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Vaccine Innovation and Adoption: Polio Vaccines in the UK, the Netherlands and West Germany, 1955–1965

Published online by Cambridge University Press:  16 November 2012

Ulrike Lindner  and
Stuart S Blume
Ulrike Lindner
Affiliation:
Clare Hall, Herschel Road, Cambridge CB3 9AL
Stuart S Blume
Affiliation:
Amsterdam School for Social Science Research, University of Amsterdam, o.z. Achterburgwal 185, 1012 DK Amsterdam, The Netherlands
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“An effective AIDS vaccine could be found as early as 2012, saving 6 million lives if the world is willing to put £10 bn a year into a new programme, the chancellor, Gordon Brown, said in a speech last night in Tanzania”. Faith in biomedical science; the conviction that new vaccines will be translated into lives saved; belief in the necessity of globally concerted action: the British minister's statement reflects views of vaccine innovation that are widely held today. New and improved vaccines seem our best hope of coping with the scourge of AIDS, of arming ourselves against the unknown threats of emergent diseases and potential bioterrorism, and of tackling the resurgence of old diseases arising once more in Europe. Global coordination, pooling our resources, seems self-evidently necessary, given the international nature of a modern epidemic. Much current discussion of vaccine development and use thus has a global character. That is to say, it is conducted under the banner of global slogans or it seeks to establish globally integrated approaches to vaccine research and development (R&D). Over the past two decades the development and rapid introduction of new vaccines have come to dominate the vaccine agenda worldwide. Social scientists and health policy analysts have been set to work, examining barriers to the implementation of international priorities at the national level. Why, for example, are national responses to the availability of new vaccines often so lethargic? A recent study of the adoption of Hemophilus influenza b (Hib) conjugate vaccine is a good example. It shows policy makers in four countries rationally weighing the burden to public health of the diseases against which the vaccine offers protection (bacterial meningitis and pneumonia), against the high cost of the vaccine. Health policy analysts tend to explain the decision to introduce a new vaccine, or to replace an existing vaccine by a new alternative, in terms of the epidemiology and seriousness of the disease, and of scientific consensus regarding the efficacy and potential risks of the vaccine and (perhaps) their costs. The studies of vaccine diffusion and adoption that they conduct have little or nothing to say about political disagreements, or the influence of commercial interests, national traditions, international relations, or global agendas. Where any attention is paid to vaccine history, it is generally in the attempt to illustrate factors (such as resistance to vaccination) that might cause deviations from the rational deployment of vaccines.

Type
Articles
Information
Medical History , Volume 50 , Issue 4 , 01 October 2006 , pp. 425 - 446
Copyright
Copyright © The Author(s) 2006. Published by Cambridge University Press

References

1 P Wintour, ‘Aids vaccine possible by 2012, Brown tells Africa’, Guardian, 13 Jan. 2005, p. 10.

2 A Hardon and S Blume, ‘Shifts in global immunisation goals (1984–2004): unfinished agendas and mixed results’, Soc. Sci. Med., 2005, 60: 345–56.

3 For example, R D Klausner, A S Fauci, L Corey, et al., ‘The need for a global HIV vaccine enterprise’, Science, 2003, 300: 2036–9.

4 W Muraskin, The politics of international health: the Children's Vaccine Initiative and the struggle to develop vaccines for the third world, Albany, SUNY Press, 1998.

5 J D Wenger, J DiFabio, J M Landaverde, O S Levine and T Gaafar, ‘Introduction of Hib conjugate vaccines in the non-industrialized world: experience in four “newly adopting” countries’, Vaccine, 1999, 18: 736–42.

6 A M Stern and H Markel, ‘The history of vaccines and immunization: familiar patterns, new challenges’, Health Affairs, 2005, 24: 611–21.

7 J Stanton, ‘What shapes vaccine policy? The case of hepatitis B in the UK’, Soc. Hist. Med., 1994, 7: 427–46.

8 Ibid., p. 444.

9 L Bryder, ‘“We shall not find salvation in inoculation”: BCG vaccination in Scandinavia, Britain and the USA, 1921–1960’, Soc. Sci. Med., 1999, 49: 1157–67; see also C Bonah, ‘“As safe as milk or sugar water”: perceptions of the risks and benefits of the BDG vaccine in the 1920s and 1930s in France and Germany’, in T Schlich and U Tröhler (eds), The risks of medical innovation: risk perception and assessment in historical context, Abingdon and New York, Routledge, 2006, pp. 71–92.

10 Bryder, op. cit., note 9 above, p. 1157.

11 J Rogers Hollingsworth, J Hage and R A Hanneman, State intervention in medical care: consequences for Britain, France, Sweden and the United States, 1890–1970, Ithaca and London, Cornell University Press, 1990.

