October 12, 2023 • 27 mins
What can the mythical jackalope teach us about HPV? Author Michael Branch tells the story of how scientists first discovered horned rabbits, and how their findings paved the way for the study of all different kinds of papilloma viruses. Then, Elena Conis joins the shows to discuss the rollout of the human papilloma virus (HPV) vaccine in the US and Americans’ complicated relationship with vaccine mandates.
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
What's a jackalope.
Speaker 2 (00:08):
A jackalope is a mythological creature, a sort of iconic
to the American West. It's a combination of a jack
rabbit and a prong horn antelope. So it's a jack
rabbit that has antlers or horns, and it exists richly
in the imagination of Americans, especially in the West. But
it is a mythological creature.
Speaker 1 (00:28):
This is Michael Branch, a man who loves the jackalope
so much that he wrote a book about it. It's
called On the Trail of the Jackalope. Is that a
jackalope on your shirt? Or am I mistaken?
Speaker 2 (00:40):
Yeah, that's a jacalobe. Of course. Jacoalobe kitch is a
huge part of the phenomenon. And so you know, if
you've ever seen a jacalobe bumper stick or t shirt,
shot glass, taxidermy mount, you're part of the hoax. You're
in on the joke.
Speaker 1 (00:55):
The jackalope is a myth, but there are in fact,
real horned rabbits. Is an expert on these two, and
those horned rabbits led to a key breakthrough in understanding
how viruses cause disease. Today on the show Horned rabbits,
human papilloma virus AKAHPV, and a vaccine backlash. This is incubation.
(01:18):
I'm Jacob Goldstein. So there's this myth of the jackalope
in the US. There are mythological horned rabbits, and in fact,
there are real horned rabbits in the world. Right, we've
(01:40):
been talking only of myth. But tell me about tell
me about real horned rabbits.
Speaker 2 (01:46):
So called horned rabbits are actually various species of rabbits
that develop these weird, grotesque growths on their heads, sometimes
on their faces, and they're produced by a papilloma virus.
And both hunters and common people and also naturalists have
noticed these forever without having any idea what caused them.
Speaker 1 (02:08):
And what does it look like.
Speaker 2 (02:12):
Let me put it this way. When the slide of
an actual horn rabbit comes up when I'm doing book talks,
you can hear a collective groan from the audience. I mean,
it is quite grotesque. And if you can just imagine bumpy, wordy,
caratinous black growths all over the face or head of
an animal, that's what it looks like.
Speaker 1 (02:32):
So you mentioned that that these horns, these growths are
caused by a papolloma virus, which turns out to be
important in the history of understanding viruses and ultimately in
the history of human health.
Speaker 2 (02:45):
Right yeah, And it involves a guy named Richard shop
who had actually been involved in trying to figure out
what had caused the global pandemic of nineteen eighteen. By
the time he got interested in horn rabbits, he was
already a well known virologist. This would have been the
late nineteen twenties early nineteen thirties, and he had come
from his home in Iowa to Princeton to take up
(03:06):
this research position as a medical researcher. And he heard
stories from his friends back in Iowa and Kansas who said, hey,
you know, sometimes when we're out rabbit hunting, we kill
these rabbits that have these weird growths on them. And
of course, you know, being a scientific researcher guy interested
in viruses, you know, he immediately wanted to see one
(03:27):
of these rabbits. In fact, he wanted to see him
so badly that he made a special trip back to
Iowa with a hunter who had claimed to have shot
a number of these rabbits, and Shope himself hunted specifically
to try to get one of these rabbits with the
strange growths. After four days, he was unsuccessful and he
had to go back to Princeton. There was a young
young kid who had been hunting with them, and he
(03:48):
told that kid, Hey, I'm going to leave you a
five dollar bill and a bottle of glycerol solution, and
if you can find one of these rabbits, cut off
its horns, put him in the solution, mail them to me,
and I'll give you another five dollars. He could see
from the very beginning that if he could demonstrate a
link between viruses and cancer in a mammal that he
(04:10):
would be opening the way to research that might ultimately
address that question in human beings.
Speaker 1 (04:15):
Ah. So he wants to find out whether a virus
is causing these growths, these horns to grow out of
the heads of rabbits exactly.
Speaker 2 (04:25):
And soon as Chope left Iowa, this kid just made
it his mission to get one of these rabbits, and
he did so. He mailed Shope the horns in the
glyceral solution. He got his other five dollars, and after
that the word get out among the communities of hunters
in Kansas and Iowa, and people began to literally mail
specimens of horn rabbits to shop in Princeton.
Speaker 1 (04:48):
So he's there in Princeton and he goes down and
gets his like whatever, his insurance bill, and then a
box with a dead rabbit in it, exactly.
Speaker 2 (04:56):
And he started working on horn rabbits there at the
Rockefeller Inns Institute in nineteen thirty two with the goal
of understanding what caused those odd growths. He is especially
interested in viruses, and he is doing his work at
a time when the consensus in the scientific community is
that it is impossible that a virus could cause cancer,
(05:18):
especially in a mammal. And at the time, you know,
nobody knew what caused these weird growths, and he wanted
to find out what caused them, but he suspected that
it was a virus, and so he set out to
sort of test that hypothesis through his own experimental method.
Speaker 1 (05:35):
So when you say his own experimental method, what do
you mean, what do you do?
Speaker 2 (05:40):
Well? First, he samples these weird growths on the rabbit's heads,
and he takes those samples and pulverizes them, adds them
to a saline solution and then runs them through a centrifuge.
