Book review of “Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases” by Paul A. Offit

I mentored a student on a summer project on vaccines, and I thought it would be a useful addition to do weekly readings from a book on the topic. I found a Top 5 books on public health list put together by the former director of the CDC Thomas Frieden, and Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases by Paul Offit was at the top of the list.

The book is a kind of a dual tale of the development of vaccines and a biography of a man billed as “the father of modern vaccines” Maurice Hilleman. Offit credits Hilleman as the creator of no less than 9 vaccines (measles, mumps, rubella, chickenpox, hepatitis A & B, pneumococcus, meningococcus, and Hib). A big question answered in the book is: if this guy did so much, why haven’t I heard of him? That’s a good question. The author highlights two reasons that I think read as a critique of the way credit works in the scientific community.

The first is that Maurice Hilleman worked in the private sector. He was a research scientist at Merck, not a government agency or a university. Offit offers this:

Because most people view industry researchers as being different from academic researchers, Hilleman’s choice to work for a pharmaceutical company also contributed to his anonymity. Scientists, teachers, and researchers in academia believe that they are pursuing a higher calling, free from the bonds of commercialism. The public believes it too: people want scientists to be so dedicated and idealistic that they can live on air.

The second reason is what scientists think is “cool”, and public health efforts are not as cool as cutting edge research. Offit comments:

Scientists are often more enamored with technological innovations than with public health achievements. As a consequence, the most important discoveries in the field of medicine have not been given to those who have saved the most lives

The biography captures a very interesting character primarily through the medium of interview. Hilleman comes off as a man rough around the edges both from the way others described him and his own words. The title of the first chapter is “My God: This is the pandemic. It’s here!” taken from Hilleman’s own words when he realized a 1957 outbreak of influenza would result in a pandemic. He regularly peppers his speech with profanity, which gives the book a very informal feel. I liked it. Oh, and Anthony Fauci, the current director of the CDC, is also quoted describing his friend:

As tough as he was on people, he did it in a way that was clear that he was trying to get a message to people and not to put anybody down. He just wanted straight talking. And when people veered from straight talking, he did not hesitate to get up and say, ‘You’re full of crap.’ He was an adorable grump.

My favorite chapter though didn’t center on Hilleman but rather his predecessors. Chapter 4 “Eight Doors” starts with the famous quote from Newton “If I have seen farther than others, it was because I was standing on the shoulders of giants.” It recounts eight important developments in vaccines that Hilleman built off of when he developed his own vaccine, and is a great narrative of how we arrived at modern vaccines today. Perhaps most of heard of Edward Jenner’s vaccine for smallpox– just injecting someone with pus from a case of cowpox. It sounds very crude when we think of the efforts we put into sanitation today but it worked. What were all the intermediate steps that got us from there to here? There are some interesting tidbits you may not have known. For instance, did you know Louis Pasteur developed a vaccine for rabies by infecting rabbits, then drying their spines?

Also of interest are all the ethical issues at stake with vaccines. Offit dedicates a chapter to the use of aborted fetuses to make vaccines. Throughout the twentieth century, vaccines were tested on vulnerable populations such as the mentally ill. And, of course, the charge that vaccines cause autism at the turn of the century. Vaccines have again become a lightning rod in light of COVID-19.

Hilleman has an interesting prediction that is casually included in one passage dealing with his work on influenza outbreaks:

Hilleman saw two patterns in [influenza] outbreaks. First, the types of hemagglutinins occurred in order: H2, H3, H1, H2, H3, H1. Second, the intervals between pandemics of the same type were always sixty-eight years– not approximately sixty-eight years, but exactly sixty-eight years…

Hilleman predicted that an H2 virus, similar to the ones that had caused disease in 1889 and 1957, would cause the next pandemic– a pandemic that would begin in 2025.

Well, we’ll see; will we have another pandemic in another 4 years?

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