12 Ibid., p. 122.

13 D J Rothman, Beginnings count: the technological imperative in American health care, New York, Oxford University Press, 1997.

14 Ibid., p. 13.

15 P A David, ‘Clio and the economics of QWERTY’, Am. Econ. Rev., 1985, 75, Papers and proceedings, pp. 332–7.

16 Historical studies of polio vaccines have tended to focus on the United States, where the vaccines were developed. Little attention has been paid to their introduction and use in Europe.

17 It was decided that vaccine would not be imported from the USA, because the standards that IPV was required to meet in that country were felt to be inadequate and manufacturers had their hands full meeting domestic need (which could lead to problems in supply). A Belgian producer was selected by the RIV. See H Cohen and R Hofman, letter to the Editor, Nederlands Tijdschrift voor Geneeskunde, 2002, 146: 2454.

18 The basis of these religious objections, and their effect on Dutch legislation relating to vaccination, are described in detail in P F Maas, Parlement & Polio, 's-Gravenhage, SDU-uitgeverij, 1988, esp. pp. 35–51.

19 We are grateful to Dr R J F Burgmeijer, medical director of the National Vaccination Programme, for help with the facts contained in this paragraph.

20 G Henneberg, ‘Zum Problem der Poliomyelitisschutzimpfung in Deutschland’, Der öffentliche Gesundheitsdienst, 1956/57, 18: 181–7.

21 Bundesarchiv Koblenz (BAK), B 142/22, Vermerk, 30 Sept. 1955.

22 BAK, B 142/22, Protokoll Wiesbadner Symposium der ‘Ventnor-Foundation’, 2 June 1956; see also ‘Robert-Koch-Institut – Tradition und Fortschritt’, Epidemiologisches Bulletin, 2000, no. 39, pp. 311–18.

23 There was a widespread scientific discourse on polio therapy in West Germany, but almost no publications on polio vaccines, since research in the FRG on vaccination was negligible. Der öffentliche Gesundheitsdienst, the official journal of the German Association for the Fight against Polio, had only one original article on virological issues before 1960, see also details in R Wohlrab, ‘Praktische Anwendung neuester virologischer Untersuchungen’, Der öffentliche Gesundheitsdienst, 1959/60, 21: 558–74. Therefore the scientific discourse on polio vaccination was dominated by only a few people such as the health politician Franz Redeker and the immunologist Georg Henneberg.

24 BAK, B 142/23, Referat Dr Lundt über die Impfungen gegen Poliomyelitis in der Bundesrepublik Deutschland, Sept. 1958.

25 For the change in attitudes, see, for example, reports of German delegates at the European Poliomyelitis-Symposiums in 1958 and 1960: BAK, B 142/23, Bericht Poliomyelitis-Symposium Madrid für das Innenministerium, 1958; Vorarchiv Arbeitsministerium NRW, 1200, Sitzung, 7 April 1960.

26 For the more positive attitude in West German ministries and councils in 1957/58, see Vorarchiv Arbeitsministerium NRW, 1200, Konferenz der für das Gesundheitswesen zuständigen Minister und Senatoren Berlin, 1 March 1957; BAK, B 142/23 Vermerk, 5 Sept. 1959.

27 L v. Manger-Koenig, ‘Der öffentliche Gesundheitsdienst zwischen Gestern und Morgen’, Das öffentliche Gesundheitswesen, 1975, 37: 433–8.

28 BAK, B 142/22, Protokoll über die Besprechung der leitenden Medizinalbeamten der Länder, 10 Feb. 1956.

29 U Lindner, Gesundheitspolitik in der Nachkriegszeit. Großbritannien und die Bundesrepublik Deutschland im Vergleich, Munich, Oldenbourg, 2004, pp. 239–40.

30 W Bartmann, Zwischen Tradition und Fortschritt. Aus der Geschichte der Pharmabereiche von Bayer, Höchst und Schering von 1935–1975, Stuttgart, Franz Steiner, 2003.

31 BAK, B 142/22, Protokoll über die Besprechung mit den Leitenden Medizinalbeamten der Länder, 10. Feb. 1956; Die Schutzimpfung gegen Poliomyelitis, Behringwerk-Mitteilungen, Heft 31, Marburg a.d. Lahn, Elwert, 1956, p. 258.

32 Statement of the Minister for Health, Dr Elisabeth Schwarzhaupt, Verhandlungen des Deutschen Bundestages, 4. Wahlperiode, 26. Meeting, 12 April 1962, p. 1069.

33 National Archives (NA), Public Record Office (PRO), MH 55/1769, Infantile Paralysis Fellowship to Minister of Health, 27 Sept. 1951.

34 Wellcome Library, London, Archives and Manuscripts, GC 139, F 22.

35Report of the Chief Medical Officer on the state of the public health, 1955, PP 1956–57, XIII, p. 77.

