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Excerpt: Elena Conis’s Vaccine Nation


An excerpt from Vaccine Nation: America’s Changing Relationship with Immunization

by Elena Conis

(recent pieces featuring the book at the Washington Post and Bloomberg News)


“Mumps in Wartime”

Between 1963 and 1969, the nation‘s flourishing pharmaceutical industry launched several vaccines against measles, a vaccine against mumps, and a vaccine against rubella in rapid succession. The measles vaccine became the focus of the federally sponsored eradication campaign described in the previous chapter; the rubella vaccine prevented birth defects and became entwined with the intensifying abortion politics of the time. Both vaccines overshadowed the debut of the vaccine against mumps, a disease of relatively little concern to most Americans in the late 1960s. Mumps was never an object of public dread, as polio had been, and its vaccine was never anxiously awaited, like the Salk polio vaccine had been. Nor was mumps ever singled out for a high–profile immunization campaign or for eradication, as measles had been. All of which made it quite remarkable that, within a few years of its debut, the mumps vaccine would be administered to millions of American children with little fanfare or resistance.

The mumps vaccine first brought to market in 1968 was developed by Maurice Hilleman, then head of Virus and Cell Biology at the burgeoning pharmaceutical company Merck. Hilleman was just beginning to earn a reputation as a giant in the field of vaccine development; upon his death in 2005, the New York Times would credit him with saving “more lives than any other scientist in the 20th century.” Today the histories of mumps vaccine that appear in medical textbooks and the like often begin in 1963, when Hilleman‘s daughter, six–year–old Jeryl Lynn, came down with a sore throat and swollen glands. A widower who found himself tending to his daughter‘s care, Hilleman was suddenly inspired to begin work on a vaccine against mumps—which he began by swabbing Jeryl Lynn‘s throat. Jeryl Lynn‘s viral strain was isolated, cultured, and then gradually weakened, or attenuated, in Merck‘s labs. After field trials throughout Pennsylvania proved the resulting shot effective, the “Jeryl–Lynn strain” vaccine against mumps, also known as Mumpsvax, was approved for use.

But Hilleman was not the first to try or even succeed at developing a vaccine against mumps. Research on a mumps vaccine began in earnest during the 1940s, when the United States‘ entry into World War II gave military scientists reason to take a close look at the disease. As U.S. engagement in the war began, U.S. Public Health Service researchers began reviewing data and literature on the major communicable infections affecting troops during the First World War. They noted that mumps, though not a significant cause of death, was one of the top reasons troops were sent to the infirmary and absent from duty in that war—often for well over two weeks at a time. Mumps had long been recognized as a common but not “severe” disease of childhood that typically caused fever and swelling of the salivary glands. But when it struck teens and adults, its usually rare complications—including inflammation of the reproductive organs and pancreas—became more frequent and more troublesome. Because of its highly contagious nature, mumps spread rapidly through crowded barracks and training camps. Because of its tendency to inflame the testes, it was second only to venereal disease in disabling recruits. In the interest of national defense, the disease clearly warranted further study. PHS researchers estimated that during World War I, mumps had cost the United States close to 4 million “man days” from duty, contributing to more total days lost from duty than foreign forces saw.

The problem of mumps among soldiers quickly became apparent during the Second World War, too, as the infection once again began to spread through army camps. This time around, however, scientists had new information at hand: scientists in the 1930s had determined that mumps was caused by a virus and that it could, at least theoretically, be prevented through immunization. PHS surgeon Karl Habel noted that while civilians didn‘t have to worry about mumps, the fact that infection was a serious problem for the armed forces now justified the search for a vaccine. “To the military surgeon, mumps is no passing indisposition of benign course,” two Harvard epidemiologists concurred. Tipped off to the problem of mumps by a U.S. Army general and funded by the Office of Scientific Research and Development (OSRD), the source of federal support for military research at the time, a group of Harvard researchers began experiments to promote mumps virus immunity in macaque monkeys in the lab.