And then he takes the fluid that has been produced
by that process and then does what is really the
most important thing. That is, he takes that fluid and
(06:02):
puts it through a filter. Now, back in the nineteen thirties,
in the kind of pioneering era of viral research, these
porcelain filters were very important because they could filter out
bacteria and other larger things. The only thing small enough
to go through these filters was a virus. Huh.
Speaker 1 (06:20):
It's interesting, right, because that it seems sort of primitive
to us on a certain level, but also kind of ingenious, right, Like,
they know not that much about viruses at the time,
but they know they're way smaller than bacteria and that
those are the two main kind of disease causing pathogens, right,
And so they're like, Okay, let's just make a filter
(06:41):
that will take out bacteria and anything else that can
cause a disease, but that will allow viruses to pass
through that we know that that's the only pathogen that
could be left in here.
Speaker 2 (06:49):
Exactly exactly the fact that he uses this technique to
make sure that the only thing that can come through
that porcelain filter. Is a virus is kind of a
key moment.
Speaker 1 (06:59):
Okay. So now he has his whatever, his gou his
solution that we know has no bacteria in it that
he's going to do something with. What's he do with it?
Speaker 2 (07:09):
Okay? So he takes live rabbits that are healthy. He
shaves a little bit of their fur off and then
scarifies their skin, just roughs it up just a little
bit with some sandpaper, and then he takes that fluid
that has gone through the filter and applies it to
that little spot on the rabbits. And the idea is
right that since this fluid has been taken from the
(07:29):
horns of disease rabbits, and since it's been filtered to
make sure the only thing that can be in it
is viruses, he has essentially applied a fluid to these
healthy rabbits. So the whole idea is to wait and see.
Having no idea if virus is the cause, or if
it is what the incubation period might be, he applies
this to these patches on his test rabbits, and sure enough,
(07:52):
after about ten days, all of the rabbits that he
has inoculated with this fluid begin to develop exactly the
same kinds of growth that were present on the diseased rabbit.
And that's sort of the Eureka moment in the story,
because that's the moment at which Shope has essentially proven
that the growths on horned rabbits are in fact caused
(08:13):
by a virus.
Speaker 1 (08:14):
Does he publish the results? How does this finding land?
Speaker 2 (08:18):
He publishes his work the following year, which is nineteen
thirty three, in a watershed article in the Journal of
Experimental Medicine, and you know, outside of fellow researchers in
the virology community, it really doesn't go far at all,
even though it's a huge breakthrough.
Speaker 1 (08:35):
After his paper comes out, do people recognize that viruses
can cause cancer in mammals?
Speaker 2 (08:43):
They do, but it takes a while, you know. I
think that the scientific community was so thoroughly resistant to
this idea that it wasn't as if everyone realized right
away what the implications of the work were. That's going
to be left to other researchers, most importantly a guy
named peyton Us who was a colleague of Shops at
the Rockefeller Institute. Peyton Russ will go on to do
(09:05):
the extended studies that will prove the hunch that showpad
all along, which is that some of those growths can
become cancerous.
Speaker 1 (09:13):
Aha. So that's ultimately showing Shope's work and the work
of his colleague shows that in fact, a virus is
causing cancer in a mammal.
Speaker 2 (09:24):
That's the kind of big breakthrough exactly. And so that's
sort of the first step toward working on viruses as
cancer causing agents in human beings. It's going to take
several generations of scientists to explore the implications fully.
Speaker 1 (09:41):
In the decades after Shope did his studies on rabbits,
scientists kept studying papillomaviruses. They discovered a human version of
the papaloma virus, which reasonably enough, they called the human
papalomavirus or HPV, and in work that wound up winning
a Nobel Prize, another researcher definitively HPV to cervical cancer. Eventually,
(10:03):
we learned that over ninety percent of cervical cancer cases
are caused by HPV, and that HPV is also a
common cause of throat cancer. Despite all that, when a
new vaccine promised to prevent HPV, infection. Not everybody was excited.
That's after the break the first HPV vaccine was rolled
(10:31):
out nearly twenty years ago. People in the vaccine world,
in the public health world, and the cancer world were
very excited. This was a vaccine that could prevent cancer
or at least some kinds of cancer, and HPV vaccines
are in fact used around the world today. As it
turned out, though back when the vaccine was first approved,
(10:51):
many people were not excited.
Speaker 3 (10:53):
Support was coming from everywhere, but backlash was coming from
everywhere too, like all over the political spectrum. Exaggeration to
say it's a total mess.
Speaker 1 (11:03):
This is Elena Konis. She wrote a book called Vaccine Nation,
America's Changing Relationship with Immunization, and she told me that
the controversy over the HPV vaccine was really part of
this much bigger story. She said, it was the culmination
of this deep seated conflict that had been building for decades.
Speaker 3 (11:21):
In my view, you really can't understand what happens with
the HPV vaccine in the early two thousands unless you
rewind the clock back to the nineteen fifties actually, and
that was because that was a decade when we got
a new vaccine, the polio vaccine that was desperately hoped
for the entire public. Really in some level was invested,
(11:44):
and when that vaccine was developed and rolled out to
the public in nineteen fifty five, it ushered in a
new era of vaccination in the US. We started vaccinating kids,
especially against a wide range of diseases. We started ensuring
(12:06):
that they were vaccinated by making vaccines required for kids
to enroll in school. We made them required by passing
laws and regulations at the state level, and we did
all of this with a lot of federal support. Polio, smallpox, measles, mumps, rubella.