36 ‘Poliomyelitis vaccine trials deferred’, Br. med. J., 1955, i: 1535; T Gould, A summer plague: polio and its survivors, New Haven and London, Yale University Press, 1995, p. 160.

37 NA, PRO, MH 133/467, Joint Committee on Poliomyelitis Vaccine, Meeting 13 July 1955; Joint Committee on Polio Vaccine to Senior Administrative Medical Officers, 16 Aug. 1955.

38 NA, PRO, MH 133/467, Joint Committee on Poliomyelitis Vaccine Meeting, 10 Oct. 1955.

39 ‘Medical notes in Parliament: Poliomyelitis vaccine’, Br. med. J., 1956, i: 299.

40 C Webster, The health services since the war. Vol. 2: Government and health care: the National Health Service 1958–1979, London, The Stationary Office, 1996, pp. 27, 128–9; A Hardy, ‘Poliomyelitis and the neurologists: the view from England, 1896–1966’, Bull. Hist. Med., 1997, 71: 249–72; for the anti-vaccination movements in Britain, see N Durbach, Bodily matters: the anti-vaccination movement in England 1853–1907, Durham, NC, Duke University Press, 2005, and for post-1945 development, especially pp. 200–7.

41 NA, PRO, MH 55/2462, County Councils Association to Enid Russel-Smith, Ministry of Health, Sept. 1957. For the public discussion, see articles with headings as “Three shots needed” or “We're 7,000,000 jabs short, yet there is plenty of Salk vaccine in the US and Canada” in the Daily Express, the Star and other British newspapers during the winter of 1957/58.

42Report of the Chief Medical Officer on the state of public health, 1957, PP 1958–59, XV, pp. 85–6.

43 NA, PRO, MH 55/2464, Poliomyelitis Vaccine–Ordering Policy, 1958.

44 NA, PRO, MH 55/2462, Enid Russel-Smith, Ministry of Health to Mr Dacey, County Councils Association, 27 Sept. 1957.

45 NA, PRO, MH 55/2212, Heald to Dodds, 15 Oct. 1958.

46 NA, PRO, MH 55/2469, Memorandum on Poliomyelitis Vaccine, 9 May 1960.

47Report of the Chief Medical Officer on the state of public health, 1958, PP 1959–60, XVI, p. 82.

48 “Though no one questioned the overall success of Sabin's mission in Russia, it was, as Smorodintsev belatedly admitted during a visit to the United States in 1964 ‘a public-health measure not a field trial’. Sabin's live vaccine was never subjected to the kind of rigorous field trial that Salk's killed vaccine had undergone in 1954”, Gould, op. cit., note 36 above, p. 183.

49 J L Melnick and J C Brennan, ‘Monkey neurovirulence of attenuated poliovirus vaccines being used in field trials’, in Live poliovirus vaccines, First International Conference on Live Poliovirus Vaccines, Scientific Publication, No. 44, Washington DC, PAHO, Pan American Sanitary Bureau, 1959, pp. 65–101.

50 A E Klein, Trial by fury: the polio vaccine controversy, New York, Charles Scribner's Sons, 1972, p. 147.

51 This discussion is based on S Blume, ‘Lock in, the state, and vaccine development: lessons from the history of the polio vaccines’, Research Policy, 2005, 34: 159–73.

52 Maas, op. cit., note 18 above, pp. 119–28.

53 BAK, B 142/3677, Sitzung der Arbeitsgemeinschaft der leitenden Medizinalbeamten der Länder, 7 April 1960, in Saarbrücken.

54 See several articles in Berlin newspapers, for example, ‘Auch Affen trinken Impf-Cocktail’, Berliner Morgenpost, 6 May 1960; ‘Aktion gegen Kinderlähmung beginnt’, Der Tagesspiegel, 10 May 1960.

55 See ‘Seit dem 10. Juli kein neuer Polio-Fall’, Der Tagesspiegel, 30 July 1960; ‘Beginnende Polio-Epidemie zum Stehen gebracht’, Der Tagesspiegel, 2 Aug. 1960.

56 There are no articles covering this incident in June or July 1960 in newspapers and journals throughout West Germany, such as the Frankfurter Allgemeine Zeitung, Die Zeit, and Der Spiegel. In July 1960 there were some articles reporting from the Copenhagen Conference, where German scientists referred to the incidents in Berlin, see Frankfurter Allgemeine Zeitung, 29 July 1960, no. 175.

57 BAK, B 142/3527, Niederschrift über die Sitzung des Ausschusses 2 (Seuchenbekämpfung und Hygiene) des Bundesgesundheitsrates, 28/29 Sept. 1961.

58 BAK, B 142/3527, Niederschrift über die Sitzung des Ausschusses 2 des Bundesgesundheitsrates, 28/29 Sept. 1961, in Bonn.

