Ounce of Prevention, Pound of Misery?

0 Comments | Insight on the News, March 22, 1999 | by Aimee Howd

Halsey tells Insight he doubts the credibility of people questioning the vaccine. But Dunbar's 25 years as a research scientist and medical-school professor and her National Institutes of Health honors for pioneering work in contraceptive vaccines are sturdy credentials.

Today's recombinant hepatitis B vaccine derives from a surface protein of the virus molecule. Dunbar suggests that similarities between the antigen and proteins in human nerves and tissues could trick the autoimmune systems of the genetically susceptible into attacking themselves. In Science magazine last summer, Halsey scoffed at that theory, asking how a fragment of virus protein used in a vaccine could cause symptoms not even caused by the virus.

Dunbar explains that any part of a virus molecule introduced into the human body can be met by a unique immune response. "The same rigorous testing [is required] every time you change the vaccine. The companies don't want to hear that because it is going to cost them a lot of money."

William Hildebrand, an immunogeneticist at the University of Oklahoma, plans to take a close look at the five or six genes that are responsible for controlling the immune response. Three observations lead him to conjecture that an individual's HLA genotype may mediate how he or she responds to the vaccine: Almost all negative responses occur in Caucasians, the number of genes determining autoimmune responses varies from race to race and the reported adverse responses are consistently autoimmune in nature. "It justifies asking what are the reactions and how frequent are they," Huldebrand says, "and that's all I would argue needs to be done at this time. If you understand which genes are involved in the adverse response, you can begin to understand the adverse response."

Until the research is done, however, Hildebrand remains skeptical of both sides of the debate. "One side is saying you can't prove [a cause-and-effect relationship]. The other side is saying, `You know something is going on here.' I say let's find out. If you say that the world is flat and you don't do research, maybe the world will stay flat."

Denied government grants, funding for this research is being supplied by private donations, often from patients and surviving families. The initiatives of the inquiring scientists are important to bewildered survivors such as the Jacks, who have moved to Pennsylvania where they have been assured they can obtain a medical exemption for a second child they are expecting this summer. For two years they believed they were alone in their suspicions about the vaccine. Then a friend told them about an investigation and televised report by the TV newsmagazine 20/20.

While searching for the Internet version of the TV report, Jack found contact information for a father who had appeared on the show. That man is Michael Belkin, a New York financial adviser whose search for answers after his 5-week-old daughter died hours after her vaccination led him to apply his statistical training from the University of California at Berkeley to the tangled web of epidemiological studies at the core of the hepatitis B vaccination controversy.