email Dr Kerns
The Thesis position (which urges
bolder action) and the Antithesis position (which urges more cautious
reflection), might, despite their many disagreements, still both
agree on the ultimate value of discovering a successful preventive
vaccine. Both positions will probably also agree that the use
of prevention measures is a much more effective way to control
serious disease than the use of treatment measures. It will be
better, in other words, if most people are never infected with
the disease.
All the principles of human compassion do require, of course,
that we make every possible effort to discover treatments for
those who already suffer from the disease. But, in addition, the
principles of human compassion also require that we make every
possible effort to help prevent new infections in persons who
are not yet infected.
Preventing a disease with a vaccine is inherently more effective
than curing a disease with antibiotics or chemicals, for four
reasons: a) because prevention modalities (particularly vaccines)
by their very nature strengthen our innate resistance mechanisms,
rather than weaken them. Treatment with modern antibiotic and
chemical therapies can often weaken innate resistance to invading
microbes, thereby making us ultimately more vulnerable to infection
than we were before being treated. b) Preventive modalities are
better because they eliminate the sufferings of sickness altogether,
whereas a curative modality only shortens those sufferings (though
this shortening is extremely valuable, of course, for those who
have already contracted the disease). c) A preventive modality
also reduces the pathogen's pool of reproduction, since the pathogen
is prevented from finding other hosts. d) And finally, this in
turn has the additional advantage of reducing the pathogen's opportunities
for mutation toward increased virulence. Ben Franklin certainly
spoke wisely when he had Poor Richard remind us that an ounce
of prevention is worth a pound of cure.
The development, licensing, and
aggressive use of successful vaccines for the prevention of various
diseases around the world has been an enormous benefit to the
public health of the world's peoples. In fact, "with the
exception of safe water, no other modality, not even antibiotics,
has had such a major effect on mortality reduction". We can
only hope that there will someday be - hopefully sooner rather
than later - a vaccine that can also help diminish the incidence
of HIV infection and AIDS.
If such a successful vaccine is ever discovered, tested and licensed,
its successful development will be largely due to the courage,
the altruism, and the heroism of the thousands, and hundreds of
thousands, of individual human beings who will have volunteered
for these experiments.
There will indeed be many to admire, of course - the CEOs of the
pharmaceutical companies who made the difficult judgments and
who undertook the great financial risks of sponsoring lengthy
and expensive basic vaccine research; the directors of governmental
and intergovernmental agencies (such as WHO) who have put so much
effort into making these vaccine trials come to pass; the many
individual researchers who took the chance of staking their careers
on years-long laboratory explorations, many of which may not have
paid off; ethicists and persons sitting on ethics review boards
who had to make the hard choices, amidst intense passion, hope
and disappointment, to approve or deny proposed research protocols;
as well as many others, too numerous to mention.
But the individual persons who volunteered for these trials must
not be forgotten either. They will, after all, be the ones taking
the risks with their own bodies and receiving few, if any, of
the benefits. Their contributions will be at least as important
as the contributions of those whose names make the headlines.
They too will deserve our esteem, our admiration and our lasting
gratitude.
On the last page of his famous novel, The Plague, Albert Camus has his narrator explain to the reader that
Dr Rieux resolved to compile this
chronicle [of the plague], so that he should...bear witness in
favor of those plague-stricken people; so that some memorial of
the injustice and outrage done them might endure; and to state
quite simply what we learn in time of pestilence: that there are
more things to admire in men than to despise.