The true story of pertussis vaccination: a sordid legacy?

URING the last half of the twentieth century, pertussis vaccine has been at the center of controversies over the evaluation and marketing of vaccines for children. This controversy has transcended the simple confines of scientific research to redefine relationships among industry, government, law, and consumer advocacy. The dangerous side effects of whole-cell pertussis vaccine have been known for at least the last five decades, and for the last four a safer alternative has been available. But not until the late s has that safer alternative become routine for American children. This paper explains why and how this transformation in care took place. We were part of the transformation, supporting the advocates for the new, acellular vaccine with scientific testimony. Although our appearance in this story takes place in the s, the history of the vaccine began much earlier in the twentieth century. Even though there was incidental medical evidence as early as the s and clear-cut evidence by the s that whole-cell pertussis vaccine caused neurological sequelae,American pharmaceutical companies by and large persisted in marketing whole-cell vaccines until the end of  because the acellular versions, in their opinion, were too costly to produce, test, and sell.Nevertheless, U.S. manufacturers were granted at least one patent in every decade since the s to produce acellular pertussis vaccines, and several countries either legislated the use of the acellular form only or stopped using pertussis vaccination altogether. Change finally began in the United States in