Shutterstock/Montebasso. All rights reserved.Suspicions and conspiracy theories regarding vaccines have been around as long as vaccines themselves. Vaccines are a powerful and frankly, a scary technology. They are based on placing a version of an often grave disease in the human body, to build up an immune response. In this sense, they carry the potential to create illness instead of preventing it. Most importantly, they are usually administered to a population that is most vulnerable in a physical, social and cultural sense: children.
Since it is usually states that mandate, distribute and sometimes manufacture vaccines, distrust in this obscure and potentially risky technology often maps onto distrust in the state. Anti-vaccination movements in the United States and Europe are good examples of bringing to light the problematic relationships between citizen and state, as are the recent Ukranian polio cases during the breakdown of an administration. In other cases, distrust is toward another state or political power. This is an issue frequently encountered in global eradication campaigns, for instance resistance in recent years to polio vaccination in Northern Nigeria or Pakistan, where some fear that the Sabin vaccine is a tool of sterilization and part of a western scheme to crush local populations.
However, such suspicions of vaccine are not exclusive to current campaigns, nor are conspiracy theories like the above restricted to the Global South. The development of live polo vaccines, like the Sabin vaccine, which has been the major tool of global polio eradication for many decades, was engulfed in very similar concerns and suspicions. Part of these suspicions was rooted in the novelty of the vaccine and the scientific uncertainty surrounding the disease and its prevention. Another component of these conspiracy theories must be attributed to the unfolding Cold War.
A new vaccine
Among vaccines, live ones are especially tricky: unlike unactivated vaccine, in which the virus itself is killed, they contain a weakened, but live virus that is potent enough to elicit an immune response, but not strong enough to cause illness. The major concern regarding the live poliovirus vaccines has been their potential to turn virulent and cause paralysis – or even epidemics. This concern was very much shared among the scientific community: countless articles and international conferences debated the safety of the vaccines as virologists moved from the lab to field testing in the late 1950s.
The issue of vaccine safety has been a constant concern since the introduction of live polio vaccines. In the course of the 65 years and more since the live vaccine developed by Albert Sabin begun to be used worldwide, virologists have determined some of the risks of vaccine-associated paralytic polio (VAPP) and vaccine-derived polioviruses (VDPVs) and current eradication campaigns have integrated these possibilities. However, other suspicions about the research methods and trial procedures of the 1950s vaccine development era have surfaced recently, bringing to light distrust in the scientific community as an establishment.
The most well-known conspiracy theory in polio vaccination regards Koprowski’s trial in the Belgian Congo as put forth by journalist Edward Hooper in his book The River, published in 2000. Hooper argued that during the production process Koprowski’s vaccine was contaminated with SIV (Simian Immunodeficiency Virus) and became the ultimate cause for the origins of HIV. The HIV origin theory emerged in the wake of the shock of a global epidemic of an unknown virus and speaks most of all to current issues of power within scientific and academic communities. The book and Hooper’s argument gained worldwide publicity and the allegations were not taken lightly. The Royal Society launched an investigation and independent laboratories examined frozen samples, concluding that Hooper’s theory lacked sufficient evidence. Hooper claims that the wrong samples have been chosen for examination and firmly upholds his theory.
Cold War suspicions
Suspicions about the development and introduction of live polio vaccines in the 1950s have not only appeared retrospectively. The development of what became the tool of the current global polio eradication campaign was beset by distrust in scientific achievements and worries about intentional harm. Russian scientists feared that the Sabin vaccine and its trial in the Soviet Union was part of an American plot to sterilize or kill Soviet children by the millions, while American virologists were suspicious of the Russian claims regarding vaccine safety and efficacy based on field trials. These concerns might ring familiar today, but they were the product of a particular political and social context and existed alongside intensive co-operation that worked against the same fears.
In order to understand the suspicions and conspiracy theories that peppered live polio vaccine development and shaped scientific discourse and decision-making, we need to take a look at the geopolitical background and the often conflicting international co-operation in the history of polio.
In the face of rising epidemics, polio became to be considered as a “world problem”, as termed by Anthony Payne, head of the WHO’s Communicable Diseases Division. More and more countries experienced more and more severe polio outbreaks and by the 1950s it became a common concern that arched over political ideologies and borders. In countries that suffered grave demographic shocks in World War II, the peak in epidemics that left children paralysed by the thousands coincided with pro-natalist policies and reconstruction programs that magnified the consequences of polio’s threat.
