What makes a vaccine work? The case of the different meningococcal A vaccines (1963-69)
Résumé
In the 1960s, the WHO launched a project to produce an effective vaccine to combat cerebrospinal meningitis A, considered a significant public health problem in Africa.
In 1963, the WHO engaged the Institut Mérieux to develop a suitable vaccine. Assisted in its task by the WHO and a team from the Institut de Médecine Tropicale du Service de Santé des Armées, the Institut Mérieux prepared a prototype vaccine which was tested in Yako, Upper Volta in 1967. Although this trial demonstrated the safety of this vaccine it could not prove its effectiveness because the predicted meningitis epidemic did not break out. For 2 years after this episode the Mérieux vaccine continued to be quite widely distributed in Africa to test different properties, but never its efficacy as a prophylactic. In 1969, Emil C. Gotschlich at the Rockefeller Institute developed an effective polysaccharide vaccine against the cerebrospinal meningitis C. The WHO and the Institut Mérieux engaged a collaboration with Gotschlich, benefitting from his expertise, and his polysaccharide technique to produce an effective meningococcal A vaccine a few years later.
In this presentation, we will analyze this episode of the shift in technique to produce the meningococcal A vaccine, going from a ‘whole cell’ vaccine to a polysaccharide vaccine. Deploying the concept of ‘doable problems’ developed by Joan Fujimura, we will examine the complex range of factors (we will take into account economic, political, ethical and epidemiological considerations, among others) that led to abandoning the first technique (without any clearly stated justification), and we can thereby examine the issue of what counts as a suitable justification for using a given vaccine.