Within a few years, the Harvard researchers, led by biologist John Enders, had developed a diagnostic test using antigens from the monkey‘s salivary glands, as well as a rudimentary vaccine. In a subsequent set of experiments, conducted both by the Harvard group and by Habel at the National Institute of Health, vaccines containing weakened mumps virus were produced and tested in institutionalized children and plantation laborers in Florida, who had been brought from the West Indies to work on sugar plantations during the war. With men packed ten to a bunkhouse in the camps, mumps was rampant, pulling workers off the fields and sending them to the infirmary for weeks at a time. When PHS scientists injected the men with experimental vaccine, one man in 1,344 went into anaphylactic shock, but he recovered with a shot of adrenaline and “not a single day of work was lost,” reported Habel. To the researchers, the vaccine seemed safe and fairly effective—even though some of the vaccinated came down with the mumps. What remained, noted Enders, was for someone to continue experimenting until scientists had a strain infective enough to provoke a complete immune response while weak enough not to cause any signs or symptoms of the disease.

Those experiments would wait for well over a decade. Research on the mumps vaccine, urgent in wartime, became a casualty of shifting national priorities and the vagaries of government funding. As the war faded from memory, polio, a civilian concern, became the nation‘s number one medical priority. By the end of the 1940s, the Harvard group‘s research was being supported by the National Foundation for Infantile Paralysis, which was devoted to polio research, and no longer by OSRD. Enders stopped publishing on the mumps virus in 1949 and instead turned his full–time attention to the cultivation of polio virus. Habel, at the NIH, also began studying polio. With polio occupying multiple daily headlines throughout the 1950s, mumps lost its place on the nation‘s political and scientific agendas.

Although mumps received scant resources in the 1950s, Lederle Laboratories commercialized the partially protective mumps vaccine, which was about 50 percent effective and offered about a year of protection. When the American Medical Association‘s Council on Drugs reviewed the vaccine in 1957, they didn‘t see much use for it. The AMA advised against administering the shot to children, noting that in children mumps and its “sequelae,” or complications, were “not severe.” The AMA acknowledged the vaccine‘s potential utility in certain populations of adults and children—namely, military personnel, medical students, orphans, and institutionalized patients—but the fact that such populations would need to be revaccinated every year made the vaccine‘s deployment impractical. The little professional discussion generated by the vaccine revealed a similar ambivalence. Some observers even came to the disease‘s defense. Edward Shaw, a physician at the University of California School of Medicine, argued that given the vaccine‘s temporary protection, “deliberate exposure to the disease in childhood … may be desirable”: it was the only way to ensure lifelong immunity, he noted, and it came with few risks. The most significant risk, in his view, was that infected children would pass the disease to susceptible adults. But even this concern failed to move experts to urge vaccination. War had made mumps a public health priority for the U.S. government in the 1940s, but the resulting technology (imperfect as it was) generated little interest or enthusiasm in a time of peace, when other health concerns loomed larger.

After the war but before the new live virus vaccine was introduced, mumps went back to being what it long had been: an innocuous and sometimes amusing childhood disease. The amusing nature of mumps in the 1950s is evident even in seemingly serious documents from the time. When the New York State health department published a brochure on mumps in 1955, they adopted a light tone and a comical caricature of chipmunk–cheeked “Billy” to describe a brush with the disease. In the Chicago papers, health columnist and Chicago Medical Society president Theodore Van Dellen noted that when struck with mumps, “the victim is likely to be dubbed ‘moon–face.‘” Such representations of mumps typically minimized the disease‘s severity. Van Dellen noted that while mumps did have some unpleasant complications—including the one that had garnered so much attention during the war—“the sex gland complication is not always as serious as we have been led to believe.” The health department brochure pointed out that “children seldom develop complications,” and should therefore not be vaccinated: “Almost always a child is better off having mumps: the case is milder in childhood and gives him life–long immunity.”