What's important about this list of diseases is that they
(12:27):
were really different in kind. Polio and smallpox were widely
feared dreaded diseases. The policies that we developed for polio
ended up being applied to these other vaccines.
Speaker 1 (12:39):
Policies meaning state laws requiring them for kids to go
to school, and the federal government supporting and even subsidizing
those laws.
Speaker 3 (12:48):
Yes, and this is happening in the nineteen sixties. It's
coinciding with the rise of all of the social movements
of that decade that are encouraging young people in particular
to question authority and to ask for more information and
to push back against institutions.
Speaker 1 (13:09):
I mean, very broadly, more distrust of authority. Right plainly, Yes,
Certainly in the nineteen seventies, if not before, people in
many domains began to trust institutions and authority less, and
that persons.
Speaker 3 (13:22):
Absolutely, And that actually leads into a kind of ironic
moment in this late twentieth century history of vaccination, because
by the nineteen eighties we have an organized vaccine safety movement,
and I should say this is how they describe themselves.
They don't call themselves anti vaccinationists. They lobbied for and
(13:43):
ultimately succeeded in getting a change in federal legislation. In
nineteen eighty six, Reagan signs a new law to provide
compensation to individuals and families who have suffered injuries from
mandated vaccines, and also creates the infrastructure for a nationwide
(14:03):
system to monitor the public for vaccine injuries. So we
get to the end of the eighties with the very
organized and very successful national movement, and in the meantime,
a handful of other childhood vaccines come out in the background. However,
this organized self described vaccine safety movement has not stopped.
Speaker 1 (14:27):
So tell me the story of the HPV vaccine and
it's rollout.
Speaker 3 (14:31):
So the HPV vaccine is so interesting in the history
of vaccination because it comes out in the early two
thousands and its rollout really represents a turning point. And
when I talk about the HPV vaccine, initially, I'm talking
about Merk vaccine Gardasil.
Speaker 1 (14:49):
That was the first HPV vaccine approved in the US.
Speaker 3 (14:52):
Yes, that was the first one approved for use in
the US. It protected against four strains of HPV, and
scientists knew very well that those four strains were linked
to a very high proportion of cases of cervical cancer
in the US. So there's multiple ways of getting cervical cancer,
(15:13):
but one really important way is infection with HPV, and
this vaccine protected against four strains known to be linked
to cervical cancer. Mirke was excited about this. Reproductive health
advocates and providers were excited about this, but Mirk knew
that it faced a problem. HPV was not a virus
that the public knew much about at all. In fact,
(15:35):
they had hardly even heard of it, and that meant
that they really didn't know about the link between HPV
and cervical cancer. So before the HPV vaccine was approved,
Merk ran an ad campaign, and the ad campaign specifically
targeted women and told them that there was a virus
(15:56):
called HPV and that it was linked to cervical cancer.
Speaker 1 (16:00):
I don't know why people don't know about this.
Speaker 2 (16:02):
I don't know why I didn't know.
Speaker 1 (16:03):
I've never heard of this. I'm just shocked. I just
found out that cervical cancer is caused by certain types
of a common virus, HPV.
Speaker 3 (16:12):
Merk knows that without awareness of this virus or its
link to cancer, it's not going to get anywhere in
the marketplace. So it makes sense why they do this.
Reproductive advocates are thinking, hey, here is a vaccine that
is not only a new tool against reproductive cancer, but
(16:33):
a way of eliminating disparities in who gets cancer. In
other words, there at the time were racial and income
disparities in cervical cancer rates, and so the thinking on
the part of reproductive health advocates were use a vaccine,
administer it alongside other vaccines, and then people will be
protected against cervical cancer, regardless of wealth, or race or ethnicity.
(16:58):
Everybody's excited. Everybody's expecting a seamless rollout of this vaccine.
So FDA approves guard to CEL, and the CDC Advisory
Committee concludes that since the vaccine was tested in women,
it should be administered only to females, and because HPV
is sexually transmitted, it should ideally be administered to females
(17:22):
as young as say sixth grade.
Speaker 1 (17:25):
So, just to be clear, the idea is to vaccinate
people before they have sex and are therefore exposed to the.
Speaker 3 (17:31):
Virus exactly exactly, yeap, catch them before they're sexually active,
so that there is little to no chance that they
would have encountered this virus otherwise.
Speaker 1 (17:41):
And then, as I understand it, right, there was this
like sample legislation that was drafted to encourage states to
mandate the vaccine. And this is essentially the playbook of
how vaccines had been rolled out for decades at this point.
Speaker 3 (17:54):
Right, absolutely, absolutely, The only change really is that this
is a very new vaccine targeting and infection that the
public really wasn't aware of yet, and that they were
targeting only girls.
Speaker 2 (18:09):
Well.
Speaker 3 (18:09):
As soon as lawmakers introduced these bills, debates erupted in
state houses and what happened was the anti pharma backlashed,
combined with a conservative trend in sexual education, combined with
the advent of kind of religious conservatism, meant that there
(18:30):
was pushback coming from a handful of different spheres, all
of whom had their own reasons for arguing against these
HPV vaccination mandates. They said, vaccines are for children to
protect them against diseases that are spread in the school environment.
HPV is not. Let's leave it out of it. The
best protection against sexually transmitted infections anyway, they said, was abstinence,
(18:55):
not vaccines, and were probably quote unquote encouraging promiscuity if
we use this vaccine. It made some people, especially a
bunch of people who self identified as feminists and women's
rights activists, say, hold on, why should it be women's
or girls sole responsibility to prevent the spread of a
(19:16):
sexually transmitted infection. That's sexist and unfair. And so what
this did was it contributed another argument to the backlash,
and it's another part of why the HPV story is
so interesting because support was coming from everywhere, but backlash
was coming from everywhere too, like all over the political spectrum.
