Defeating the Ministers of Death
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Glossary of terms and abbreviations
Adjuvant A substance added to a vaccine to improve the immune response.
ADT The name of an adult diphtheria and tetanus vaccine, used as a ‘booster’ for previously immunised adults and children over five.
AEFI Adverse events following immunisation; this term is preferred to calling them vaccine side effects, because they may have been caused by the vaccine or may have occurred by coincidence.
Antibiotics Substances that destroy bacteria and are used to treat bacterial infections.
Antibodies Proteins produced by the immune system in response to antigens. The antigens may come from an organism causing an infection or from a vaccine. Another name for an antibody is an immunoglobulin.
Antigens Foreign substances that stimulate an immune response.
Attenuated An attenuated vaccine has been modified so it is still alive but is harmless or unlikely to cause a severe infection. Examples are viral vaccines like measles, mumps and rubella (MMR), chickenpox and rotavirus vaccines, and the bacterial BCG vaccine against tuberculosis.
BCG Bacille Calmette–Guérin vaccine against tuberculosis, a live attenuated vaccine, and the oldest vaccine still in use.
CDC Centers for Disease Control, the United States national health protection agency
Conjugate vaccines Highly effective vaccines produced by joining (conjugating) outer-coat polysaccharides (which do not stimulate an immune response in infants) to a protein that does elicit an immune response, in order to generate better immunity, e.g. Hib, meningococcal and pneumococcal conjugate vaccines.
DT The general abbreviation for childhood diphtheria and tetanus vaccines, the capital letters indicating higher concentrations of the diphtheria toxoid.
dT The general abbreviation for adult diphtheria and tetanus vaccines, which have lower levels of the diphtheria toxoid than childhood preparations.
DTPa A three-in-one diphtheria, tetanus and pertussis vaccine. The small ‘a’ indicates acellular pertussis vaccine, a more purified form. dTpa An adult three-in-one diphtheria, tetanus and pertussis vaccine with lower levels of antigens than DTPa. Used for pregnant women.
DTPw A three-in-one diphtheria, tetanus and pertussis vaccine. The small ‘w’ indicates whole-cell pertussis vaccine, containing inactivated whole pertussis bacteria.
Encephalitis Inflammation of the brain.
Endemic An endemic infection is one that is always present in a community, e.g. malaria is endemic in most of Africa.
Epidemic A rapidly spreading outbreak of infection, e.g. influenza epidemics occur every winter but disappear in summer.
FDA The Food and Drug Administration, an agency of the United States Health Department that oversees the safety of foods, drugs and vaccines.
Gastroenteritis An illness characterised by diarrhoea, often with vomiting and abdominal pain, Mostly caused by viruses, e.g. rotaviruses and noroviruses. Often known as ‘gastro’.
Gavi Gavi, the Vaccine Alliance, previously the Global Alliance for Vaccines and Immunization (GAVI), is a partnership to promote immunisation in poor countries. It was started in 2000, and has received massive financial support from the Bill and Melinda Gates Foundation.
Haemophilus influenzae type b See Hib.
Hepatitis Inflammation of the liver.
Hib An abbreviation of Haemophilus influenzae type b, an organism that can cause bloodstream infection and meningitis in infants and young children. There are highly effective vaccines available.
HPV Human papillomavirus, a virus that can cause a range of diseases, including cervical cancer.
Immune response The body’s protective mechanism against disease.
Immunisation The process of giving a vaccine to induce immunity or protection from infection (often used interchangeably with ‘vaccination’).
Immunity Protection from infection.
Infection When an organism enters the body; infection can be asymptomatic (latent) or can cause a symptomatic illness.
Intussusception Telescoping of an infant’s bowel, blocking it and requiring treatment or even an operation. Can occur spontaneously and is a very rare complication of rotavirus vaccines.
IPV Inactivated polio vaccine.
