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  In the mid-1950s a researcher named Carleton Gadjusek traveled to New Guinea to study kuru, a disease characterized by a slow but relentless decent into dementia. Gadjusek found that the disease occurred mostly in cannibals who ate human brains. At first, Gadjusek and others thought that the disease was either genetic or caused by a virus. But neither theory was correct. Kuru was caused by unusual proteins called proteinaceous infectious particles, or prions. Mad cow disease, caused by eating meat contaminated with infected brains or spinal cords, is also caused by prions. And Creutzfeldt-Jakob disease, a similar ailment, although not caused by eating contaminated meat, is also caused by prions. When Hilleman made his hepatitis B vaccine, he was afraid that blood might be contaminated with prions. “I’ll tell you one thing that really worried me at the time, and that was Creutzfeldt-Jakob,” recalled Hilleman. “This disease was known to be infectious. It had been shown, quite uniquely, that urea would destroy [prions]. We used [urea] and had a pretty good reason to believe that there would be no problem.”

  Hilleman wasn’t finished. He wanted to add one more chemical to destroy any contaminating viruses. So he picked the one that had been used successfully by Jonas Salk to kill polio virus: formaldehyde. Polio virus, like hepatitis B virus, was difficult to destroy, but formaldehyde readily destroyed both.

  Now Hilleman had his method: he would treat human blood with a combination of pepsin, urea, and formaldehyde. He knew that each of these treatments caused a one hundred-thousandfold decrease in hepatitis B virus; the combination of the three caused a quadrillionfold (1,000,000,000,000,000) decrease. Hilleman didn’t know whether his method would destroy all other contaminating viruses, so he carefully tested representatives of every virus known: viruses similar or identical to rabies, polio, influenza, measles, mumps, smallpox, herpes, and the common cold. These viruses cause infections of the brain, spinal cord, liver, lungs, nose, throat, and intestines. Hilleman’s chemical treatments completely destroyed every one of them. “[I thought] that if we could show that each step could kill surrogate viruses,” recalled Hilleman, “a whole bunch of different viruses, then we had a process in which viruses would be deader than deader than dead. A process that would destroy all life forms.”

  As it turned out, hepatitis B surface protein was quite hardy. While the combination of chemical treatments destroyed other proteins in blood like gamma globulin, the hepatitis surface protein remained intact. Hilleman used a series of filtration steps to further purify his vaccine. In the end, Hilleman’s blood-derived hepatitis B vaccine was virtually 100 percent pure hepatitis B surface protein—a technical miracle. But the road to a final product wasn’t easy. “This was a precedent,” recalled Hilleman, “and it really took a lot of god-damned guts to take Merck down that trail. You can imagine the progress that we made. It was just about a damned zero data base [to start]. Shall we drop it this week, or should we wait another week? We were walking around in the dark or in the mud. This was one big gamble, I’m telling you.”

  In the late 1970s Hilleman didn’t test his chemical inactivation method to determine whether it killed HIV because HIV hadn’t been discovered yet. Harvey Alter, a microbiologist who worked with Baruch Blumberg, remembered that “Hilleman was very careful about making the vaccine. He inactivated it in many more ways than were absolutely necessary. As it turned out, it was a great thing because then AIDS came along and scared everybody to death about taking vaccines. But he had done all the right things to kill the AIDS virus, even if he didn’t know it was in there.”

  Hilleman had to convince people that a vaccine made from the blood of intravenous drug users and homosexual men was safe. “You can go ahead and [take a protein],” he said, “and you can purify it, and you think you have a way of inactivating it, but you’re still pretty much in the area of faith. You still don’t know the potency, the safety, or the efficacy.” Hilleman had trouble getting permission from the FDA to test his new product. Then he ran headlong into the same man who had tried to torpedo Stanley Plotkin’s rubella vaccine, Albert Sabin, a respected virologist whose opinions continued to influence researchers and regulators. “We had to get [permission from the FDA], and we had trouble,” recalled Hilleman. “What do you think happened? Sabin hears about it, says that [our] vaccine will not be used in any human being. Sabin said that if there was a lawsuit, he would go to court to testify against us. He would sue Krugman [his first cousin] if there were any problems with the studies. My feeling was, ‘Screw you, Albert.’ We went to see John Seal [at the NIH]. He advised us against using our [blood-derived] vaccine. He said, ‘You know Albert says he’s going to go public.’ We had futzed around for about one year. I told Saul [Krugman] that I couldn’t wait any longer, that I was going to go ahead and put this into people.”

