Kim Tolley, Vaccine Wars: The Two-Hundred-Year Fight for School Vaccinations

Kim Tolley's book offers several important contributions to the large literature on vaccine controversies, rich with important new information and a coherent, compelling story.First, the book's focus is unique: rather than focus on public health (though the book also addresses the public health effects of vaccine decisions and outbreaks, and offers extensive data on that score, too), the book looks at the unique place schools occupy in the struggle around vaccination rates.Because of this focus, Tolley covers issues I have not seen in any other book -such as curriculum coverage of infectious diseases and vaccines, the role of school officials, including school boards and superintendents, in battles around vaccination rates, the role of parents, and the way the government interacts with both education and infectious diseases.Second, the book's approach is more comprehensive and more interdisciplinary than most books on vaccines.Tolley includes developments in science and public health in the time period covered -early nineteenth-century to present (in the United States), but also an in-depth review of litigation and social activism, and a careful examination of the political context and the different actors struggling.Her story is both topdown -what government did -and bottom-up, what activists, parents and citizens did, and she looks at how these interacted.She also includes careful empirical examination of news coverage of the issues involved and legislation trends.All of these make the book a valuable addition to the literature on vaccine controversies that covers topics that have not yet been thoroughly examined.Tolley's thesis is one of both change and continuity from past to present.Although she opens the book by suggesting that "the differences are great" (6), throughout the book she highlights both continuities and dramatic changes.Starting with the similarities across periods, Tolley rightly emphasizes that since early days, alternative medicine practitioners had a role in opposition to vaccines.She also tracks the changes that resulted from growing acceptance of germ theory -alternative practitioners' attitudes changed, and the interaction between alternative medicine and allopathic medicine developed over time, and Tolley provides a careful, nuanced, and in-depth story of these developments.Another common thread Tolley highlights is the role vaccine risks -real and perceived -play in creating hesitancy around and in opposition to vaccines.In the early days, those risks included the very real threats of contamination of the smallpox vaccine with other viruses or bacteria in a time when hygiene was not always practiced, and the risks of the vaccine itself.Closer to today it was both the risks of real but rare vaccine side effects and the risks of harms that vaccines do not cause, but that opponents attributed to them, which contributed to hesitancy.For example, the Cutter Incident (1955)-in which children were injected with a polio vaccine where the virus was not inactivated, in effect, with a live polio virus -caused real harms that shook confidence in the polio vaccine.But the untrue claims of a link between vaccines and autism also undermined trust.