The growing global concern over polio provided space for international co-operation on a seemingly neutral ground. Virologists working on live vaccines participated in an intensive exchange of knowledge, data and specimens that reached over the iron curtain and crossed continents. Scientists met regularly at international conferences, lab visits and study trips. In the 1950s, Albert Sabin, Hilary Koprowski and Herald Cox tested three different vaccines in field trials spanning four continents, from Singapore through Poland to Mexico.
At the same time these co-operations were often engulfed in mutual mistrust and the suspicion of hidden political agendas. A Hungarian physician’s experience in the Soviet Union shows the extent to which suspicions pervaded scientific work and public health policies. Domokos Boda, paediatrician and key player in polio prevention and treatment in Hungary, was part of the delegation sent to the Soviet Union in 1959. The task at hand was to give expert advice on whether to implement the Sabin vaccine in Hungary, which was at that point tested in mass vaccination trials across the USSR. The members of the delegation visited labs engaged in both Salk and Sabin vaccine production. According to Boda, one of the Russian virologists there pulled them aside and told them not to trust the Sabin vaccine. His argument was the following: the Americans conducted field trials on home ground for the Salk vaccine, but the Sabin vaccine did not go through the same process. It was only being tested abroad, on Russian soil. The Salk vaccine therefore is safe, but the Sabin vaccine was designed as part of a plan to undercut the Russian population.
The Hungarians were aghast. What should they do? Many Hungarian virologists had long-standing professional relationships with Sabin and were overall convinced by the results. They were to include all their experiences in the report to the government, but they knew that if they spoke of this theory, the Hungarian leadership would not proceed with the implementation. They chose to keep quiet and went on to recommend the Sabin vaccine, and Hungary became one of the first countries in the world to use the new vaccine in a nation-wide mass vaccination campaign.
The Hungarian virologists’ concerns were well founded. By the end of the 1950s the choice of vaccine in Hungary was a high stakes one. Despite mass campaigns with the Salk vaccine, an unexpected and severe outbreak shook the country. The state needed to act fast: after the bloody 1956 revolution, the government needed to prove that it was capable of solving crises. It could not risk any signs of weakness. Unsurprisingly, the Kádár government, whose members had assisted in crushing the revolution were not regarded as highly trustworthy. Rumors of the time still circulate to this day to the effect that the government cut Salk vaccine doses by half, and that it was this disregard for the health of children that led to the new outbreak.
Suspicions and conspiracy theories were abundant on the western side of the Iron Curtain as well. Many American scientists distrusted the Russian field trials and were reluctant to accept the data on efficacy and safety as produced by the Soviet system. Just like some of their Russian colleagues, albeit for different reasons, they did not trust the Sabin vaccine, precisely because it was tested on Russian soil. Their Russian colleagues responded with a sentiment similar to that voiced in Sting’s Cold War hit decades later: the Russians love their children too. Why would they put their own in harm’s way?
In order to resolve the situation, the WHO emerged as a neutral agency to determine if the Sabin trials were scientifically sound. On American request, Dorothy Horstmann, renowned virologist from Yale University visited the Soviet Union to investigate the field trials on site and to investigate the validity of the data. Horstmann’s positive report to the WHO was a game-changer for the western world and for the acceptance of the Sabin vaccine as a polio prevention tool on a global scale. Interestingly, the arguments Horstmann lined up to back her claims fed from the same stereotypes of the Soviet state system as those on which American fears were based. It was exactly because it was the Soviet Union that one should trust the trials, she argued. They had the military-like public health organization system, the compliant population and total control that were all ideal for such a trial and served as guarantees for conducting the mass vaccination efficiently and reliably. Three years after the Soviet Union, Czechoslovakia and Hungary introduced the Sabin vaccine into their national vaccination program, the United States followed suit. (You can read more on the Hungarian story and Horstmann’s visit to the USSR here).
Easily dismissed by some as fictional and outright entertaining, or considered the ultimate truth by others, these suspicions and conspiracy theories, whether voiced by the target population, the authorities or the scientific community have very real consequences. Some have laid the foundations for new outbreaks of forgotten diseases, others served as a springboard for an international organization to find a long-lasting role in its formative years.
From a historical – and contemporary – perspective, it is precisely because of the palpable effects of the lack or presence of confidence in vaccines, and because of the high stakes involved (both for the health and safety of individuals and society) - that these suspicions and conspiracy theories warrant a need for a closer analysis.
Trust is key in any public health intervention, whether local or global, and examining suspicions, such as those surrounding polio vaccines, reveals much about how that trust is produced and reasons why it might be lacking. The relationships and expectations between state and citizens, scientific communities and the public, and political or ideological adversaries, is above all what we need to understand.