  Hilleman knew that he would have a tough time convincing people to try his vaccine. So he turned to the one group he was certain would take it—midlevel executives in his own company. “I went to a meeting for marketing, sales, production, and research,” recalled Hilleman, “and I headed up the meeting. And I said, ‘Look, guys, our next product is going to be a hepatitis B vaccine, but I need to have volunteers.’ I said that I could not use lab people because if any of us came down with hepatitis B, that would be the end of the product. I said, ‘Here are the consent forms. Just sign these and I’ll collect them after the meeting, and then I’ll figure out who are the chosen people.’” Hilleman soon found that he hadn’t been very persuasive. “There wasn’t a damn one of them that sent in the form,” he said. At the next meeting Hilleman made it clear that the consent form didn’t contain “No” as an option. “I said, ‘I need volunteers, damn it. Just decide who among you are going to take this vaccine. Give yourselves a little bit of time to regain your senses.’” Joan Staub, one of those asked to take the vaccine, remembers things differently. “Consent forms? What consent forms?” she asked. “We got that vaccine because we had to get it. If Hilleman told you to do something, you did it.” Staub learned months later where the blood had come from and that there was a possibility that it might be contaminated with HIV. “We were scared to death,” she recalled. “I thought I was going to die. Maurice pulled us all into one room and had to explain to us over and over again about the inactivation process and that we were going to be OK.”

  Hilleman’s coercion of Merck employees to get his hepatitis B vaccine was just one example of his tough, profane, and demanding style. “We worked hard, seven days a week,” recalled Hilleman. “If I ever caught anybody delaying a set of tests because [results] might come out on a weekend, it would be grounds for dismissal. You can imagine how that went over. They all had wives and that sort of thing. Now Merck tells [employees] that they don’t need to put in any extra time and that you have to balance your life. And that you have to have enjoyment with your job; [that way] you can do a better job and have fun. It’s all just a pile of shit. What the company should be doing is kicking ass. But that’s from the old school. I was told that I had a very unusual management style.”

  Robert Weibel injects Maurice Hilleman with an experimental hepatitis B vaccine made from human blood, circa late 1970s.

  Hilleman demanded from others what he demanded from himself. “He was totally fixated on what he did,” recalled Bert Peltier, former vice president of medical affairs at Merck. “He didn’t play cards or have any particular hobbies. He didn’t take a lot of vacations. He’d hit the office, and he was just totally at it all day long. He didn’t relax very much at all. He was absolutely and totally dedicated to what he was doing. And he could be intimidating. He tended to run roughshod over people below him. He didn’t wait around for all of the niceties. He just wanted to do it.” Staub recalled that Hilleman would occasionally show disdain for scientists whose work he didn’t respect. “Maurice would have different people in to give seminars,” she said. “Every once in a while we would all be invited. Mostly people were coming in to pitch something to Maurice, like a program th
at they wanted to have us fund. One day we were all assembled in a large room, and Hilleman wasn’t buying what this guy was saying. Before long I heard a little click, click, click going on a couple of rows behind me. What Maurice had done to show his boredom was that he was back there cutting his nails.”

  NOTHING WAS MORE INTIMIDATING ABOUT HILLEMAN THAN HIS relentless profanity. “He liked to curse,” recalled former Merck CEO Roy Vagelos. “He had language that characterized his being, and he brought that wherever he went. And he never changed.” Hilleman recalled, “I remember that at about age three, I was sitting on the kitchen table while [Aunt Edith] was putting on my long stockings. I had the sudden urge to practice my gradually increasing vocabulary. And I said, ‘Oh, fuck.’ Swat. And I was lying prone on my side. ‘Wow,’ I said. ‘What a powerful word. I wonder what it means.’”

