Vaccinated
Authors: Paul A. Offit
VACCINATED
One Man's Quest to Defeat the
World's Deadliest Diseases
F
OR
B
ONNIE,
WHO MADE DREAMS COME TRUE,
AND FOR OUR CHILDREN,
W
ILL AND
E
MILY,
THE TWO METEORS STREAKING THROUGH OUR LIVES
“And now,” cried Max, “let the wild rumpus start.”
M
AURICE
S
ENDAK,
W
HERE
T
HE
W
ILD
T
HINGS
A
RE
S
cientists aren't famous. They never endorse products or sign autographs or fight through crowds of screaming admirers. But at least you know a few of their names, like Jonas Salk, the developer of the polio vaccine; or Albert Schweitzer, the missionary who built hospitals in Africa; or Louis Pasteur, the inventor of pasteurization; or Marie Curie, the discoverer of radiation; or Albert Einstein, the physicist who defined the relationship between mass and energy. But I'd bet not one of you knows the name of the scientist who saved more lives than all other scientists combined-a man who survived Depression-era poverty; the harsh, unforgiving plains of southeastern Montana; abandonment by his father; the early death of his mother; and, at the end of his life, the sad realization that few people knew who he was or what he had done: Maurice Hilleman, the father of modern vaccines.
Hilleman's science followed a long, rich tradition.
In the late 1700s Edward Jenner, a physician working in southern England, made the world's first vaccine. Jenner found that he could protect people from smallpox-a disease that has claimed five hundred million victims-by injecting them with cowpox, a related virus.
One hundred years passed.
In the late 1800s Louis Pasteur, a chemist working in Paris, made the world's second vaccine. Pasteur's vaccine, made by drying spinal cords from infected rabbits, prevented the single most deadly infection of man-rabies. Only one person has ever survived rabies without receiving a rabies vaccine.
During the first half of the twentieth century, scientists made six more vaccines. In the 1920s French researchers found that bacteria made toxins and that toxins treated with chemicals could be used as vaccines. These observations led to vaccines against diphtheria, tetanus, and, in part, whooping cough. In the 1930s a researcher at the Rockefeller Institute in New York City made a yellow fever vaccine by growing the virus in mice and chickens. In the 1940s Thomas Francis, working at the University of Michigan, made an influenza vaccine by growing the virus in eggs and killing it with formaldehyde. And in the 1950s Jonas Salk and Albert Sabin, using monkey kidneys, made polio vaccines that eventually eradicated polio from the Western Hemisphere and much of the world.
The second half of the twentieth century witnessed an explosion in vaccine research and development, with vaccines to prevent measles, mumps, rubella (German measles), chickenpox, hepatitis A, hepatitis B, pneumococcus, meningococcus, and
Haemophilus influenzae
type b (Hib). Before these vaccines were made, Americans could expect that every year measles would cause severe, fatal pneumonia; rubella would attack unborn babies, causing them to go blind or deaf or become mentally retarded; and Hib would infect the brain and spinal cord, killing or disabling thousands of young children. These nine vaccines virtually eliminated all of this suffering and disability and death. And Maurice Hilleman made every one of them.
In October 2004, doctors told Hilleman that he had an aggressive form of cancer, one that had already spread to his lungs and would likely soon overwhelm him. During the six months before he died, Hilleman talked to me about his life and work. This book-the story of the triumphs, tragedies, controversies, and uncertain future of modern vaccines-is largely his story.
T
he dedication of the National Millennium Time Capsule marked the end of the twentieth century. To fill the capsule, First Lady Hillary Clinton sent an invitation to four hundred presidential and congressional medal winners. “You have been recognized for your contributions to the nation,” she wrote. “Now I would like to ask you for another contribution. If you could choose just one item or idea to represent America at the end of the twentieth century, and to be preserved for the future, what would it be?”
Ray Charles submitted a pair of his sunglasses.
Wilma Mankiller, chief of the Cherokee Nation, submitted the eighty-five-letter Cherokee alphabet, hoping that her language would still be spoken a hundred years from now.
Hans Liepmann, a mathematician and scientist, submitted the first transistorâdeveloped by Bell Telephone Laboratoriesâto mark the beginning of the electronic age.
