truly panicked—about the safety of their young children. According to one chronicler of the event, Seth Mnookin, the station “provided callers with the phone numbers of other people who had also called” and thereby nucleated a grass-roots movement that quickly gained momentum.30
The heartbreak conveyed by the parents in DTP: Vaccine Roulette was sincere, but the report on the tragedies was simplistic, unscientific, biased, and inaccurately implicated the DTP vaccine. According to a well-researched account of the subject in The Panic Virus, by Seth Mnookin, the documentary was based on incomplete data analysis and highly edited quotes.31 In a later article, Mnookin cited an official of the American Academy of Pediatrics who indicated that “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.”32 As detailed further by Paul Offit in his outstanding book, Deadly Choices, Lea Thompson was described as selective in her presentation of details, subjecting unwitting viewers to a cacophony of half-truths and manipulations of incomplete or inaccurate data.33 Whereas such oversights are frequently identified by the scientific peer-review system that guides medical research, no such filter for objective, evidence-based truth constrains the media.
Despite a lack of medical and scientific credibility, DTP: Vaccine Roulette was critically acclaimed, and Lea Thompson received a local Emmy award.34 As the sensation associated with the documentary began a long chain reaction, its impact was felt well beyond the local Washington, D.C. market. Soon parents across the country were consumed by the same fear that their British counterparts had felt a decade before. In the more litigious United States, lawyers were the big winners as class-action lawsuits began being leveled at most major manufacturers of the DTP vaccine.
The selective filtering of information was not limited to Vaccine Roulette. A similar cherry picking of information led to the publication of a best-selling book and the creation of an anti-vaccinator advocacy group that will feature prominently in our next chapter. On the heels of the sensation created by the sensationalistic local television show, Dr. Harris Coulter and Barbara Loe Fisher founded an organization with the impressive-sounding name of the National Vaccine Information Center (NVIC). This nonprofit amplified unsubstantiated reports arising from the rapidly-organizing anti-vaccine, movement.
Dr. Coulter, who passed away in 2009, was not trained in medicine or science; he was a social scientist who advocated homeopathy, an 18th-century form of pseudoscientific alternative medicine based on long-since refuted concepts such as miasma.35 Likewise, Fisher’s draw to the field was anchored in a tragic history with her child, who suffered a convulsion coincident with a DTP immunization in 1980. Although she had not made the association prior to viewing Vaccine Roulette, the documentary apparently convinced Fisher to recall precise details that led her to maintain that the DTP vaccine was responsible for permanent brain damage her son had suffered eighteen months before she and Coulter had organized the NVIC.36 Trained in public relations, Fisher was well placed to organize fearful parents into the emerging NVIC.
In 1985, the pair published DTP: A Shot in the Dark, which advocated that vaccination was responsible for a variety of neurological impairments, including chronic encephalopathy, seizures, and a rather obscure malady (at the time) known as autism.37 Despite Coulter and Fisher’s lack of scientific or medical credentials, sales of A Shot in the Dark were propelled by carefully selected anecdotes and heart-wrenching descriptions of pediatric neurological damage. The book became a best seller. Many readers embraced the book despite its failure to convey objective scientific or medical information. As the fears swelled, many doctors were caught unawares and were not sufficiently armed with prior training or objective facts to adequately address the complex questions related to the risks and benefits of DTP vaccination. This would have dire implications for public health for years to come.
Increasing public concern raised by the television documentary and book led governmental and public health officials in the United States and United Kingdom to directly confront the questions surrounding the safety of the DTP vaccine. In response to the uproar, on November 14, 1986 President Ronald Reagan signed into law the National Childhood Vaccine Injury Act.38 One provision of the new law required a comprehensive analysis of the safety of the pertussis vaccine by the Institute of Medicine of the prestigious National Academy of Sciences. A nonpartisan task force comprised of prominent investigators was tasked with a twenty-month assignment to assess all medical and scientific literature and carefully review the relationship between vaccines for pertussis (and rubella, a subject to which we will return in the next chapter). Their deliberations included a series of workshops and public meetings to gather all relevant data and in a transparent manner to refute future allegations of bias.
