Mapping disasters: The application of a disaster-sociological 'theoretical superstructure' and methodology in a prima facie case for investigating the role of hepatitis B vaccines in the contamination of the Canadian blood supply with human immunodeficiency (AIDS) virus (HIV) and hepatitis C virus (HCV).

摘要

Building on advances and difficulties encountered in disaster sociology (compiled in Quarantelli (ed.), 1998) and following Quarantelli's suggestion of a 'theoretical superstructure', a methodology for the analysis of disasters was developed and applied to an exploration of the genesis of the contamination of the Canadian blood supply with human immuno-deficiency virus HIV and hepatitis C virus (HCV). The superstructure is grounded in concepts of general and human ecology, such as phenomena of organization and disorganization. Two classes of ecological contingencies are mapped: (1) material contingencies and their spatio-temporal relationships; (2) the social constructions of such contingencies. The methodology employs a technique for the modeling of critical paths, which are constituted by key decisions (milestone decisions) and practices concerning a specific technology through all its phases of development and operation. The application of the methodology to the analysis of the contamination of the Canadian blood supply yielded 'a prima facie case for investigating the role of trial and commercial hepatitis B vaccines in the contamination of the Canadian blood supply with HIV and HCV.' The evidence for the case is circumstantial as most of the critical direct evidence can be assumed to have been concealed or destroyed. The indirect evidence suggests that at least one of the experimental hepatitis B vaccines developed during the seventies in the US and in Europe may have been contaminated with HIV-1 of chimpanzee origin. The outbreak of the AIDS pandemic may have been related to the experimental use of such vaccines in the US, and possibly on Haitians, Africans and Europeans. Alternatively, contaminated needles and syringes used for hepatitis and vaccine research on chimpanzees in African facilities (e.g. Liberia) may have found their way into black markets for 'injectionists,' and thus may have played a role in the spread of HIV in Africa. The Canadian evidence suggests that a HCV contamination of one or more of the Merck hepatitis B vaccines cannot be excluded; and that, alternatively/additionally, specific and non-specific gammaglobulin preparations from human plasma, (e.g. HBIG---hepatitis B immunserum used for passive immunization, such as provided by Connaught Laboratories, Toronto), were contaminated with HCV. The vaccines and the HB immunesera were licensed for experimental and/or routine use by (then) Health and Welfare Canada, while the Canadian Food and Drugs Act specifically prohibits the use of plasma from individuals with a history of a disease transmissible by blood (such as hepatitis B surface antigen and antibody positive donors, as a source of raw material). The case study also points to two deficiencies in the standards (codes of ethics) for research on side-effects: (1) an unresolved conflict between corporate proprietary privileges and 'informed consent'; (2) the lack of unequivocal rules for the investigation of side-effects and their remedies. The discussion of the case explores the risks associated with the capitalist mode of competitive, secretive development of technology; and with the techniques of dysinformation employed by government, business, and scientific institutions whenever technological mishaps or 'socio-technical disasters' occur as a result of flawed technology development. Traditional sociology is focused on conditions of production, consumption and related discourses. The case study demonstrates the need for a sociology of the capitalist mode of technological development; and for a sociology of the 'genesis of disasters' arising from technological development. Without such an understanding of technological development, the public, in Western industrialized and developing nations alike, cannot seek and be assured of effective protection from adverse outcomes of relentless, competitive technological development: from the 'tragedy of capitalism.'