Such conceptualizations helped shape popular representations of the illness. In press reports from the time, an almost exaggeratedly lighthearted attitude toward mumps prevailed. In Atlanta, papers reported with amusement on the oldest adult to come down with mumps, an Englishwoman who had reached the impressive age of ninety–nine. Chicago papers featured the sad but cute story of the boy whose poodle went missing when mumps prevented him from being able to whistle to call his dog home. In Los Angeles, the daily paper told the funny tale of a young couple forced to exchange marital vows by phone when the groom came down with mumps just before the big day.Los Angeles Times readers speculated on whether the word “mumps” was singular or plural, while Chicago Daily Defender readers got to laugh at a photo of a fat–cheeked matron and her fat–cheeked cocker spaniel, heads wrapped in matching dressings to soothe their mumps–swollen glands. Did dogs and cats actually get the mumps? In the interest of entertaining readers, newspapers speculated on that as well.

The top reason mumps made headlines throughout the fifties and into the sixties, however, was its propensity to bench professional athletes. Track stars, baseball players, boxers, football stars, and coaches all made the news when struck by mumps. So did Washington Redskins player Clyde Goodnight, whose story revealed a paradox of mumps at midcentury: the disease was widely regarded with casual dismissal and a smirk, even as large enterprises fretted over its potential to cut into profits. When Goodnight came down with a case of mumps in 1950, his coaches giddily planned to announce his infection to the press and then send him into the field to play anyway, where the Pittsburgh Steelers, they gambled, would be sure to leave him open for passes. But the plan was nixed before game time by the Redskins‘ public relations department, who feared the jubilant Goodnight might run up in the stands after a good play and give fans the mumps. Noted one of the team‘s publicists: “That‘s not good business.”

When Baltimore Orioles outfielder Frank Robinson came down with the mumps during an away game against the Los Angeles Angels in 1968, however, the tone of the team‘s response was markedly different. Merck‘s new Mumpsvax vaccine had recently been licensed for sale, and the Orioles‘ managers moved quickly to vaccinate the whole team, along with their entire press corps and club officials. The Orioles‘ use of the new vaccine largely adhered to the guidelines that Surgeon General William Stewart had announced upon the vaccine‘s approval: it was for preteens, teenagers, and adults who hadn‘t yet had a case of the mumps. (For the time being, at least, it wasn‘t recommended for children.) The Angels‘ management, by contrast, decided not to vaccinate their players—despite their good chances of having come into contact with mumps in the field.

Baseball‘s lack of consensus on how or whether to use the mumps vaccine was symptomatic of the nation‘s response as a whole. Cultural ambivalence toward mumps had translated into ambivalence toward the disease‘s new prophylactic, too. That ambivalence was well–captured in the hit movie Bullitt, which came out the same year as the new mumps vaccine. In the film‘s opening scene, San Francisco cop Frank Bullitt readies himself for the workday ahead as his partner, Don Delgetti, reads the day‘s headlines aloud. “Mumps vaccine on the market … the government authorized yesterday what officials term the first clearly effective vaccine to prevent mumps … ,” Delgetti begins—until Bullitt sharply cuts him off. “Why don‘t you just relax and have your orange juice and shut up, Delgetti.” Bullitt, a sixties icon of machismo and virility, has more important things to worry about than the mumps. So, apparently, did the rest of the country. The Los Angeles Times announced the vaccine‘s approval on page 12, and the New York Times buried the story on page 72, as the war in Vietnam and the race to the moon took center stage.

Also ambivalent about the vaccine—or, more accurately, the vaccine‘s use—were the health professionals grappling with what it meant to have such a tool at their disposal. Just prior to Mumpsvax‘s approval, the federal Advisory Committee on Immunization Practices at the CDC recommended that the vaccine be administered to any child approaching or in puberty; men who had not yet had the mumps; and children living in institutions, where “epidemic mumps can be particularly disruptive.” Almost immediately, groups of medical and scientific professionals began to take issue with various aspects of these national guidelines. For some, the vaccine‘s unknown duration was troubling: ongoing trials had by then demonstrated just two years of protection. To others, the very nature of the disease against which the shot protected raised philosophical questions about vaccination that had yet to be addressed. The Consumers Union flinched at the recommendation that institutionalized children be vaccinated, arguing that “mere convenience is insufficient justification for preventing the children from getting mumps and thus perhaps escorting them into adulthood without immunity.” The editors of the New England Journal of Medicine advised against mass application of mumps vaccine, arguing that the “general benignity of mumps” did not justify “the expenditure of large amounts of time, efforts, and funds.” The journal‘s editors also decried the exaggeration of mumps‘ complications, noting that the risk of damage to the male sex glands and nervous system had been overstated. These facts, coupled with the ever–present risk of hazards attendant with any vaccination program, justified, in their estimation, “conservative” use of the vaccine.