The conclusions of this comprehensive National Academy of Sciences study were summarized in a 1990 report, which wholly discredited any relationship between the DTP vaccine and autism, meningitis, chronic neurologic damage, spasms, and many other potential side-effects.39 The first line of the executive summary of the report began with, “Next to clean water, no single intervention has had so profound an effect on reducing mortality from childhood diseases as has the widespread introduction of vaccines.” The report declared “insufficient evidence to indicate a causal relation between DPT vaccine and a large number of side effects advocated by vaccine skeptics, including chronic neurologic damage.” Nonetheless, the report did link the whole cell pertussis vaccine with rare cases of shock, anaphylaxis, and protracted crying. A parallel report concluded, “There clearly is an increased risk of a convulsion after diphtheria-tetanus-pertussis immunization but no evidence that this produces brain injury or is a forerunner of epilepsy. Studies have also not linked immunization with either sudden infant death syndrome or infantile spasms.”40 A key figure in the investigation summed up the outcome in the title of a manuscript published in the Journal of the American Medical Association: “‘Pertussis Vaccine Encephalopathy’: It Is Time to Recognize It as the Myth That It Is.”41
Meanwhile in Britain, the government had quickly commissioned a smaller study, which was led by Dr. David Miller of London. Miller organized a questionnaire, known as the National Childhood Encephalopathy Study (NCES), which was distributed to pediatricians between 1976 and 1979 to report any evidence of either “fever” or “other” arising within seventy-two hours after DPT immunization.42 Compiling the results of the s
urvey, Miller shocked the world in 1982 with the statement that vaccination could cause acute neurological symptoms, most notably a spike in fever. He captured more headlines by speculating that DTP vaccination might be expected to cause permanent damage in 1 of 100,000 children, a staggering risk if this were determined to be accurate in more thorough studies to be conducted in the future.
The reporting of the early findings from Miller’s NCES study created a firestorm on all sides of the vaccine debate. On one side, the anti-vaccine community claimed their beliefs had been vindicated. On the other, the design of Miller’s study was rigorously scrutinized and found to be fundamentally flawed. For example, the number of participants studied by NCES was insufficient to make the broad conclusions originally voiced by Miller. Looking further, the design of the questionnaire, as well as the responses received, were likely to have conveyed inaccurate outcomes. For example, cases of viral encephalitis or Reye’s Syndrome, two indications wholly unrelated to DPT vaccination, were included in the analysis.43 These deficiencies, along with public questions about whether vaccines were safe, inspired a flurry of studies all throughout the world, including the American study being led by the National Academy of Sciences. Each study independently concluded there was no link between the DPT vaccine and neurological damage. Indeed, even a 10-year follow-up of the NCES study had discounted the link.44, 45 Nonetheless, the damage had been done
Building upon inconsistent reports from the United States and United Kingdom, the battle over pertussis vaccine began being waged in the courts, where the pecuniary motivations of both sides had the unintended consequence of bringing all the facts into focus. The most thorough assessments were performed in Britain, largely because American cases tended to be settled out of court in the interests of expediency and to avoid protracted, high-profile headlines. In the United Kingdom, a complex series of court cases began in the mid-1980s following lawsuits filed by the anti-vaccine coalition.
One of the most vocal advocates against vaccines arose from a most unusual source. Gordon T. Stewart was born on February 5, 1919 in the west central Lowlands of Scotland. He earned his bachelor and medical degrees at the University of Glasgow. With the outbreak of war, Stewart spent some of his time as a ship’s surgeon on the dangerous convoy escort groups. His remaining efforts were spent in the laboratory studying penicillin. Although some people erroneously credited him with codiscovering penicillin with Alexander Fleming, that event occurred in 1928, when Stewart was nine years old. Rather, the naval physician published his first laboratory-based studies of penicillin in 1945, evaluating early clinical investigations of the antibiotic.46 Two decades later, in 1963, Stewart published early evidence that bacteria could become resistant to methicillin, a derivative of penicillin that was a mainstay of infection control.47 Indeed, the subject of drug-resistant pathogens has grown in the years since.
As the 1960s were drawing to a close, Stewart’s research began tacking towards the fringes of conventional science. One example was his controversial paper entitled “Limitations of the Germ Theory,” which was published in the May 18, 1968 issue of the Lancet.48 This paper argued that Koch’s postulates of disease were a “gross simplification” as they ignored the complexity of other factors that determine if and how a disease arises. These factors included genetic constitution (i.e., race), behavior, and socioeconomics.
Whether Stewart originally intended it as such, the paper quickly became a manifesto for far radical fringe elements, which eventually came to include Stewart himself. For example, by the early 1980s, Stewart was publically on record stating that AIDS was not due to HIV but was a disease of the gay lifestyle. He further maintained a debunked theory that the deposition of sperm in the rectum triggered a vigorous immune response that caused a later collapse of the immune system, eventually manifesting itself as AIDS.49, 50 He further antagonized the conventional scientific and medical establishments with statements such as “Every time an avowedly homosexual or bisexual rock or film star dies of the disease, he is elevated to martyr and hero.”51 Perhaps most damaging, Steward excoriated public health officials who were trying to limit the spread of the disease through the use of antiretroviral drugs such as AZT.
