The Need for Support From the General Public

Vaccine development has historically been influenced by many social forces, including media attention, the interests of pharmaceutical companies, and the hopes and fears of the general public. In the past, the interplay of these forces has had a critical impact on the ultimate public health outcomes of vaccine research.

Public enthusiasm was an essential ingredient in the race to find a vaccine for polio. Most of the funding for research came from the National Foundation for Infantile Paralysis (better known as the March of Dimes) which depended on individual contributions. Public support was needed to maintain financial contributions, but also played an important role in pushing the scientific establishment towards endorsement for a massive human trial. The press gave extensive coverage to polio vaccine research. In his analysis of the politics and public relations of polio vaccine development, Harvard medical school historian Allan M. Brandt observed that," ...where public demands and expectations are great, sound scientific judgment may be jeopardized. The Salk vaccine was sold to the public before its safety and efficacy were proven."5

Three decades later, it was fear of public reaction which prompted medical professionals to take the opposite approach and minimize the general public's knowledge of an epidemic in their midst. High rates of hepatitis B infection had been identified in some sectors of the population, including health care workers, gay men, Asian immigrants, and others. What followed was a series of decisions designed to quiet public concern about the problem: the medical community played down the potential threat of patient infection by health care workers, and physician organizations resisted large-scale testing of their members. hepatitis B was portrayed as primarily a problem of particular groups and not a major concern for the general population.

In 1982, a hepatitis B vaccine was developed with the assistance of the pharmaceutical company Merck, but because of previous efforts to keep the epidemic quiet, the public remained largely ignorant of the danger of the disease or the new potential to prevent it. William Muraskin, a professor at City University of New York, has observed that, "since there was no public concern, there was not public outrage at the high cost of the vaccine or the quasi-monopoly that Merck had obtained for itself."6 The result was a costly vaccine which failed to stem the epidemic for years after it was licensed.

In both these examples, leaders in the medical establishment and the media made choices about what should become general knowledge because it was assumed the public's expectations would play a pivotal role. A similar dynamic with HIV is likely.

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