This debate over how to use the mumps vaccine was often coupled with the more generalized reflection that Mumpsvax helped spark over the appropriate use of vaccines in what health experts began referring to as a new era of vaccination. In contrast to polio or smallpox, the eradication of mumps was far from urgent, noted the editors of the prestigious medical journal the Lancet. In this “next stage” of vaccination, marked by “prevention of milder virus diseases,” they wrote, “a cautious attitude now prevails.” If vaccines were to be wielded against diseases that represented only a “minor inconvenience,” such as mumps, then such vaccines needed to be effective, completely free of side effects, long–lasting, and must not in any way increase more severe adult forms of childhood infections, they argued. Immunization officials at the CDC acknowledged that with the approval of the mumps vaccine, they had been “forced to chart a course through unknown waters.” They agreed that the control of severe illnesses had “shifted the priorities for vaccine development to the remaining milder diseases,” but how to prevent these milder infections remained an open question. They delineated but a single criterion justifying a vaccine‘s use against such a disease: that it pose less of a hazard than its target infection.

To other observers, this was not enough. A vaccine should not only be harmless—it should also produce immunity as well as or better than natural infection, maintained Oklahoma physician Harris Riley. The fact that the mumps vaccine in particular became available before the longevity of its protection was known complicated matters for many weighing in on the professional debate. Perhaps, said Massachusetts health officer Morton Madoff, physicians should be left to decide for themselves how to use such vaccines as “a matter of conscience.” His comment revealed a hesitancy to delineate policy that many displayed when faced with the uncharted territory the mumps vaccine had laid bare. It also hinted at an attempt to shift future blame in case mumps vaccination went awry down the line—a possibility that occurred to many observers given the still–unknown duration of the vaccine‘s protection.

Mumps was not a top public health priority in 1967—in fact, it was not even a reportable disease—but the licensure of Mumpsvax would change the disease‘s standing over the course of the next decade. When the vaccine was licensed, editors at the Lancet noted that there had been little interest in a mumps vaccine until such a vaccine became available. Similarly, a CDC scientist remarked that the vaccine had “stimulated renewed interest in mumps” and had forced scientists to confront how little they knew about the disease‘s etiology and epidemiology. If the proper application of a vaccine against a mild infection remained unclear, what was clear—to scientists at the CDC at least—was that such ambiguities could be rectified through further study of both the vaccine and the disease. Given a new tool, that is, scientists were determined to figure out how best to use it. In the process of doing so, they would also begin to create new representations of mumps, effectively changing how they and Americans in general would perceive the disease in the future.

A Changing Disease

Shortly after the mumps vaccine‘s approval, CDC epidemiologist Adolf Karchmer gave a speech on the infection and its vaccine at an annual immunization conference. In light of the difficulties that health officials and medical associations were facing in trying to determine how best to use the vaccine, Karchmer devoted his talk to a review of existing knowledge on mumps. Aside from the fact that the disease caused few annual deaths, peaked in spring, and affected mostly children, particularly males, there was much scientists didn‘t know about mumps. They weren‘t certain about the disease‘s true prevalence; asymptomatic cases made commonly cited numbers a likely underestimate. There was disagreement over whether the disease occurred in six– to seven–year cycles. Scientists weren‘t sure whether infection was truly a cause of male impotence and sterility. And they didn‘t know the precise nature of the virus‘s effects on the nervous system. Karchmer expressed a concern shared by many: if the vaccine was administered to children and teens, and if it proved to wear off with time, would vaccination create a population of non–immune adults even more susceptible to the disease and its serious complications than the current population? Karchmer and others thus worried—at this early stage, at least—that trying to control mumps not only wouldn‘t be worth the resources it would require, but that it might also create a bigger public health problem down the road.