Many otherwise uninformed people listened to Stewart and were irreparably harmed or killed by HIV/AIDS. For example, the president of South Africa, Thabo Mbeki, invoked Stewart’s strident views in support of the false claim that HIV was not the cause of the AIDS epidemic sweeping his nation. Citing the John Le Carré thriller The Constant Gardener, Mbeki announced his belief that AIDS was a conspiracy propagated by the pharmaceutical industry, which was profiting from the sales of antiretroviral drugs targeting an irrelevant virus known as HIV.52 Gordon Stewart actively supported Mbeki’s misguided views, which had been inspired by Stewart’s 1968 manuscript, until August 2007, when Stewart unveiled a public letter renouncing Mbeki to the high commissioner of the Republic of South Africa, who was probing Mbeki for his reckless statements and policies.53 The death toll arising from Mbeki and Stewart’s bellicose and irresponsible actions rose quickly. A 2008 report from the Harvard School of Public Health estimated 365,000 South Africans had unnecessarily died because of the Stewart-supported policies of Mbeki based on HIV denial.54
Courting Disaster
Pertussis provided another opportunity for Stewart to rail against the widely accepted germ theory of disease. Starting in the late 1970s, Stewart published a series of papers decrying the safety and efficacy of some of the most important medical breakthroughs of the 20th century, including antibiotics and the pertussis vaccine.55 Based on his increasingly extreme views on these subjects, Gordon had become an obvious choice for a key interview profiled in Vaccine Roulette, where he stated, “I believe that the risk of damage from the vaccine is now greater than the risk of damage from the disease.”56 Unsurprisingly, Stewart was also set to be the superstar witness in support of a lawsuit targeting the pertussis vaccine.
Prior to Stewart’s involvement in the legal wrangling over the pertussis vaccine, the first trial took place in his native Scotland in 1985. The parents of a nine-year-old child, Richard Bonthrone, sued their doctor, nurse, and health department, claiming their son had suffered a series of seizures, culminating in severe retardation, that began nine days after he received a dose of DTP vaccine.57 The judge ruled against the parents, citing the testimony of experts that cast significant doubt upon the parents’ claims of negligence.
The Scottish trial was but a small skirmish in a rapidly escalating war. The second encounter occurred months later a bit further south in England. This case was brought by the parents of Johnnie Kinnear, who claimed their child had begun to suffer from seizures seven hours after receiving a dose of pertussis vaccine.58 The litigants further claimed the doctor discounted their ordeal and that the seizures persisted for many months and caused irreparable brain damage. As pointed out by Paul Offit in Deadly Choices, the doctor and health department were the primary defendants; the Wellcome Foundation (the vaccine manufacturer) was excused, since the exact manufacturer responsible for the vaccine was unclear.59 In a surprising turn, Wellcome voluntarily joined the case, risking considerable liability to clear its name, which had been sullied by the Kinnears’ vocal claims in the months leading up to the trial. The judge agreed to allow Wellcome to join the case but determined it would not be liable for damages.
As planned, the charismatic Stewart was the star witness for the claimants, citing various anecdotes implicating the toxicity of the pertussis vaccine.60 As his testimony dragged on, it became ever more dramatic, and he undermined himself by citing extravagant claims about the toxicity of the vaccine that were far outside the bounds of even the most aggressive anti-vaccinator. For example, Gordon Stewart expounded upon the results of one study implicating the vaccine in brain damage of sensitized children, only to be embarrassed in cross-examination with the revelation that the study he cited had been conducted with rats, not people.61 All this was for naught, as subsequent st
atements from the parents uncovered considerable discrepancies in their testimony about the time period between vaccination and the onset of seizures and brain damage. Specifically, the mother initially testified that seizures began seven hours after her son received the vaccine. Subsequent questioning revealed the symptoms had begun not at that time but five months later. Based on such inconsistencies, the judge dismissed the case.
The third and final attempt by the anti-vaccine lobby to derail the pertussis vaccine in the United Kingdom occurred in February 1988, in a class-action suit centered around a seventeen-year-old English girl by the name of Susan Loveday. At first glance, the case of Loveday v. Renton and Wellcome Foundation seemed like a proverbial slam dunk.62 Loveday’s parents testified that the girl had suffered from an unusually high fever and persistent crying almost immediately after receiving her first dose of DPT vaccine. The child’s second exposure a year later triggered an even more vigorous response, and a third immunization was linked with severe and irreversible developmental retardation. Again, the Wellcome Foundation volunteered to join the case in hopes of clearing their name in the face of what they believed to be spurious claims.
Between Hope and Fear Page 28