Speaker 1 (19:37):
And clearly there are a lot of particular things, things
that are particular to this vaccine. But when you zoom
out and you think about the bigger historical arc, why
is this an important moment beyond this one vaccine.
Speaker 3 (19:48):
It's an important moment for this reason. About two dozen
states considered laws or regulations to make HPV mandatory for
young girls, and this was between two thousand and six
and two thousand and eight, and only one of them succeeded.
Speaker 1 (20:06):
So was that the first time that this decade's old
sort of playbook of a new vaccine comes out and
it's mandated in state after state? Was it the first
time that had failed?
Speaker 3 (20:15):
Yes? What happened was all these lawmakers in these states
and then others that were watching, they rolled back and
they took the mandates off the table. So it's a
really important moment because we see the public being really
successful in pushing back against this era of child vaccination mandates.
Speaker 1 (20:33):
So the rollout does not go as planned. The HPV
vaccine does not join all the other childhood vaccines that
are mandated in many states.
Speaker 3 (20:44):
What happens, Yeah, So what happens next is really interesting.
Epidemiologists who weren't studying HPV before started to say, hmm,
this is interesting. Does it make sense to only vaccinate girls?
What about boys? What about other forms of cancer other
types of Researchers too, start asking questions about it. In
(21:05):
other words, the existence of the vaccine invites further scientific
study and scrutiny of its target infection. What we learn
with HPV is that, yes, there's a link to cervical cancer,
but males get infected with HPV two, and it can
cause forms of reproductive cancers in males, and it can
(21:27):
cause cancers in other parts of the body as well.
So what's interesting about what happens next is that slowly
we change HPV's reputation and we change or start to
change public understanding and scientific understanding first of HPV's relationship
(21:47):
to cancer generally, males are eventually added. Another HPV vaccine
is approved for market, and there are more and more
efforts promoting education and an awareness of both HPV and
the vaccine for males and females. After a decade on
the market, there is way more knowledge about the vaccine's
(22:12):
safety profile. HPV becomes normalized. For about the first ten
years of the HPV vaccine's existence, we were stuck at
below fifty percent, like around forty percent uptake of this vaccine,
and a lot of lawmakers and a lot of parents
(22:33):
just kind of unwilling to touch it or talk about it.
But the trajectory is pretty steadily upward, and in fact,
it's continued upward since then. By the early twenty twenties,
uptake is over sixty percent across young teens male and
female in the US.
Speaker 1 (22:52):
So most teenagers now, even in the absence of mandates,
largely are getting vaccinated against HPV.
Speaker 3 (23:00):
Yeah, most teenagers, and in fact, I think that in
the last couple of years the numbers have continued to
march upwards.
Speaker 1 (23:08):
If we sort of think here about you know, what's
happened with the HPV vaccine and this longer history of
vaccine mandates in general, what do you think at this
point about state mandates for vaccines.
Speaker 3 (23:22):
This is one of those things where this is so
politicized that I want to be very careful about what
I say. Mandates are political tools, and in this country,
since the era of mandates began at the turn of
(23:43):
the twentieth centuries, we have included exemptions to those mandates.
Three kinds of exemptions historically a medical exemption, a religious exemption,
and a philosophical exemption or a belief based exemption. Those
exemptions are to me an indication of how political a
(24:03):
tool vaccine mandates are. We knew from the outset that
mandates were the best way of ensuring the broad and
widespread use of a vaccine, But we also knew that
there was going to be resistance because this is a
country that was founded on enlightened principles of individual liberty
and autonomy, and these ideas about individual rights were in
(24:30):
an inherent conflict with the idea of a state mandated
vaccination program. The exemptions reconciled those two things. So my
feeling is that mandates are an incredibly powerful tool, and
that when you have a disease as horrifying as smallpox
(24:52):
was in its earliest forms, they are a really important
way of stopping this of those diseases. When I, as
a historian of medicine, think about the history of disease,
I look at COVID. It's a horrible, horrible disease, and
then I think about things like smallpox and yellow fever,
(25:14):
kinds of diseases we can't even imagine in this country
today because of the depth of suffering.
Speaker 1 (25:21):
Way worse than COVID, just to way.
Speaker 3 (25:24):
Worse than COVID. Bodies disfigure from internal bleeding, reeking skins
sloughing off like left in the street to die. And
this is what I see in the past. This is
what we were trying to prevent with vaccination. That is
what we were trying to prevent with mandatory vaccination. So
(25:46):
this is a really, really sticky question, and it's not
a question that, in my view, any one individual can
come to. It's about a community or a nation state
deciding how do we want to balance our values in
the pursuit of public health.
Speaker 1 (26:04):
Thanks to my guest today, Michael Branch and Elena Konis.
Next week another show, another virus HSV aka Herpes.
Speaker 3 (26:14):
When I was diagnosed with herpes, I was like, am
I going to have an outbreak forever?
Speaker 1 (26:18):
And no?
Speaker 3 (26:19):
Viruses are weird and they don't behave the way you expect.
Speaker 1 (26:27):
Incubation is a co production of Pushkin Industries and Ruby
Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz,
and Amy Gaines McQuaid. Our editors are Julia Barton, and
Karen Chakerjie mastering by Anne Pope, fact checking by Joseph Friedman.