To address this concern, CDC scientists took a two–pronged approach to better understanding mumps and the potential for its vaccine. They reinstated mumps surveillance, which had been implemented following World War I but suspended after World War II. They also issued a request to state health departments across the country, asking for help identifying local outbreaks of mumps that they could use to study both the disease and the vaccine. Within a few months, the agency had dispatched teams of epidemiologists to study mumps outbreaks in Campbell and Fleming Counties in Kentucky, the Colin Anderson Center for the “mentally retarded” in West Virginia, and the Fort Custer State Home for the mentally retarded in Michigan.

The Fort Custer State Home in Augusta, Michigan, hadn‘t had a single mumps outbreak in its ten years of existence when the CDC began to investigate a rash of 105 cases that occurred in late 1967. In pages upon pages of detailed notes, the scientists documented the symptoms (largely low–grade fever and runny noses) as well as the habits and behaviors of the home‘s children. They noted not only who slept where, who ate with whom, and which playgrounds the children used, but also who was a “toilet sitter,” who was a “drippy, drooley, messy eater,” who was “spastic,” who “puts fingers in mouth,” and who had “impressive oral–centered behavior.” The index case—the boy who presumably brought the disease into the home—was described as a “gregarious and restless child who spends most of his waking hours darting from one play group to another, is notably untidy and often places his fingers or his thumbs in his mouth.” The importance of these behaviors was unproven, remarked the researchers, but they seemed worth noting. Combined with other observations—such as which child left the home, for example, to go on a picnic with his sister—it‘s clear that the Fort Custer children were viewed as a petri dish of infection threatening the community at large.

Although the researchers‘ notes explicitly stated that the Fort Custer findings were not necessarily applicable to the general population, they were presented to the 1968 meeting of the American Public Health Association as if they were. The investigation revealed that mumps took about fifteen to eighteen days to incubate, and then lasted between three and six days, causing fever for one or two days. Complications were rare (three boys ages eleven and up suffered swollen testes), and attack rates were highest among the youngest children. The team also concluded that crowding alone was insufficient for mumps to spread; interaction had to be “intimate,” involving activities that stimulated the flow and spread of saliva, such as the thumb–sucking and messy eating so common among not only institutionalized children but children of all kinds.

Mumps preferentially strikes children, so it followed that children offered the most convenient population for studying the disease‘s epidemiology. But in asking a question about children, scientists ipso facto obtained an answer—or series of answers—about children. Although mumps had previously been considered a significant healthproblem only among adults, the evidence in favor of immunizing children now began to accumulate. Such evidence came not only from studies like the one at Fort Custer, but also from local reports from across the country. When Bellingham and Whatcom Counties in Washington State made the mumps vaccine available in county and school clinics, for example, few adults and older children sought the shot; instead, five– to nine–yearolds were the most frequently vaccinated. This wasn‘t necessarily a bad thing, said Washington health officer Phillip Jones, who pointed out that there were two ways to attack a health problem: you could either immunize a susceptible population or protect them from exposure. Immunizing children did both, as it protected children directly and in turn stopped exposure of adults, who usually caught the disease from kids. Immunizing children sidestepped the problem he had noticed in his own county. “It is impractical to think that immunization of adults and teen–agers against mumps will have any significant impact on the total incidence of adult and teen–age mumps. It is very difficult to motivate these people,” said Jones. “On the other hand, parents of younger children eagerly seek immunization of these younger children and there are numerous well–established programs for the immunization of children, to which mumps immunization can be added.”

Setting aside concerns regarding the dangers of giving children immunity of unknown duration, Jones effectively articulated the general consensus on immunization of his time. The polio immunization drives described in chapters 1 and 2 had helped forge the impression that vaccines were “for children” as opposed to adults. The establishment of routine pediatric care, also discussed in chapter 1, offered a convenient setting for broad administration of vaccines, as well as an audience primed to accept the practice. As a Washington, D.C., health officer remarked, his district found that they could effectively use the smallpox vaccine, which most “mothers” eagerly sought for their children, as “bait” to lure them in for vaccines against other infections. The vaccination of children got an added boost from the news that Russia, the United States‘ key Cold War opponent and foil in the space race, had by the end of 1967 already vaccinated more than a million of its youngsters against mumps.