  Although Hilleman’s daughters Jeryl and Kirsten were never victims of his profanity, they occasionally heard cursing around the house and picked it up. “Dad had enrolled me in a Quaker school about fifteen minutes from our house,” recalled Jeryl, “where I had a lovely, dedicated, but very fundamentalist first grade teacher. She proceeded to go on with a lesson about Adam and Eve, and I was sitting in the back of the class. I can remember this as if it were yesterday. I eagerly raised my hand because I understood that she was on the wrong track and really was in need of some of the enlightenment that I had received in my own home. So she looks back and calls, ‘Jeryl.’ And I proceed to look her in the eye and say, ‘My dad says that’s a lot of crap.’ The next scene in my mind is of this very large, suddenly gigantic teacher coming back, tearing to the back of the room, grabbing me by the arm, pulling me into the bathroom, yanking the soap out of the crank dispenser, and washing out my mouth. I was completely mystified because there was absolutely nothing wrong with the language. I was, after all, helping her to understand the way the world worked. But I really would have loved to have witnessed the call that night to my father who, I’m sure, was hard pressed not to laugh.”

  By the mid–1960s, hoping to make better, happier workers, Merck hired several psychologists to help senior executives with their management techniques. “About seven or eight years [after I came to Merck], they were sending everybody off to charm school, everybody in upper management,” recalled Hilleman. “The purpose was to teach people to get along, to make joint decisions, not to blow up, to suppress the ego. [Sessions] were run by psychologists.” Max Tishler had the unenviable task of asking Hilleman to go to these group sessions. (Tishler couldn’t possibly have been paid enough money to do this.) “Max said that I had to go to charm school and that I shouldn’t cuss so much,” recalled Hilleman. “[Max] heard me [curse] at a meeting [of department heads], and he said that I should never use [those words] again. I told him, ‘Fuck it. What is this, fucking parochial school?’” Tishler later said, “Usually when people came into my office they left shaking. But when Maurice came into my office, I’m the guy who was shaking.” Hilleman never attended the sessions.

  Although Hilleman’s tirades were legendary, one meeting stands apart from all the rest, recorded in a memo still discussed among Merck employees twenty-five years later. They call it “the truck driver memo.” Hilleman’s explosion resulted from the confluence of several events. When Hilleman was making his hepatitis B vaccine, he was adamant that his method of inactivation be followed precisely. If not, he feared that children might be injected with live deadly hepatitis B virus. But Hilleman’s research group didn’t make the vaccine; Merck’s manufacturing division did. And the manufacturing division was controlled by the unions: the Teamsters Union (hence truck drivers) and the Oil, Chemical, and Atomic Workers Union. Hilleman, who demanded total control, didn’t control the employees who made his vaccines. Roy Vagelos remembers the conflict between Hilleman and the manufacturing division. “[Hilleman] was from Walter Reed, which is military. All you had to do was walk into his [laboratory] to realize that he had transformed [the department of] virus and cell biology at Merck into a military organization. Everybody knew what to do at the beginning of every day. Well, that worked in virus and cell biology, but when he started to transfer the process to manufacturing, the people [there] weren’t quite used to that. And so there was a constant rumble at the end of the campus, where the transfer of technology took place.” On August 15, 1980, the rumble turned into a roar.

