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Debates over virulence, killed versus live virus, and antigenic strains have played a critical role in setting the parameters of the production and manufacture of safe and effective vaccines for more than one hundred years. The controversy between Jonas Salk, who advocated a killed polio vaccine, and Albert Sabin, who preferred a live polio vaccine, characterizes this divide, although there are many more examples. 29 For instance, as measles immunization was becoming widely accepted in the United States in the 1960s, a formalin-inactivated vaccine licensed in 1963 was withdrawn because it induced short-lived immunity and predisposed recipients to atypical measles syndrome if they were exposed to the wild-type measles virus. Ultimately safe and reliable vaccines were developed from the original Edmonston B strain (initially isolated by John Enders and Thomas Peebles in human and monkey cell cultures in 1954). 30 One of these attenuated vaccines, the Moraten strain, is the only measles vaccine used in the United States today, while two additional strains—the Schwarz and Edmonston-Zagreb—are employed in worldwide immunization campaigns against a disease that infects approximately thirty million children per year, killing approximately 750,000 of them. 31 In the case of BCG (bacillus Calmette-Guérin) vaccination against tuberculosis, developed in France in 1921, concerns about efficacy and safety led to very different patterns of vaccine acceptance. In Scandinavia, BCG was mass-distributed as part of the emergence of a comprehensive social welfare program. Conversely, in the United States and Britain, acceptance was much slower because of greater confidence in the long-term benefits of tuberculosis testing and treatment and apprehension that mass BCG vaccination might misconstrue the results of mass-scale tuberculin Mantoux PPD (purified protein derivative) testing by delivering large numbers of false positives.

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Protesting VaccinesEspecially in the 1830s, after an initial generation had been vaccinated and the incidence of smallpox had declined markedly in the United States and Europe, a vociferous antivaccination movement emerged. 33 Sometimes antivaccinationists were protesting what they considered the intrusion of their privacy and bodily integrity. Many working-class Britons, for example, viewed compulsory vaccination laws, passed in 1821, as a direct government assault on their communities by the ruling class. 34 In addition, by the mid-eighteenth century the rise of irregular medicine and unabashed quackery encouraged antivaccinationism. For instance, irregulars generally viewed vaccination as a destructive and potentially defiling procedure of heroic medicine, akin to blood-letting. 35 In addition, antivivisectionists, who abhorred animal experimentation, sometimes joined forces with antivaccinationists.