The initial hesitation to vaccinate children against mumps was further dismantled by concurrent discourse concerning a separate vaccine, against rubella (then commonly known as German measles). In the mid1960s, rubella had joined polio and smallpox in the ranks of diseases actively instilling fear in parents, and particularly mothers. Rubella, a viral infection that typically caused rash and a fever, was harmless in children. But when pregnant women caught the infection, it posed a risk of harm to the fetus. A nationwide rubella epidemic in 1963 and 1964 resulted in a reported 30,000 fetal deaths and the birth of more than 20,000 children with severe handicaps. In fact, no sooner had the nation‘s Advisory Committee on Immunization Practices been formed, in 1964, than its members began to discuss the potential for a pending rubella vaccine to prevent similar outbreaks in the future. But as research on the vaccine progressed, it became apparent that while the shot produced no side effects in children, in women it caused a “rubella–like syndrome” in addition to swollen and painful joints. Combined with the fact that the vaccine‘s potential to cause birth defects was unknown, and that the vaccination of women planning to become pregnant was perceived as logistically difficult, federal health officials concluded that “the widespread immunization of children would seem to be a safer and more efficient way to control rubella syndrome.” Immunization of children against rubella was further justified based on the observation that children were “the major source of virus dissemination in the community.” Pregnant women, that is, would be protected from the disease as long as they didn‘t come into contact with it.

The decision to recommend the mass immunization of children against rubella marked the first time that vaccination was deployed in a manner that offered no direct benefit to the individuals vaccinated, as historian Leslie Reagan has noted. Reagan and, separately, sociologist Jacob Heller have argued that a unique cultural impetus was at play in the adoption of this policy: as an accepted but difficult–to–verify means of obtaining a therapeutic abortion at a time when all other forms of abortion were illegal, rubella infection was linked to the contentious abortion politics of the time. A pregnant woman, that is, could legitimately obtain an otherwise illegal abortion by claiming that she had been exposed to rubella, even if she had no symptoms of the disease. Eliminating rubella from communities through vaccination of children would close this loophole—or so some abortion opponents likely hoped. Eliminating rubella was also one means of addressing the growing epidemic of mental retardation, since the virus was known to cause birth defects and congenital deformities that led children to be either physically disabled or cognitively impaired. Rubella immunization promotion thus built directly upon the broader public‘s anxieties about abortion, the “crippling” diseases (such as polio), and mental retardation.

In its early years, the promotion of mumps immunization built on some of these same fears. Federal immunization brochures from the 1940s and 1950s occasionally mentioned that mumps could swell the brain or the meninges (the fluid surrounding the brain), but they never mentioned a risk of brain damage. In the late 1960s, however, such insinuations began to appear in reports on the new vaccine. Hilleman‘s early papers on the mumps vaccine trials opened with the repeated statement that “Mumps is a common childhood disease that may be severely and even permanently crippling when it involves the brain.” When Chicago announced Mumps Prevention Day, the city‘s medical director described mumps as a disease that can “contribute to mental retardation.” Though newspaper reporters focused more consistently on the risk that mumps posed to male fertility, many echoed the “news” that mumps could cause permanent damage to the brain. Such reports obscured substantial differentials of risk noted in the scientific literature. For unlike the link between mumps and testicular swelling, the relationship between mumps and brain damage or mental retardation was neither proven nor quantified, even though “benign” swelling of meninges was documented to appear in 15 percent of childhood cases. In a nation just beginning to address the treatment of mentally retarded children as a social (instead of private) problem, however, any opportunity to prevent further potential cases of brain damage, no matter how small, was welcomed by both parents and cost–benefit–calculating municipalities.