Meningococcus Another name for a bacterium called Neisseria meningitidis that can cause serious meningococcal infections, including bloodstream infection and meningitis, at any age, but particularly in infants and young adults. There are frequent severe epidemics in sub-Saharan Africa. There are highly effective vaccines available.
MMR Measles-mumps-rubella vaccine.
OPV Oral polio vaccine.
Pandemic A global epidemic, almost always of influenza. The most recent was the ‘swine flu’ pandemic of 2009.
Pneumococcus Another name for a bacterium called Streptococcus pneumoniae that can cause serious infections, including pneumonia and meningitis, particularly in infants and the elderly. Aboriginal people and Native Americans have a high incidence of pneumococcal infections. There are highly effective vaccines available.
Polysaccharide vaccines Vaccines made from purified polysaccharides (sugars) in the outer capsule of bacteria, e.g. pneumococcal polysaccharide vaccine.
RCT Randomised controlled trial, a scientific study in which patients are assigned at random to one or another treatment, minimising bias. In a ‘double-blind’ RCT, neither the patient nor the doctor knows which treatment the patient received.
Shingles Colloquial term for zoster.
Toxins Harmful substances produced by bacteria, e.g. Corynebacterium diphtheriae toxin causes the worst symptoms of diphtheria, and Clostridium tetani toxin causes the muscle spasms of tetanus.
Toxoid vaccines Vaccines produced by treating bacterial toxins so that they are no longer harmful but stimulate an immune response, e.g. diphtheria toxoid, tetanus toxoid.
Vaccination The process of giving a vaccine (often used interchangeably with ‘immunisation’).
Vaccine A biological substance manufactured to produce immunity to an infectious organism.
Varicella zoster virus (VZV) Chickenpox virus. After people recover from chickenpox, the virus remains in their nerves and can reactivate years later as zoster (shingles). There are live attenuated chickenpox vaccines.
Virus A minuscule infectious organism, 1000 times smaller than a human cell, that needs to reproduce in cells.
WHO The World Health Organization, a subsidiary of the United Nations, established in 1948 and based in Geneva.
Zoster A painful rash on one side of the body or face caused by reactivation of infection with the chickenpox virus (varicella zoster virus, VZV). Also called shingles. There are live attenuated zoster vaccines.
Suggested reading
Australian Government Department of Health. The Australian Immunisation Handbook. 10th ed. Canberra: Commonwealth of Australia, 2015. Updated version available online since December 2017: immunisationhandbook.health.gov.au/.
Australian Government Department of Health and Ageing. Myths and Realities Responding to Arguments Against Vaccination – A Guide for Providers. 5th ed. Canberra: Commonwealth of Australia, 2013, beta.health.gov.au/resources/publications/myths-realities-about-immunisation.
Ada G, Isaacs D. Vaccination: The Facts, the Fears, the Future. Sydney: Allen & Unwin, 2000.
Offit P. The Cutter Incident. New Haven/London: Yale University Press, 2005.
Offit P. Autism’s False Prophets: Bad Medicine, Risky Medicine, and the Search for a Cure. Columbia: Columbia University Press, 2008.
Offit PA. Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. New York: Basic Books, 2010.
Plotkin SA, Orenstein WA, Offit P, Edwards KM (eds). Vaccines. 7th ed. Philadelphia: Elsevier Saunders, 2017.
Acknowledgements
My special thanks to Mary Rennie for suggesting I write this book, which I found an exhilarating process. Mary was tirelessly enthusiastic, and kept coming up with new stories for me to investigate and grea
t advice about what to include and what to leave out. I loved doing the reading necessary to learn more, and I learned a lot of things I really ought to have known already. My wonderful colleague Ken Nunn told me that a friend once described him as an encyclopaedia of slightly inaccurate information. This describes me to a tee. I would be embarrassed by my ignorance if embarrassment were still in my armoury.