Our executive producers are Katherine Girardeau and Matt Romano. Special
(26:47):
thanks to Ian Fraser. I'm Jacob Goldstein. Thanks for listening.
What's a jackalope.
Speaker 2 (00:08):
A jackalope is a mythological creature, a sort of iconic
to the American West. It's a combination of a jack
rabbit and a prong horn antelope. So it's a jack
rabbit that has antlers or horns, and it exists richly
in the imagination of Americans, especially in the West. But
it is a mythological creature.
Speaker 1 (00:28):
This is Michael Branch, a man who loves the jackalope
so much that he wrote a book about it. It's
called On the Trail of the Jackalope. Is that a
jackalope on your shirt? Or am I mistaken?
Speaker 2 (00:40):
Yeah, that's a jacalobe. Of course. Jacoalobe kitch is a
huge part of the phenomenon. And so you know, if
you've ever seen a jacalobe bumper stick or t shirt,
shot glass, taxidermy mount, you're part of the hoax. You're
in on the joke.
Speaker 1 (00:55):
The jackalope is a myth, but there are in fact,
real horned rabbits. Is an expert on these two, and
those horned rabbits led to a key breakthrough in understanding
how viruses cause disease. Today on the show Horned rabbits,
human papilloma virus AKAHPV, and a vaccine backlash. This is incubation.
(01:18):
I'm Jacob Goldstein. So there's this myth of the jackalope
in the US. There are mythological horned rabbits, and in fact,
there are real horned rabbits in the world. Right, we've
(01:40):
been talking only of myth. But tell me about tell
me about real horned rabbits.
Speaker 2 (01:46):
So called horned rabbits are actually various species of rabbits
that develop these weird, grotesque growths on their heads, sometimes
on their faces, and they're produced by a papilloma virus.
And both hunters and common people and also naturalists have
noticed these forever without having any idea what caused them.
Speaker 1 (02:08):
And what does it look like.
Speaker 2 (02:12):
Let me put it this way. When the slide of
an actual horn rabbit comes up when I'm doing book talks,
you can hear a collective groan from the audience. I mean,
it is quite grotesque. And if you can just imagine bumpy, wordy,
caratinous black growths all over the face or head of
an animal, that's what it looks like.
Speaker 1 (02:32):
So you mentioned that that these horns, these growths are
caused by a papolloma virus, which turns out to be
important in the history of understanding viruses and ultimately in
the history of human health.
Speaker 2 (02:45):
Right yeah, And it involves a guy named Richard shop
who had actually been involved in trying to figure out
what had caused the global pandemic of nineteen eighteen. By
the time he got interested in horn rabbits, he was
already a well known virologist. This would have been the
late nineteen twenties early nineteen thirties, and he had come
from his home in Iowa to Princeton to take up
(03:06):
this research position as a medical researcher. And he heard
stories from his friends back in Iowa and Kansas who said, hey,
you know, sometimes when we're out rabbit hunting, we kill
these rabbits that have these weird growths on them. And
of course, you know, being a scientific researcher guy interested
in viruses, you know, he immediately wanted to see one
(03:27):
of these rabbits. In fact, he wanted to see him
so badly that he made a special trip back to
Iowa with a hunter who had claimed to have shot
a number of these rabbits, and Shope himself hunted specifically
to try to get one of these rabbits with the
strange growths. After four days, he was unsuccessful and he
had to go back to Princeton. There was a young
young kid who had been hunting with them, and he
(03:48):
told that kid, Hey, I'm going to leave you a
five dollar bill and a bottle of glycerol solution, and
if you can find one of these rabbits, cut off
its horns, put him in the solution, mail them to me,
and I'll give you another five dollars. He could see
from the very beginning that if he could demonstrate a
link between viruses and cancer in a mammal that he
(04:10):
would be opening the way to research that might ultimately
address that question in human beings.
Speaker 1 (04:15):
Ah. So he wants to find out whether a virus
is causing these growths, these horns to grow out of
the heads of rabbits exactly.
Speaker 2 (04:25):
And soon as Chope left Iowa, this kid just made
it his mission to get one of these rabbits, and
he did so. He mailed Shope the horns in the
glyceral solution. He got his other five dollars, and after
that the word get out among the communities of hunters
in Kansas and Iowa, and people began to literally mail
specimens of horn rabbits to shop in Princeton.
Speaker 1 (04:48):
So he's there in Princeton and he goes down and
gets his like whatever, his insurance bill, and then a
box with a dead rabbit in it, exactly.
Speaker 2 (04:56):
And he started working on horn rabbits there at the
Rockefeller Inns Institute in nineteen thirty two with the goal
of understanding what caused those odd growths. He is especially
interested in viruses, and he is doing his work at
a time when the consensus in the scientific community is
that it is impossible that a virus could cause cancer,
(05:18):
especially in a mammal. And at the time, you know,
nobody knew what caused these weird growths, and he wanted
to find out what caused them, but he suspected that
it was a virus, and so he set out to
sort of test that hypothesis through his own experimental method.
Speaker 1 (05:35):
So when you say his own experimental method, what do
you mean, what do you do?
Speaker 2 (05:40):
Well? First, he samples these weird growths on the rabbit's heads,
and he takes those samples and pulverizes them, adds them
to a saline solution and then runs them through a centrifuge.
And then he takes the fluid that has been produced
by that process and then does what is really the
most important thing. That is, he takes that fluid and
(06:02):
puts it through a filter. Now, back in the nineteen thirties,
in the kind of pioneering era of viral research, these
porcelain filters were very important because they could filter out
bacteria and other larger things. The only thing small enough
to go through these filters was a virus. Huh.