The notion that vaccines protected the health (and, therefore, the productivity and utility) of future adult citizens had long been in place by the time the rubella vaccine was licensed in 1969. In addition to fulfilling this role, the rubella vaccine and the mumps vaccine—which, again, was most commonly depicted as a guard against sterility and “damage to the sex glands” in men—were also deployed to ensure the existence of future citizens, by protecting the reproductive capacities of the American population. The vaccination of children against both rubella and mumps was thus linked to cultural anxiety over falling fertility in the post–Baby Boom United States. In this context, mumps infection became nearly as much a cause for concern in the American home as it had been in army barracks and worker camps two decades before. This view of the disease was captured in a 1973 episode of the popular television sitcom The Brady Bunch, in which panic ensued when young Bobby Brady learned he might have caught the mumps from his girlfriend and put his entire family at risk of infection. “Bobby, for your first kiss, did you have to pick a girl with the mumps?” asked his father, who had made it to adulthood without a case of the disease. This cultural anxiety was also evident in immunization policy discussions. CDC scientists stressed the importance of immunizing against mumps given men‘s fears of mumps–induced impotence and sterility—even as they acknowledged that such complications were “rather poorly documented and thought to occur rarely, if at all.”

As the new mumps vaccine was defining its role, the revolution in reproductive technologies, rights, and discourse that extended from the 1960s into the 1970s was reshaping American—particularly middle–class American—attitudes toward children in a manner that had direct bearing on the culture‘s willingness to accept a growing number of vaccines for children. The year 1967 saw more vaccines under development than ever before. Merck‘s own investment in vaccine research and promotion exemplified the trend; even as doctors and health officials were debating how to use Mumpsvax, Hilleman‘s lab was testing a combined vaccine against measles, rubella, and mumps that would ultimately help make the company a giant in the vaccine market. This boom in vaccine commodification coincided with the gradual shrinking of American families that new contraceptive technologies and the changing social role of women (among other factors) had helped engender.

The link between these two trends found expression in shifting attitudes toward the value of children, which were well–captured by Chicago Tribune columnist Joan Beck in 1967. Beck predicted that 1967 would be a “vintage year” for babies, for the 1967 baby stood “the best chance in history of being truly wanted” and the “best chance in history to grow up healthier and brighter and to get a better education than his forebears.” He‘d be healthier—and smarter—thanks in large part to vaccines, which would enable him to “skip” mumps, rubella, and measles, with their attendant potential to “take the edge off a child‘s intelligence.” American children might be fewer in number as well as costly, Beck wrote, but they‘d be both deeply desired and ultimately well worth the tremendous investment. This attitude is indicative of the soaring emotional value that children accrued in the last half of the twentieth century. In the 1960s, vaccination advocates appealed directly to the parent of the highly valued child, by emphasizing the importance of vaccinating against diseases that seemed rare or mild, or whose complications seemed even rarer still. Noted one CDC scientist, who extolled the importance of vaccination against such diseases as diphtheria and whooping cough even as they became increasingly rare: “The disease incidence may be one in a thousand, but if that one is your child, the incidence is a hundred percent.”

Discourse concerning the “wantedness” of individual children in the post–Baby Boom era reflected a predominantly white middle–class conceptualization of children. As middle–class birth rates continued to fall, reaching a nadir in 1978, vaccines kept company with other commodities—a suburban home, quality schooling, a good college—that shaped the truly wanted child‘s middle–class upbringing. From the late 1960s through the 1970s, vaccination in general was increasingly represented as both a modern comfort and a convenience of contemporary living. This portrayal dovetailed with the frequent depiction of the mild infections, and mumps in particular, as “nuisances” American no longer needed to “tolerate.” No longer did Americans of any age have to suffer the “variety of spots and lumps and whoops” that once plagued American childhood, noted one reporter. Even CDC publications commented on “the luxury and ease of health provided by artificial antigens” of the modern age.

And even though mumps, for one, was not a serious disease, remarked one magazine writer, the vaccination was there “for those who want to be spared even the slight discomfort of a case.” Mumps vaccination in fact epitomized the realization of ease of modern living through vaccination. Because it kept kids home from school and parents home from work, “it is inconvenient, to say the least, to have mumps,” noted a Massachusetts health official. “Why should we tolerate it any longer?” Merck aimed to capitalize on this view with ads it ran in the seventies: “To help avoid the discomfort, the inconvenience—and the possibility of complications: Mumpsvax,” read the ad copy. Vaccines against infections such as mumps might not be perceived as absolutely necessary, but the physical and material comfort they provided could not be undervalued.

To read more about Vaccine Nation, click here.