Recent papers on vaccine-autism history, mandates, vaccine law, and YouTube

There have been an exceptional number of papers published in medical journals over the past several weeks that are worth mentioning...

• "Mercury, Vaccines, And Autism: One Controversy, Three Histories" -- American Journal of Public Health (subscription required for full text; published online ahead-of-print). From Jeffrey Baker, a physician and historian of medicine at Duke, an examination of the multiple histories that have contributed to the nature of current arguments linking vaccines to autism. Baker traces the parallel histories of thimerosal as a vaccine preservative, mercury as a health risk, autism as a diagnosis, and the relatively recent intersection of these stories.

• "Mandating Vaccination: What Counts as a "Mandate" in Public Health and When Should They Be Used?" -- American Journal of Bioethics (subscription required for full text). By Matthew Wynia of the American Medical Association, a commentary on the imprecise usage of the term 'mandate' (with respect to both vaccination and other public health activities) and the implications thereof. A nice introduction to a topic that deserves more attention from scholars.

• "Vaccine Law 101" -- Journal of Law, Medicine, and Ethics (subscription required for full text). Exactly what the title suggests, a high-altitude overview of the many laws, regulations, and types of litigation related to vaccines. A summary of a conference panel session of the same name. Short on insights and argument, but a very useful starting point for those interested in legal aspects of vaccination.

• "YouTube as a Source of Information on Immunization: A Content Analysis" -- JAMA (subscription required for full text). From a research team at the University of Toronto, a review of vaccine-related content posted on YouTube, examining claims made about vaccines and vaccination as well as the general attitude expressed toward vaccines. Slightly more than half of all videos were not expressly positive about vaccination, and those critical of vaccination tended to receive higher ratings from YouTube visitors. Here's a press release about the paper.
  

HIV, Malaria, TB: vaccine research issues and planning

Several items of note over the past few weeks on research for vaccines that would have the greatest potential benefit in the developing world:

-- HIV/AIDS: In the July-August issue of Health Affairs, a paper appears titled, "The Impact of An AIDS Vaccine In Developing Countries: A New Model and Initial Results." (free abstract). Among its findings, the paper notes that a vaccine with 50% effective administered to 30% of the developing world population (both reasonable estimates) could prevent 17 million infections in 15 years.

Speaking of HIV vaccines, the death of Dr. Edward Brandt was announced this weekend. Brandt was assistant secretary of HHS in the early 1980s when AIDS and HIV were first identified. His (and HHS secretary Margaret Heckler's) overly optimistic predictions of an HIV vaccine's arrival are featured prominently in Brandt's New York Times obituary. He opined that an HIV vaccine would be available by 1987, three years after HIV was identified.

-- Malaria: A news story in the current issue of JAMA reports on malaria vaccine development ("'Roadmap' AIDS Malaria Vaccine Efforts" -- free extract.) The story provides a very good summary of progress toward a malaria vaccine and challenges needing to be addressed. The 'roadmap' referred to is the Malaria Vaccine Technology Roadmap, the product of an international series of consultations.

-- Tuberculosis: We don't talk all that often about the development of new vaccines against tuberculosis, but a paper in PLoS Medicine ("Development of New Tuberculosis Vaccines: A Global Perspective on Regulatory Issues") summarizes the content of an international meeting on the topic. The paper summarizes many of the challenges facing vaccine development and offers recommend strategies to address them.

For the bookshelf: Vaccine by Arthur Allen

A new book released this month is sure to be of interest to readers of this site: Vaccine: The Controversial Story of Medicine's Greatest Lifesaver by Arthur Allen. Allen is a journalist who has written frequently in the popular press on vaccine-related issues. We haven't yet read the book, so we can't vouch for its merits, but all accounts point to it being a comprehensive work (as any 500+ page book is likely to be) tracing the history of vaccination from Jenner to today.

Allen has published vaccine-related essays in several publications this month, providing well-timed promotion for his book. On January 15, Allen wrote a piece for Slate titled "The Autism Numbers: Why There's No Epidemic" that looks broadly at the rise in autism rates in recent years, including the alleged link to vaccines.

Last Thursday, Allen had an op-ed published in the New York Times titled "For the Good of the Herd," a strong defense of the merits of vaccination framed by some of the major events (both good and bad) of U.S. vaccination programs in the 20th century. By the end of the op-ed, there's little doubt that Allen is a strong proponent of vaccination. He writes:

"But the experts are certain that it is only a matter of time before a flu pandemic strikes. Keeping the vaccine pipeline running and building immunity against all types of flu will help us prepare. Even in apparently humdrum flu years like this one, it behooves us to join the herd and be vaccinated."

Finally, the book's website, www.vaccinecontroversy.com, includes an extended essay by the author with his take on "how to think about vaccination."

Update, 2/6/06: In this weekend's New York Times, David Oshinsky gave the book a quite favorable review.