Speaker 1 (06:20):
It's interesting, right, because that it seems sort of primitive
to us on a certain level, but also kind of ingenious, right, Like,
they know not that much about viruses at the time,
but they know they're way smaller than bacteria and that
those are the two main kind of disease causing pathogens, right,
And so they're like, Okay, let's just make a filter
(06:41):
that will take out bacteria and anything else that can
cause a disease, but that will allow viruses to pass
through that we know that that's the only pathogen that
could be left in here.
Speaker 2 (06:49):
Exactly exactly the fact that he uses this technique to
make sure that the only thing that can come through
that porcelain filter. Is a virus is kind of a
key moment.
Speaker 1 (06:59):
Okay. So now he has his whatever, his gou his
solution that we know has no bacteria in it that
he's going to do something with. What's he do with it?
Speaker 2 (07:09):
Okay? So he takes live rabbits that are healthy. He
shaves a little bit of their fur off and then
scarifies their skin, just roughs it up just a little
bit with some sandpaper, and then he takes that fluid
that has gone through the filter and applies it to
that little spot on the rabbits. And the idea is
right that since this fluid has been taken from the
(07:29):
horns of disease rabbits, and since it's been filtered to
make sure the only thing that can be in it
is viruses, he has essentially applied a fluid to these
healthy rabbits. So the whole idea is to wait and see.
Having no idea if virus is the cause, or if
it is what the incubation period might be, he applies
this to these patches on his test rabbits, and sure enough,
(07:52):
after about ten days, all of the rabbits that he
has inoculated with this fluid begin to develop exactly the
same kinds of growth that were present on the diseased rabbit.
And that's sort of the Eureka moment in the story,
because that's the moment at which Shope has essentially proven
that the growths on horned rabbits are in fact caused
(08:13):
by a virus.
Speaker 1 (08:14):
Does he publish the results? How does this finding land?
Speaker 2 (08:18):
He publishes his work the following year, which is nineteen
thirty three, in a watershed article in the Journal of
Experimental Medicine, and you know, outside of fellow researchers in
the virology community, it really doesn't go far at all,
even though it's a huge breakthrough.
Speaker 1 (08:35):
After his paper comes out, do people recognize that viruses
can cause cancer in mammals?
Speaker 2 (08:43):
They do, but it takes a while, you know. I
think that the scientific community was so thoroughly resistant to
this idea that it wasn't as if everyone realized right
away what the implications of the work were. That's going
to be left to other researchers, most importantly a guy
named peyton Us who was a colleague of Shops at
the Rockefeller Institute. Peyton Russ will go on to do
(09:05):
the extended studies that will prove the hunch that showpad
all along, which is that some of those growths can
become cancerous.
Speaker 1 (09:13):
Aha. So that's ultimately showing Shope's work and the work
of his colleague shows that in fact, a virus is
causing cancer in a mammal.
Speaker 2 (09:24):
That's the kind of big breakthrough exactly. And so that's
sort of the first step toward working on viruses as
cancer causing agents in human beings. It's going to take
several generations of scientists to explore the implications fully.
Speaker 1 (09:41):
In the decades after Shope did his studies on rabbits,
scientists kept studying papillomaviruses. They discovered a human version of
the papaloma virus, which reasonably enough, they called the human
papalomavirus or HPV, and in work that wound up winning
a Nobel Prize, another researcher definitively HPV to cervical cancer. Eventually,
(10:03):
we learned that over ninety percent of cervical cancer cases
are caused by HPV, and that HPV is also a
common cause of throat cancer. Despite all that, when a
new vaccine promised to prevent HPV, infection. Not everybody was excited.
That's after the break the first HPV vaccine was rolled
(10:31):
out nearly twenty years ago. People in the vaccine world,
in the public health world, and the cancer world were
very excited. This was a vaccine that could prevent cancer
or at least some kinds of cancer, and HPV vaccines
are in fact used around the world today. As it
turned out, though back when the vaccine was first approved,
(10:51):
many people were not excited.
Speaker 3 (10:53):
Support was coming from everywhere, but backlash was coming from
everywhere too, like all over the political spectrum. Exaggeration to
say it's a total mess.
Speaker 1 (11:03):
This is Elena Konis. She wrote a book called Vaccine Nation,
America's Changing Relationship with Immunization, and she told me that
the controversy over the HPV vaccine was really part of
this much bigger story. She said, it was the culmination
of this deep seated conflict that had been building for decades.
Speaker 3 (11:21):
In my view, you really can't understand what happens with
the HPV vaccine in the early two thousands unless you
rewind the clock back to the nineteen fifties actually, and
that was because that was a decade when we got
a new vaccine, the polio vaccine that was desperately hoped
for the entire public. Really in some level was invested,
(11:44):
and when that vaccine was developed and rolled out to
the public in nineteen fifty five, it ushered in a
new era of vaccination in the US. We started vaccinating kids,
especially against a wide range of diseases. We started ensuring
(12:06):
that they were vaccinated by making vaccines required for kids
to enroll in school. We made them required by passing
laws and regulations at the state level, and we did
all of this with a lot of federal support. Polio, smallpox, measles, mumps, rubella.
What's important about this list of diseases is that they
(12:27):
were really different in kind. Polio and smallpox were widely
feared dreaded diseases. The policies that we developed for polio
ended up being applied to these other vaccines.
Speaker 1 (12:39):
Policies meaning state laws requiring them for kids to go
to school, and the federal government supporting and even subsidizing
those laws.
