U.S.
Food and Drug Administration
FDA Consumer magazine
July-August 2002
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By Paul D. Parkman, M.D.
I worry about people who mistrust vaccines and do not have their children immunized. With the exception of safe drinking water, vaccines have been the most successful medical interventions of the 20th century.
When I was in medical school in the 1950s, I learned about the mild, rash illness rubella (German measles). An Australian eye doctor, Norman McAllister Gregg, knighted for his discovery, had shown that rubella caused serious birth defects in babies born to mothers infected early in pregnancy. I also learned that rubella vaccine development had been stymied because the virus had not been grown in cell culture.
As a young pediatrician-in-training, I was often called to the delivery room to give newly born infants their first medical exam. One day, I saw a baby that was stillborn. It seemed normal except for a rash--spots caused by bleeding into the skin. I went to talk with the baby's mother. She wanted to see her baby, and I was uncertain about what to do. But I retrieved the stillborn baby and rolled the bassinet with its sad cargo down the hall to her. Years later, I realized that her infant's death was likely the consequence of her having acquired rubella months earlier. Many thousands of babies with similar rashes, often accompanied by severe congenital deformities, died during the last major rubella epidemic in 1964. During this time, women very much feared the disease. And with good reason.
By 1961, as a young military doctor at the Walter Reed Army Medical Center, I had the chance to try to find this elusive virus. I was lucky enough to do so with two colleagues, Drs. Malcolm Artenstein and Edward Buescher. One of the many laboratory techniques we tried worked! From that day in May of 1961, the development of rubella vaccine became possible.
Spurred by the fear that another severe epidemic might occur within a few years, live virus vaccines were developed quickly, and several had been approved by 1969. Now, for decades, these products have been extensively used for immunizing infants, children, and certain adult populations in special need of protection.
As a result, the predicted epidemic of the 1970s never occurred. Nor has there been one since. In fact, instead of the many thousands of infants born with birth defects every year due to rubella, there have been fewer than 10 cases, often only one to three.
This is wonderful! So why do I worry? Because if we do not keep a high level of immunization, rubella and the other diseases we have controlled in the United States will regain a foothold and again become a threat. These illnesses still exist, particularly in the developing world, and could easily return to infect the unimmunized. Past examples that show this include the resurgence of whooping cough in the United Kingdom and Japan when parents failed to have their children vaccinated.
The world has changed since mid-20th century. Mothers no longer fear their children will be sickened by paralytic polio or measles, or that they will catch rubella. The real concerns of another age seem to have been replaced by theoretical concerns that vaccines themselves will be responsible for ill effects.
These concerns are common among young mothers. A friend's daughter, usually eminently sensible, decided not to have her children immunized because of these fears. I wrote to my friend (and through him, to her) appealing that she should heed the advice of scientists independent of those she suspects--the federal government, commercial vaccine producers, and medicine generally--who have concluded that the benefits of vaccinations far outweigh their risks. I found it chilling that I was ineffective in changing her mind.
As I look back on my career, I have come to think that perhaps I was involved in the easy part. It will be for others to take on the difficult task of maintaining the protections that we struggled to achieve. We must prevent the spread of this vaccine nihilism, for if it were to prevail, our successes could be lost.
Paul D. Parkman, M.D., served as director of the FDA's Center for Biologics Evaluation and Research from 1987 to 1990. He is a consultant for Parkman Associates in Kensington, Md.
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