  Hilleman found out that someone in the manufacturing division—in hopes of increasing production—had slightly changed his chemical inactivation process for hepatitis B vaccine. Hilleman knew that no test existed for detecting very small quantities of live hepatitis B virus, that there was no safety net if a modified process didn’t kill every single infectious hepatitis particle. And he knew that children would be at risk. So he gathered the manufacturers together in a small, non–air-conditioned room at the far end of Merck’s West Point campus and told them what he thought about their idea. “There is no fucking test for absolute safety except to put the vaccine in fucking man,” said Hilleman. “A procedure was developed to make the fucking vaccine and was shown to make the vaccine safe. Then there are always fucking people who want to make fucking brownie points by changing the process to get more yield. You have to adhere to the goddamn process. We know that the vaccine is safe, but you have to adhere to the goddamn process. What worries me is that [someone] will get a bonus if he can get more yield, so he changes the fucking process. Goddamn meatheads are everywhere.” Hilleman knew that for biological products like vaccines the manufacturing process was everything. And he refused to tolerate any change in a process that he knew was perfect, even if a change might mean greater yields, increased profits, and shorter timelines for production. He was obsessed about the safety of his vaccine. And he was intolerant of those whose work ethic was less stringent than his (which was pretty much everybody). “Maurice always wanted to have very tight control over everything that he did,” recalled Peltier. “He tolerated fools terribly.”

  If employees didn’t meet his rigorous demands, Hilleman fired them, later lining up their shrunken heads like trophies behind his desk. “One of my favorite gifts was a shrunken head kit,” recalled Maurice’s younger daughter, Kirsten. “It involved carving apples; inserting assorted grotesque teeth, eyes, and hair; and allowing them to dehydrate [for] several weeks. My dad saw an apparent remarkable resemblance in one of my shrunken heads to an employee he had recently terminated. He carted it off to work and installed it in the cabinet behind his desk. Finding this enormously funny, he put me to work carving the heads of his most memorable terminations. My mother caught wind of this enterprise and, horrified, shut down my production facility.”

  Despite his iron hand and frightening manner, Hilleman’s coworkers were fiercely devoted to him. “As afraid as I was of him, there is nothing that I would ever let tarnish his image,” remembers Staub, “because I was so overwhelmed by everything that he did. And there was a point where being overseen by a dictator paid off. There was a day called Black Friday in the 1970s where Merck laid off people, a lot of people. I had never seen Merck lay off people until that day. Not one person in virus and cell biology was touched, and that was because of Maurice. We were afraid of him. There was no doubt. But he protected us.” Hilleman successfully lobbied for yearly 10 percent increases in his research and development budgets, even though revenues from Merck’s vaccines paled in comparison with those from its drugs. Staub believes that Hilleman’s style will never be duplicated. “Today decisions are reached by achieving consensus among committee members,” she said. “Maurice had a committee. It was a committee of one. We did what the man wanted, and we did it how he wanted. He was a man of his time. If he showed up at Merck today, he couldn’t do it.”

  AS FAR AS HE KNEW, HILLEMAN HAD SUCCESSFULLY PURIFIED HEPATITIS B surface protein from the blood of homosexual men and drug users infected with the virus. Confident that he had his vaccine, he eventually persuaded Saul Krugman, Krugman’s wife Sylvia, and nine Merck executi
ves to take it. Krugman supervised the experiment. “I had the nurse give me the first injection,” recalled Krugman. “Then I gave everybody else theirs.” For the next six months a physician examined each of the volunteers and periodically checked their blood to make sure that they didn’t have hepatitis. When the experiment was over, all slowly exhaled.

  To test his hepatitis vaccine in more people, Hilleman needed someone whose reputation was unassailable. He chose Wolf Szmuness.

  Small, fifty years old, with a pockmarked face and a startling shock of blond hair, Szmuness first came to the United States in 1969. Born in Warsaw, Poland, Szmuness lost his parents in the Holocaust and later fled to Russia ahead of an advancing German army. For twenty years he practiced medicine in Siberia and Russia. One event changed the direction of his career: his wife, Maya, almost died of hepatitis following a blood transfusion. Szmuness spent the rest of his life trying to understand the disease and its causes. In 1959 he returned to the small bustling city of Lublin on Poland’s eastern border. But eight years later, in 1967, Szmuness again faced anti-Semitism. During the Six-Day War between Israel and Egypt, government officials ordered Szmuness to protest Israel’s actions at a rally. He refused and was fired the next day.