{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:40:48Z","timestamp":1790023248397,"version":"4.0.1"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2012,6,18]],"date-time":"2012-06-18T00:00:00Z","timestamp":1339977600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2012,6]]},"abstract":"<jats:p><jats:bold>Context:<\/jats:bold>Two vaccines to prevent Lyme disease (LD) were developed and tested in the 1990s. Despite evidence of their safety and efficacy in clinical trials and initial postmarketing surveillance, one vaccine was withdrawn before the regulatory review and the other after only three years on the market. An investigation of their history can illuminate (1) the challenges faced by many new risk\u2010reducing products and practices and (2) the important role played by their social and psychological, as distinct from their biomedical or scientific, efficacy in how they are used, and their ultimate market success or failure.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold>This article reviewed medical and popular literature on LD vaccines, analyzed the regulatory hearings, and conducted interviews with key participants.<\/jats:p><jats:p><jats:bold>Findings:<\/jats:bold>Even if proved safe and effective, LD vaccines faced regulatory and market challenges because the disease was geographically limited, treatable, and preventable by other means. Pharmaceutical companies nevertheless hoped to appeal to consumers\u2019 desire for protection and control and to their widespread fear of the disease. The LD advocacy community initially supported the vaccines but soon became critical opponents. The vaccines\u2019 success was seen as threatening their central position that LD was chronic, protean, and difficult to treat. The activists\u2019 opposition flipped the vaccines\u2019 social and psychological efficacy. Instead of the vaccines restoring control and reducing fear, demand was undermined by beliefs that the vaccines<jats:italic>caused<\/jats:italic>an LD\u2010like syndrome.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold>The social and psychological efficacy of many risk\u2010reducing practices and products, such as new \u201cpersonalized vaccines,\u201d is to provide insurance and reduce fear. Yet the actions of self\u2010interested actors can easily undermine this appeal. In addition to evaluating the scientific efficacy and safety of these practices and products, policymakers and others need to understand, anticipate, and perhaps shape the potential social and psychological work they might do.<\/jats:p>","DOI":"10.1111\/j.1468-0009.2012.00663.x","type":"journal-article","created":{"date-parts":[[2012,6,18]],"date-time":"2012-06-18T16:59:08Z","timestamp":1340038748000},"page":"250-277","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["The Rise and Fall of the Lyme Disease Vaccines: A Cautionary Tale for Risk Interventions in American Medicine and Public Health"],"prefix":"10.1111","volume":"90","author":[{"given":"ROBERT A.","family":"ARONOWITZ","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,6,18]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"ACIP (Advisory Committee on Immunization Practices) of the Centers for Disease Control and Prevention.1998.Meeting minutes June 24\u201325. 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