There are too many people with whom I have discussed immunisation over the years to remember, let alone acknowledge here, but I would particularly like to thank Ross Andrews, Chris Blyth, Robert Booy, Philip Britton, David Burgner, Margaret Burgess, Jim Buttery, David Durrheim, Dominic Dwyer, the late Frank Fenner, Robert Hall, Alyson Kakakios, Sam Katz, Ian Kerridge, Henry Kilham, Simon Kroll, Julie Leask, Mike Levin, Kristine Macartney, Aidan Macfarlane, Peter McIntyre, Jodie McVernon, Ben Marais, Helen Marshall, Sam Mehr, Liz Miller, Richard Moxon, Terry Nolan, Gus Nossal, Paul Offit, Stan Plotkin, Andrew Pollard, Jenny Royle, David Salisbury and Melanie Wong for the special contributions they have made to my thoughts on all aspects of immunisation. I thank Robert Booy, Phil Britton, Adam Dunn, David Durrheim, Mark Isaacs, Tim Knapp, Julie Leask, John Pearn and Kartika Putra for reading early chapter drafts and making helpful comments.
Mary Rennie and Shannon Kelly from HarperCollins gave me enormous help with my first ham-fisted draft chapters, and I am in total awe of their ability to read a chapter and make incredibly insightful and constructive suggestions. Scott Forbes of HarperCollins proved equally incisive and insightful as the book neared completion. I must express my special thanks to the wonderful Emma Dowden. Emma is a freelance editor who was handed my over-long and over-garrulous manuscript, full as it was of irrelevant and distracting digressions fascinating only to me. Emma sifted the chaff from the grain and reorganised the entire book in a way which still fills me with awe. How did she do that?
Finally, I would like to thank my wife, Carmel, for her selfless support and devotion, and for putting up with me for all the years we have been together. She has been a constant inspiration to me and to our wonderful children. She is the lodestar of my existence. I would be lost without her.
David Isaacs, 2019
Index
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ABC see Australian Broadcasting Corporation
Aboriginal Australians
hepatitis B 157
pneumococcus 326
pneumonia 134
rotavirus 139
smallpox 31–33
aborted foetuses, use in vaccines 245–246
accidents, road, cause of death 282
acellular pertussis vaccine 128, 177
acquired immune deficiency syndrome see AIDS
active immunisation 114
Ada, Gordon 3, 285
Adams, Abigail 39–40
Adams, Charles 40
Adams, John 39–40
Adams, Nabby 40
Adams, Thomas 40
additives, use in vaccines 193
adjuvants 116, 193–194
definition 323
hepatitis B vaccine 158
influenza vaccine 183–184
shingles vaccine 181
ADT, definition 323
adverse effects of vaccines 21–22, 216
acellular vs whole-cell 177
adjuvants 193–195
compensation 258–260
HPV vaccine 229–230
MMR 141–142 see also MMR-autism controversy
patches 293
preservatives 192–193
AEFI, definition 323 see also adverse effects
Afghanistan
foreign aid 275
polio immunisation 95–96
Taliban, the 95–96
Africa see also under individual countries
childhood immunisation 263–264
hepatitis B 157, 172, 174
HIV 286
malaria 324
measles 142–143, 264
meningococcal A vaccine 277–278, 296
polio eradication 91–92
smallpox eradication 55
tetanus 125
yellow fever 195–198
African-Americans, racism 242–243
Afridi, Shakil 94
Aga, Mustapha 121
AIDS 231, 268–269, 283, 285 see also HIV
denial 231
developing countries 268–269
Alaskan Natives and rotavirus 139
alcoholism and cirrhosis 156
Alda, Alan 76
Alençon, Duke of 28
algae vaccines 289
