Measles, Government and Trust
The U.S. Centers for Disease Control and Prevention has become a respected and vital household name. That is why its sponsorship of a 1989-91 study involving an unlicensed measles vaccine in Los Angeles is so troubling.
The vaccine is Edmonston-Zagreb, or E-Z. In small doses, it has been used safely for decades outside the United States and has been endorsed by the World Health Organization. But here in the United States, E-Z has been deemed experimental. It was used in Los Angeles beginning in 1989 as part of a government-sponsored study during a national measles epidemic. The purpose of the study was to determine whether children safely could be vaccinated at a younger age and to compare E-Z with the standard vaccine used in this country, Moraten.
The trial involved children in the city’s hardest-hit communities--West and East Los Angeles and Inglewood. These were chosen for the study, the CDC said, because the disease was heaviest there. Most of the youngsters given the vaccine were Latino or African American.
Within two years of the 1989 start date, similar clinical trials in the African countries of Senegal and Guinea-Bissau and in Haiti raised the question of a possible relationship between a more potent dose of E-Z and an increased death rate among female infants. That question led to the termination of the Los Angeles trial in 1991.
None of the 1,500 children in Los Angeles were injured by the unlicensed vaccine. But that knowledge, while welcome, is not the point here. The parents of these children were never told that they were part of an experiment with an unlicensed drug, and thus they had a less than adequate basis for giving their consent. The so-called “informed consent” papers signed by parents merely stated that the children would receive one of two vaccines and that E-Z had been shown to be effective worldwide.
“A mistake was made. It shocked me,” said Dr. David Satcher, CDC director. “We need to move to a new level of reassurance so people can really trust what we are doing.”
These days, the CDC is called on to provide answers about everything from how to reduce the risk of arthritis and hantavirus infection to the dangers of organized “sex tours” abroad and the effect of pollutants on brain development.
If it is to perform these diverse tasks effectively and reach those who might be suspicious of government, the CDC must ensure that an incident like the E-Z measles vaccine study can never occur again. Trust is the issue.