Historian David McCullough submitted a borrower's card from the Boston Public Library, the first public library to let readers take books home.
President Ronald Reagan submitted a piece of the Berlin Wall to represent one country's choice of democracy over communism.
Filmmaker Ken Burns submitted an original recording of Louis Armstrong's “West End Blues.”
Ernest Green, an African-American student caught on September 2, 1957, in a confrontation between Arkansas governor Orval Faubus and armed national guardsmen about his admission to an all-white public school, submitted his diploma from Little Rock Central High School.
Others submitted a microchip, the first artificial heart, a piece of the Transoceanic Cable, a copy of John Steinbeck's
The Grapes of Wrath
, a film of
Apollo II
landing on the moon, broadcasts from the Metropolitan Opera, a piece of Corning Ware, a film of Jackson Pollock creating one of his drip paintings, a copy of the genetic code, Bessie Smith's recording of “Nobody in Town Can Bake a Sweet Jellyroll Like Mine,” and photographs of the earth from space, the atomic bomb's mushroom cloud over Hiroshima, and American servicemen liberating prisoners from a Nazi concentration camp in Buchenwald.
The ceremonial placement of items in the time capsule took place on Friday, December 31, 1999, a brisk, windy, winter day in Washington, D.C. President Bill Clinton and First Lady Hillary Clinton spoke at the event, and ten thousand people lined the streets near the National Mall to watch. “It was, after all, the transistor that launched the Information Age and enabled man to walk on the moon,” said Mrs. Clinton. “It was Satchmo's trumpet that heralded the rise of jazz and of American music all over the world. And it was a broken block of concrete covered in graffiti from the Berlin Wall that announced the triumph of democracy over dictatorship.” Bill Clinton expressed his hopes for the future. “There is not a better moment to reflect on our hopes and dreams, and the gifts we want to leave to our children,” he said.
Another man was on the platform that day: Maurice Hilleman. Few in attendance recognized him. Eighty years old, bent slightly forward, Hilleman slowly, cautiously padded over to the microphone, said a few words, and reached down to place his artifact into the capsule: a block of clear plastic six inches long, two inches high, and two inches deep. Embedded in the plastic were several small vials.
Although it was never mentioned during the ceremony, Americans now lived thirty years longer than they had when the century began. Some of this increase in longevity was caused by advances such as antibiotics, purified drinking water, improved sanitation, safer workplaces, better nutrition, safer foods, the use of seat belts, and a decline in smoking. But no single medical advance had had a greater impact than what was contained in Hilleman's vialsâvaccines.
Four years after the time capsule ceremony, a reporter asked Hilleman how it felt to stand next to the president of the United States on the century's final day, how it felt to participate in a moment that crystallized his career. A taciturn, gruff, humble man, Hilleman was uncomfortable taking credit for what he had done, uncomfortable looking back. “Chilly,” he said.
1
“My God: This Is the Pandemic. It's Here!”
“I had a little bird, and its name was Enza, I opened the window, and in-flew-Enza.”
C
HILDREN
'
S RHYME DURING THE
1918
FLU PANDEMIC
I
n May 1997 a three-year-old boy in Hong Kong died of influenza. His death wasn't unusual. Every year in every country in every corner of the world healthy children die of the disease. But this infection was different. Health officials couldn't figure out what type of influenza virus had killed the boy, so they sent a sample of it to the Centers for Disease Control and Prevention (CDC) in Atlanta. There, researchers found that this particular virus had never infected people before. A few months passed. The rare influenza virus infected no one elseânot the boy's parents, or his relatives, or his friends, or his classmates. Later, the CDC sent a team of scientists to Hong Kong to investigate. Crowded into a wet market, where local farmers slaughtered and sold their chickens, they found what they were looking forâthe source of the deadly virus. “The people here like their chickens fresh,” one investigator said. “Hygiene consists of a douse with cold water. [One day] we saw a bird standing up there, pecking away at its food, and then very gently lean over, slowly fall over, to lie on its side, looking dead. Blood was trickling from [its beak]. It was a very unreal, bizarre situation. I had never seen anything like it.” The disease spread to another chicken and another.
