We stand at a moment of tremendous importance in the history of human medicine. biotechnology companies shattered records last November when they finally submitted results to the CDC and FDA for the approval of multiple novel coronavirus vaccines, and the United States is about to roll out the largest and most aggressive mass vaccination campaign in its history. Furthermore, the current nucleic acid and viral vector COVID19 vaccine platforms are truly cutting edge science and seem likely to dominate vaccine production and development going forward.
Still, the world of public health has recently been hitting major milestones beyond these new COVID vaccines. In December 2019 (just before SARS-CoV-2 was first identified in China), the FDA approved Ervebo (a recombinant, replication-competent Ebola vaccine utilizing a vesicular stomatitis viral vector). Then, in August of 2020, the WHO officially certified Africa as a wild poliovirus-free region (a 24-year campaign kicked off by a call to action from Nelson Mandella).
Still, the only way to truly understand these achievements is to understand the history that brought us here. Meredith Wadman’s The Vaccine Race takes us back to a time when these massive medical achievements may have sounded like a pipe dream and slowly walks us up to the moments when vaccinology made its biggest early leaps. If you’re the kind of person who wishes to truly understand the moment we’re in, this is the book for you.
Wadman may have written this book in the far-off, pre-COVID, days of 2017, but it is truly a book for this moment. I came into this pandemic already passionate about history and biotechnology, but reading this book during COVID made it so much more important to me.
In a practical sense, I should warn you that this is no light read. In total, the book is 361 pages split into 3 multi-chapter parts, a prologue, and an epilogue. Despite the intimidating title and size, however, this book is often fairly approachable.
I know my penchant for seemingly mundane nonfiction isn’t average, but in between Wadman’s plain-english explanations of vaccine science, the heart of this book lies in its characters. Even the seemly “small” characters are given proper recognition for the vital roles they played. In fact, this focus on the “hidden figures” may be one of the most endearing aspects of The Vaccine Race altogether.
What’s it About?
This book NEVER shies away from the science behind these vaccines and the VERY compelling drama between researchers and regulators. However, The Vaccine Race‘s biggest features are its focus on the social and political context surrounding early vaccines and the moral and ethical dilemmas arising from this era’s medical research practices.
To help understand the book’s tone, and the perspective it takes on vaccine history, I’ve included an excerpt from the prologue:
The men who conducted unethical human experiments in this era were not medical outliers. They were top physicians and research operating with the full backing of the U.S. government, private funders, and esteemed medical schools and hospitals.
To remove the history of human exploitation from vaccines and medicines that were developed in the postwar era is impossible. The knowledge that allowed their development is woven into them.
Should we, therefore, shun them? Definitely not.
Take rubella as a case in point. As I write this in the summer of 2016, 1,700 babied in a dozen countries have been born with abnormally small heads or other brain malformations; their mothers were infected with the Zika virus while pregnant.
Zika’s emergence is a vivid reminder of what life was like in the United States in 1964. Then, there was no Rubella vaccine and tens of thousands of American babies were born gravely damaged by the rubella virus, which selectively harms fetuses in the womb.
Like Zika, rubella homes in on the brains of fetuses; it also ravages their eyes, ears, and hearts. But today, thanks to the vaccine that was perfected in experiments on institutionalized orphans and intellectually disabled children, indigenous rubella has been wiped out in the Western Hemisphere. Cases occur only when they are imported from other countries.
We can’t turn the clock back. The only way we can partially make it up to these children and untold others is to honor their contributions by making them meaningful – by continuing to vaccinate against rubella and the other diseases that made childhood a perilous journey before vaccines against them existed.
We also need to strive constantly to enforce and improve the regulations and laws that protect research subjects so that in the future such abuses never happen again. We might also remember, when judging the men who took advantage of vulnerable human beings in order to advance both human health and their own careers, that they were creatures of their time, just as we are of ours.
Rather than training our criticism on them, it might be more useful to ask ourselves this: what are we doing or accepting or averting our eyes from today that will cause our grandchildren to look at us and ask, How could you have let that happen?The Vaccine Race, Meredith Wadman
Cutting through all of my previous generalities, this book focuses primarily on vaccines produced recently after the Salk dead poliovirus vaccine (including several ‘live’ polio vaccines, rabies vaccines, and rubella vaccines), and a heavy portion of our attention is spent on Leonard Hayflick and his ‘WI-38 cells’.
What are WI-38 cells?
Put as simply as I can, WI-38 cells are a line of human fibroblasts derived from fetal lung tissue collected after an elective Swedish abortion performed in 1962.
What do they have to do with vaccines?
These cells were a watershed moment in modern science and launched the study of cellular aging, but more importantly to us, they also revolutionized vaccine production. Before Leonard Hayflick, vaccines were mostly produced by utilizing harvested monkey kidney cells… a process that was far more expensive and far less safe than using human cell lines like WI-38.
The utilization of live monkeys in this process was so dangerous that it even caused the nightmarish first recorded outbreak of Marburg virus (a close relative to Ebola) in a group of German scientists handling vaccine monkeys. Still, the move away from harvested monkey kidney cell production did NOT happen overnight (especially in the United States). Many powerful people fought against the approval of WI-38 cells in vaccine production, launching the central drama of this book.
Wrapping it Up
The Vaccine Race doesn’t approach vaccines as some hard to understand bottle of liquid that only doctors and nerds like me need to worry about. It takes a proactive role in understanding these miraculous inventions and makes an argument for why everyone should care about them. This book may not be for everyone, but I think we’d be better as a country if more people gave it a read.
This spirit is best summed up by a quote Wadman includes from her conversation with an Ebola vaccine research volunteer in the United States:
Grant, a twenty-six-year-old apartment manager says that he began volunteering for vaccine trials as a way to earn some extra cash but has come to consider it something of a civic duty.
“It’s not this weird, cold, archaic process anymore,” he says when prompted to compare the trial with experiments on prisoners and orphans fifty and sixty years ago. “Why not donate my body and my time?”The Vaccine Race, Meredith Wadman
Unfortunately, the threat of pandemic diseases such as Sars-COV-19 won’t go away after this particular virus is dealt with. New, rapid to produce platforms like the mRNA Pfizer and Moderna vaccines are going to be a huge help, but these are only one piece of the puzzle and there is always room for improvement.
An increased civic focus on vaccine technology and public health more broadly may help prepare our nation for future pandemics and encourage proactive investment in public health, but changes like this often come in small steps. For now, reading The Vaccine Race was the least I could do.
Additional Resources for Exploring COVID19 Vaccines:
- ‘The US Approves a Vaccine’ (Podcast Episode from ‘The Daily’)
- ‘How to Distribute a COVID-19 Vaccines Ethically’ (Article from The Scientific American)
- ‘Protecting Ourselves from the Next Pandemic’ (Article from The Scientific American)