59 See the meeting of the leading health officers of the West German Länder when the GDR had started mass vaccination: BAK, B 142/3677, Sitzung der Arbeitsgemeinschaft der leitenden Medizinalbeamten der Länder, April 1960.

60 See report of the West German delegate at the European Polio Symposium in 1961: BAK, B 142/23, Bericht für das Innenministerium, VII. Europäisches Poliomyelitis Symposion, in Oxford, Sept. 1961.

61 BAK, B 142/3677, Sitzung der für das Gesundheitswesen zuständigen Minister und Senatoren, 20.12.1961 in Bonn; W P Kierski, ‘Polio-Gesetzgebung’, Gesundheitspolitik, 1962, 4: 97–105.

62 Verhandlungen des deutschen Bundestages, Stenographische Berichte, 4. Wahlperiode, 12 April 1962, p. 1069.

63 BAK, B 142/23, Vermerk zur Sitzung der Arbeitsgemeinschaften der Leitenden Medizinalbeamten der Länder, 2/3 May 1962, in Nürnberg.

64 ‘Stand der Poliomyelitis-Schutzimpfung in den europäischen Ländern’, Der öffentliche Gesundheitsdienst, 1964, 26: 105–11.

65 NA, PRO, MH 133/468, Joint Committee on Poliomyelitis Vaccine, 14 Oct. 1959.

66Fifth International Poliomyelitis Conference, July 26–28, 1960, Copenhagen. Abstracts of papers presented, Amsterdam, 1960.

67 NA, PRO, MH 55/2469, ‘On live poliomyelitis vaccine’, note by J A Charles, Sept. 1960.

68 NA, PRO, MH 55/2469, Draft on Polio Vaccine, 9 May 1960.

69 NA, PRO, MH 55/2469, Polio Vaccination Programme, 15 Aug. 1960.

70 NA, PRO, MH 55/2473, Ministry of Health to Commonwealth Department of Health, Australia, 25 Oct. 1961; Gould, op. cit., note 36 above, pp. 175–6.

71 NA, PRO, MH 55/2473, Poliomyelitis, Use of Live Oral Vaccine, 12 Oct. 1961; Report of the Chief Medical Officer on the state of public health, 1961, PP 1962–63, XIX, p. 47.

72 NA, PRO, MH 133/474, Joint Committee on Poliomyelitis Vaccine, Minutes of Meeting, 23 Nov. 1962.

73 NA, PRO, MH 55/2473, Sabin Polio Vaccine, 24 Jan. 1962.

74 NA, PRO, MH 55/2473, Circular, 26 April 1962; NA, PRO, MH 55/2474, CMO to GPs, Routine Immunisation against Infectious Diseases, 9 March 1962.

75 Hollingsworth, Hage and Hanneman, op. cit., note 11 above, pp. 112–37.

76 R R Nelson and S G Winter, ‘In search of a useful theory of innovation’, Research Policy, 1977, 6: 36–76.

77 C Edquist, ‘Innovation policy – a systemic approach’, in D Archibugi and B-Å Lundvall (eds), The globalizing learning economy, Oxford University Press, 2001, pp. 219–38.

78 C Edquist, ‘Systems of innovation approaches –their emergence and characteristic’, in idem (ed.), Systems of innovation: technologies, institutions and organizations, London and Washington, Pinter, 1997, p. 17; R Nelson and K Nelson, ‘Technology, institutions and innovation systems’, Research Policy, 2002, 31: 265–72, and their broad definition of institutions as “widely employed social technologies” in their understanding of systems of innovation.

79 Or more generally what David calls “lock in” and Thomas Hughes “technological momentum”. See David, op. cit., note 15 above, and T P Hughes, ‘The evolution of large technological systems’, in W E Bijker, T P Hughes and T J Pinch (eds), The social construction of technological systems, Cambridge, MA, MIT Press, 1987, pp. 51–82.

80 We can distinguish effects due to international standards, economic pressures (reflecting, for example, growing concentration in the vaccines industry), and political pressures (e.g., the rivalry between countries, the growing importance of global forums in seeking to structure global vaccination efforts and vaccine development).

81 For example, J V Pickstone (ed.), Medical innovations in historical perspective, Basingstoke, Macmillan, 1992; J P Gaudillière and I Löwy (eds), The invisible industrialist: manufacture and the construction of scientific knowledge, Basingstoke, Macmillan, 1998; J Stanton (ed.), Innovations in health and medicine: diffusion and resistance in the twentieth century, London, Routledge, 2002.

82 J Stanton, ‘Introduction. On theory and practice’, in idem (ed.), Innovations in health and medicine. Diffusion and resistance in the twentieth century, London, Routledge, 2002, pp. 2–4.