The strain of influenza virus that infected birds in Southeast Asia was particularly deadly, killing seven of every ten chickens. On December 30, 1997, Hong Kong health officials, in an effort to control the outbreak of bird flu before it spread to more people, slaughtered more than a million chickens. Still the virus spread. Bird flu attacked chickens in Japan, Vietnam, Laos, Thailand, Cambodia, China, Malaysia, and Indonesia. Then, to the horror of local physicians, the virus infected eighteen more people, killing sixâa death rate of 33 percent. (Typically influenza kills fewer than 2 percent of its victims.) Soon the virus disappeared. Officials waited for an outbreak the following year, but none came. And it didn't come the year after that or the year after that. The virus lay silent, waiting.
In late 2003, six years after the initial outbreak, bird flu reappeared in Southeast Asia. This time health officials found it even harder to control. Again, the virus first infected chickens. Officials responded by slaughtering hundreds of millions of them. Despite their efforts, bird flu spread from chickens to ducks, geese, turkeys, and quail. Then the virus spread to mammals: first to mice, then to cats, then to a tiger in a Thai zoo, then to pigs, then to humans. By April 2005, bird flu had infected ninety-seven people and killed fifty-threeâa death rate of 55 percent.
By September 2006 the virus had spread from birds in Asia to those in Europe, the Near East, and Africa. Two hundred fifty people living close to these birds got sick, and 146 of them died. International health officials feared that the appearance of bird flu in Southeast Asia signaled the start of a worldwide epidemic (pandemic). One later remarked, “The clock is ticking. We just don't know what time it is.”
Health officials feared an influenza pandemic because they knew just how devastating pandemics could be. During the pandemic of 1918 and 1919âthe one called the last great plagueâinfluenza infected five hundred million people, half the world's population. The virus, which traveled to virtually every country and territory in the world, hit the United States particularly hard. In a single month, October 1918, four hundred thousand Americans died of influenza. Influenza typically kills the most vulnerable members of the population, the sick and the elderly. But the 1918 virus was different: it killed healthy young adults. In one year the average life span of Americans in their twenties and thirties decreased by 25 percent. When it was over, the 1918 pandemicâthe most devastating outbreak of an infectious disease in medical historyâhad killed between fifty million and one hundred million people worldwide, all within a single year. In comparison, since the 1970s the AIDS pandemic has killed twenty-five million people.
Pandemics of influenza are inevitable. During the past three hundred years, the world has suffered ten of them, about three per century. No century has ever avoided one. But despite their frequency and reproducibility, only one man has ever successfully predicted an influenza pandemic and done something about it.
Â
H
IS NAME WAS
M
AURICE
H
ILLEMAN
. B
ORN
S
ATURDAY MORNING,
August 30, 1919, during the worst influenza pandemic in history, Hilleman was the eighth child of Anna and Gustave Hillemann. (Because of intense anti-German sentiment following the First World War, Hilleman's parents deleted the second
n
on his birth certificate.) Devoutly religious, Anna and Gustave named him and his sister (Elsie) and all of his brothers (Walter, Howard, Victor, Harold, Richard, and Norman) after heroic characters in the Elsie Dinsmore books, stories of Christian faith popular in the late 1800s. The birth took place in the family's home on the banks of the Tongue and Yellowstone Rivers, near Miles City, Montana.
After Maurice's birth, and to the surprise of the homeopath who delivered him, a second child, Maureen, was also born, still and lifeless. The doctor tried desperately but unsuccessfully to revive her. He cupped his hands around her back and, using only his thumbs, periodically pushed down on her tiny chest. At the same time, he tried to breathe air into her lungs. It was no use. From the corner of the room, Anna Hillemann quietly watched the doctor try to save her baby daughter. When she learned that Maureen was dead, Anna closed her eyes, saying nothing. Gustave buried Maureen the following day, August 31.
Hilleman's birthplace, Custer County, Montana, circa 1919.