Alma-Ata, Declaration of 265
al-Qaeda 94
al-Razi, Muhammad ibn Zakariya 140
altruistic immunisation 256–258
healthcare workers 257–258
HPV vaccine for boys 257
rubella vaccine for boys 256–257
alum 116, 193
hepatitis B vaccine 158, 250
aluminium salts see alum
Alzheimer’s disease 282, 286, 287 see also dementia
alum 193
American Civil War 7
American colonisation
measles 9–10
smallpox 9–10, 25, 30–31
Americans, Native see Native Americans
Amherst, Jeffery 31
Amish community 143
amyloid-beta protein 287
anal cancer 120, 162, 257
anaphylaxis 124
Andrewes, Frederick 112
Angola, childhood immunisation 279
Animal Farm (book) 199
anthrax 62–63
antibiotics 9, 59
Helicobacter pylori 164
pneumonia 184–185
resistance to 108–109
tuberculosis 105–109
antibodies
definition 323
injecting 114
antigenic drift 176
antigens
definition 323
influenza vaccine 183
anti-immunisation movement see anti-vaccination movement
antisepsis 59
antitoxin 113–114
diphtheria 113–116, 187–189
tetanus 124, 187
anti-vaccination movement 2, 220–237
Anti-Vaccination League (UK) 49–50
Anti-Vaccination Society of America 50
autism 220–225 see also MMR-autism controversy
ethics 238–239
HPV vaccine 228–235
media influence 222–223
smallpox 48–51
Trump, Donald 223
Archibald Prize 75
Arntzen, Charles 289
Aronson, Jeff 149
Art Gallery of NSW 75
arthritis, septic 129
ascites 138
aspirin 247
Assignment Children (film) 267
asymptomatic infection
hepatitis B 137, 155–156
polio 77, 90
tuberculosis 108, 189
varicella zoster virus 147, 181
Athens, Plague of 7–8, 15
attention deficit hypersensitivity disorder 192–193
attenuation 61–62, 120
anthrax vaccine 62
BCG vaccine 104, 165
chickenpox vaccine 150, 326
definition 323
HIV vaccine 285
influenza vaccine 183, 290
MMR vaccine 146
nasal vaccines 290–291
polio vaccine 84, 86, 288
rabies vaccine 66
RSV vaccine 291
rotavirus vaccine 139, 288
rubella vaccine 169
shingles vaccine 181, 327
smallpox vaccine 34
yellow fever vaccine 197
Auschwitz concentration camp 242
Austin, Thomas 63
A
ustralia
Aboriginal people see Aboriginal Australians
antigen see hepatitis B surface antigen (HBs)
compensation for vaccine injuries 260
colonisation 25, 31–33
foreign aid 275–276
HPV vaccine 151, 162, 163, 230–231, 234
MMR–autism controversy 222
smallpox immunisation 45–47
unimmunised children 255–256
Australian Broadcasting Corporation (ABC) 23–24
autism
changed definition 223–224
MMR see anti-vaccination movement, MMR–autism controversy
thiomersal 192–193, 225
Autism Media Channel (Texas) 221–222
Autism’s False Prophets (book) 220, 224
autistic enterocolitis see MMR–autism controversy
autoimmune disease 155–156
autonomy
healthcare workers 257–258
principle 247–252
Aztec Empire 30
Aβ see amyloid-beta protein
Baby-Friendly Hospital Initiative 267
Bacille Calmette-Guérin vaccine see BCG vaccine
bacterial infections 8–9
meningitis see meningitis
Baker, Bessie 188
Band-Aid vaccines see patch vaccines
Bangladesh, influenza trial 175
Banu, Rahima 54–55, 57
Barnes, Graeme 138
Barr, Richard 210
Bashir, Qari 95
Bayer 204
BCG vaccine
bladder cancer 154, 165–166
current use 107–108
development 104, 106
definition 324
effectiveness 104–105
jet injectors 291
Lübeck tragedy 189–190
statistics 228
Beauchamp, Tom 246, 247
Beazley, Kim 76
Bedson, Henry 56–57
Behring, Emil von see von Behring, Emil
Belgium, compulsory immunisation 254
beneficence principle 246
Bergen, Dr de see de Bergen, Dr
Bernhardt, Sarah 64–65
Bert’s Balls 75
bias and clinical trials 107
bilirubin 195