Speaker 3 (12:48):
Yes, and this is happening in the nineteen sixties. It's
coinciding with the rise of all of the social movements
of that decade that are encouraging young people in particular
to question authority and to ask for more information and
to push back against institutions.
Speaker 1 (13:09):
I mean, very broadly, more distrust of authority. Right plainly, Yes,
Certainly in the nineteen seventies, if not before, people in
many domains began to trust institutions and authority less, and
that persons.
Speaker 3 (13:22):
Absolutely, And that actually leads into a kind of ironic
moment in this late twentieth century history of vaccination, because
by the nineteen eighties we have an organized vaccine safety movement,
and I should say this is how they describe themselves.
They don't call themselves anti vaccinationists. They lobbied for and
(13:43):
ultimately succeeded in getting a change in federal legislation. In
nineteen eighty six, Reagan signs a new law to provide
compensation to individuals and families who have suffered injuries from
mandated vaccines, and also creates the infrastructure for a nationwide
(14:03):
system to monitor the public for vaccine injuries. So we
get to the end of the eighties with the very
organized and very successful national movement, and in the meantime,
a handful of other childhood vaccines come out in the background. However,
this organized self described vaccine safety movement has not stopped.
Speaker 1 (14:27):
So tell me the story of the HPV vaccine and
it's rollout.
Speaker 3 (14:31):
So the HPV vaccine is so interesting in the history
of vaccination because it comes out in the early two
thousands and its rollout really represents a turning point. And
when I talk about the HPV vaccine, initially, I'm talking
about Merk vaccine Gardasil.
Speaker 1 (14:49):
That was the first HPV vaccine approved in the US.
Speaker 3 (14:52):
Yes, that was the first one approved for use in
the US. It protected against four strains of HPV, and
scientists knew very well that those four strains were linked
to a very high proportion of cases of cervical cancer
in the US. So there's multiple ways of getting cervical cancer,
(15:13):
but one really important way is infection with HPV, and
this vaccine protected against four strains known to be linked
to cervical cancer. Mirke was excited about this. Reproductive health
advocates and providers were excited about this, but Mirk knew
that it faced a problem. HPV was not a virus
that the public knew much about at all. In fact,
(15:35):
they had hardly even heard of it, and that meant
that they really didn't know about the link between HPV
and cervical cancer. So before the HPV vaccine was approved,
Merk ran an ad campaign, and the ad campaign specifically
targeted women and told them that there was a virus
(15:56):
called HPV and that it was linked to cervical cancer.
Speaker 1 (16:00):
I don't know why people don't know about this.
Speaker 2 (16:02):
I don't know why I didn't know.
Speaker 1 (16:03):
I've never heard of this. I'm just shocked. I just
found out that cervical cancer is caused by certain types
of a common virus, HPV.
Speaker 3 (16:12):
Merk knows that without awareness of this virus or its
link to cancer, it's not going to get anywhere in
the marketplace. So it makes sense why they do this.
Reproductive advocates are thinking, hey, here is a vaccine that
is not only a new tool against reproductive cancer, but
(16:33):
a way of eliminating disparities in who gets cancer. In
other words, there at the time were racial and income
disparities in cervical cancer rates, and so the thinking on
the part of reproductive health advocates were use a vaccine,
administer it alongside other vaccines, and then people will be
protected against cervical cancer, regardless of wealth, or race or ethnicity.
(16:58):
Everybody's excited. Everybody's expecting a seamless rollout of this vaccine.
So FDA approves guard to CEL, and the CDC Advisory
Committee concludes that since the vaccine was tested in women,
it should be administered only to females, and because HPV
is sexually transmitted, it should ideally be administered to females
(17:22):
as young as say sixth grade.
Speaker 1 (17:25):
So, just to be clear, the idea is to vaccinate
people before they have sex and are therefore exposed to the.
Speaker 3 (17:31):
Virus exactly exactly, yeap, catch them before they're sexually active,
so that there is little to no chance that they
would have encountered this virus otherwise.
Speaker 1 (17:41):
And then, as I understand it, right, there was this
like sample legislation that was drafted to encourage states to
mandate the vaccine. And this is essentially the playbook of
how vaccines had been rolled out for decades at this point.
Speaker 3 (17:54):
Right, absolutely, absolutely, The only change really is that this
is a very new vaccine targeting and infection that the
public really wasn't aware of yet, and that they were
targeting only girls.
Speaker 2 (18:09):
Well.
Speaker 3 (18:09):
As soon as lawmakers introduced these bills, debates erupted in
state houses and what happened was the anti pharma backlashed,
combined with a conservative trend in sexual education, combined with
the advent of kind of religious conservatism, meant that there
(18:30):
was pushback coming from a handful of different spheres, all
of whom had their own reasons for arguing against these
HPV vaccination mandates. They said, vaccines are for children to
protect them against diseases that are spread in the school environment.
HPV is not. Let's leave it out of it. The
best protection against sexually transmitted infections anyway, they said, was abstinence,
(18:55):
not vaccines, and were probably quote unquote encouraging promiscuity if
we use this vaccine. It made some people, especially a
bunch of people who self identified as feminists and women's
rights activists, say, hold on, why should it be women's
or girls sole responsibility to prevent the spread of a
(19:16):
sexually transmitted infection. That's sexist and unfair. And so what
this did was it contributed another argument to the backlash,
and it's another part of why the HPV story is
so interesting because support was coming from everywhere, but backlash
was coming from everywhere too, like all over the political spectrum.