Hours after the delivery, while she was holding her infant son, Anna's body stiffened, her eyes rolled up in her head, foam collected at the corners of her mouth, and her arms and legs twitched rhythmically and unstoppably. The seizure was the first of many; for several hours after each one she lay unconscious in her bed. The doctor declared that Anna was suffering from eclampsia, a disease unique to pregnant women, caused by a progressive, unrelenting swelling of the brain. Anna knew that she was dying. So she called her husband, Gustave; his brother, Robert; and Robert's wife, Edith, to her bedside. She asked that the older boys remain on the family farm with Gustave; that Elsie, Richard, and Norman live with her relatives in Missouri; and that her new baby, Maurice, be raised by Robert and Edith, who lived just down the road. Anna felt bad for the childless couple, so she gave them her infant son. Two days after the birth, Anna Hillemann, like her baby daughter, died. But before she died, Anna made one more request. Two days later Gustave obliged, exhuming baby Maureen and burying her in her mother's arms. Maurice was the only one who survived the birth. “I always felt that I cheated death,” he said.
Maurice Hilleman, circa 1920.
Although he lived with Robert and Edith in a house separate from his brothers and sisterâall later reunited with GustaveâMaurice worked on the family farm, the Riverview Garden and Nursery. “At one time [our farm] provided an escape for thieves and outlaws who were [being] pursued by vigilante posses from Miles City,” recalled Hilleman. “There was still a tall cottonwood on the high ground that carried a hangman's noose in its branches.” Hilleman remembered life on the farm: “We sold anything that people would buy: potatoes, tomatoes, cabbage, lettuce, radishes, corn, squash, cottage cheese, dressed chickens, hatching eggs, eating eggs, and pumpkins. We made brooms from the straw of sorghum sugarâbrooms that lasted forever. In Miles City, we did landscaping, tree surgery, and sprayed the trees for worms and insect manifestations. We even did landscaping for the whorehouses. [Prostitution was legal in Miles City.] We raised perennials and annuals and sold flowers, usually on Sundays, to the local florist. When I was old enough to tell the difference between a weed and a plant, I was sent out into the sun, working from sunup to sunset. My jobs were to pick berries, bring in the horses, pump water, feed and water the chickens, collect eggs, keep the chicken coop real clean, shovel shit from the roost, and pick beans. I worked only during the summer months because during school the frost killed everything.”
“Everyone had to earn their keep in Montana,” recalled Hilleman's eldest daughter, Jeryl. “This was the eastern plains, where life was very, very brutal: broiling hot summers, freezing winters, snow drifts above [your] head. When he was four years old, [my father] was sent down to sell strawberries. He was told what [price] to ask for, but he didn't really sell anything. As the day went by, the strawberries got softer and less attractive, and he ended up selling them for a fraction of what he was supposed to. And he got seriously punished for it. Even at the age of four there was no mercy. He had a tough life growing up.”
Maurice Hilleman, circa 1923.
By the time he was only ten years old, Hilleman had survived near drowning, an unyielding freight train, and diphtheria. “In Montana you were responsible for yourself,” he recalled. “Nobody was out looking after you. At flood time the Yellowstone River, which comes down from the mountains, takes out trees and houses. One day a hobo floated downstream in a small flatbed boat. He sold us this little piece of junk, this wooden thing, for one dollar. So my brother and I rowed down the Yellowstone. Now this was like rowing over a fallsâlike going over Niagara Fallsâand there were these big cottonwood trees turning over, and junk and everything floating downstream. I couldn't swim. I barely made it back to the bank of the river, full of mud.” Hilleman ran back to his aunt, breathless and muddy. He told her how he had almost drowned. Edith looked up, stared at Maurice for a moment, and went back to washing her family's clothes, saying nothing. “She was Lutheran,” recalled Hilleman. “She figured that when your time had come, your time had come.”
Another of Hilleman's misadventures involved the unexpected appearance of a freight train on a narrow bridge over the Tongue River. “The Milwaukee Railroad ran two trains through Miles City, the Olympian from Chicago to Seattle and the Columbian. Every morning we took our bicycles across a small bridge over the Tongue River. I always looked to make sure that the Olympian wasn't coming and that I saw the tail end. Well, we started on the bridge and we were about two-thirds across and, Jesus Christ, here comes the freight train. Those bastards had sent through an extra freight train. I was with my brother Norman. You know what it costs to stop a freight train, about a million bucks. It ruins the rails. [The conductor] is blowing his whistle, and he [doesn't] stop the brakes for anything. I looked back and the bridge was shaking. So we ran with our bicycles and we got to the end of the bridge and I threw my bicycle on the ground and we jumped. We had about one or two seconds before the train caught us.”