Speaker 1 (19:37):
And clearly there are a lot of particular things, things
that are particular to this vaccine. But when you zoom
out and you think about the bigger historical arc, why
is this an important moment beyond this one vaccine.
Speaker 3 (19:48):
It's an important moment for this reason. About two dozen
states considered laws or regulations to make HPV mandatory for
young girls, and this was between two thousand and six
and two thousand and eight, and only one of them succeeded.
Speaker 1 (20:06):
So was that the first time that this decade's old
sort of playbook of a new vaccine comes out and
it's mandated in state after state? Was it the first
time that had failed?
Speaker 3 (20:15):
Yes? What happened was all these lawmakers in these states
and then others that were watching, they rolled back and
they took the mandates off the table. So it's a
really important moment because we see the public being really
successful in pushing back against this era of child vaccination mandates.
Speaker 1 (20:33):
So the rollout does not go as planned. The HPV
vaccine does not join all the other childhood vaccines that
are mandated in many states.
Speaker 3 (20:44):
What happens, Yeah, So what happens next is really interesting.
Epidemiologists who weren't studying HPV before started to say, hmm,
this is interesting. Does it make sense to only vaccinate girls?
What about boys? What about other forms of cancer other
types of Researchers too, start asking questions about it. In
(21:05):
other words, the existence of the vaccine invites further scientific
study and scrutiny of its target infection. What we learn
with HPV is that, yes, there's a link to cervical cancer,
but males get infected with HPV two, and it can
cause forms of reproductive cancers in males, and it can
(21:27):
cause cancers in other parts of the body as well.
So what's interesting about what happens next is that slowly
we change HPV's reputation and we change or start to
change public understanding and scientific understanding first of HPV's relationship
(21:47):
to cancer generally, males are eventually added. Another HPV vaccine
is approved for market, and there are more and more
efforts promoting education and an awareness of both HPV and
the vaccine for males and females. After a decade on
the market, there is way more knowledge about the vaccine's
(22:12):
safety profile. HPV becomes normalized. For about the first ten
years of the HPV vaccine's existence, we were stuck at
below fifty percent, like around forty percent uptake of this vaccine,
and a lot of lawmakers and a lot of parents
(22:33):
just kind of unwilling to touch it or talk about it.
But the trajectory is pretty steadily upward, and in fact,
it's continued upward since then. By the early twenty twenties,
uptake is over sixty percent across young teens male and
female in the US.
Speaker 1 (22:52):
So most teenagers now, even in the absence of mandates,
largely are getting vaccinated against HPV.
Speaker 3 (23:00):
Yeah, most teenagers, and in fact, I think that in
the last couple of years the numbers have continued to
march upwards.
Speaker 1 (23:08):
If we sort of think here about you know, what's
happened with the HPV vaccine and this longer history of
vaccine mandates in general, what do you think at this
point about state mandates for vaccines.
Speaker 3 (23:22):
This is one of those things where this is so
politicized that I want to be very careful about what
I say. Mandates are political tools, and in this country,
since the era of mandates began at the turn of
(23:43):
the twentieth centuries, we have included exemptions to those mandates.
Three kinds of exemptions historically a medical exemption, a religious exemption,
and a philosophical exemption or a belief based exemption. Those
exemptions are to me an indication of how political a
(24:03):
tool vaccine mandates are. We knew from the outset that
mandates were the best way of ensuring the broad and
widespread use of a vaccine, But we also knew that
there was going to be resistance because this is a
country that was founded on enlightened principles of individual liberty
and autonomy, and these ideas about individual rights were in
(24:30):
an inherent conflict with the idea of a state mandated
vaccination program. The exemptions reconciled those two things. So my
feeling is that mandates are an incredibly powerful tool, and
that when you have a disease as horrifying as smallpox
(24:52):
was in its earliest forms, they are a really important
way of stopping this of those diseases. When I, as
a historian of medicine, think about the history of disease,
I look at COVID. It's a horrible, horrible disease, and
then I think about things like smallpox and yellow fever,
(25:14):
kinds of diseases we can't even imagine in this country
today because of the depth of suffering.
Speaker 1 (25:21):
Way worse than COVID, just to way.
Speaker 3 (25:24):
Worse than COVID. Bodies disfigure from internal bleeding, reeking skins
sloughing off like left in the street to die. And
this is what I see in the past. This is
what we were trying to prevent with vaccination. That is
what we were trying to prevent with mandatory vaccination. So
(25:46):
this is a really, really sticky question, and it's not
a question that, in my view, any one individual can
come to. It's about a community or a nation state
deciding how do we want to balance our values in
the pursuit of public health.
Speaker 1 (26:04):
Thanks to my guest today, Michael Branch and Elena Konis.
Next week another show, another virus HSV aka Herpes.
Speaker 3 (26:14):
When I was diagnosed with herpes, I was like, am
I going to have an outbreak forever?
Speaker 1 (26:18):
And no?
Speaker 3 (26:19):
Viruses are weird and they don't behave the way you expect.
Speaker 1 (26:27):
Incubation is a co production of Pushkin Industries and Ruby
Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz,
and Amy Gaines McQuaid. Our editors are Julia Barton, and
Karen Chakerjie mastering by Anne Pope, fact checking by Joseph Friedman.
Our executive producers are Katherine Girardeau and Matt Romano. Special
(26:47):
thanks to Ian Fraser. I'm Jacob Goldstein. Thanks for listening.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Nikki Glaser Podcast
Every week comedian and infamous roaster Nikki Glaser provides a fun, fast-paced, and brutally honest look into current pop-culture and her own personal life.