Lyme Disease Vaccines: A Cautionary Tale 265 also led the LYMErix clinical trial while simultaneously championing a theory that suggested that the vaccine might be dangerous. Why would you develop and study a vaccine against Lyme disease that you had serious reason to believe might cause some of its late manifestations (Sigal personal communication, July 6, 2011)? According to a New York Times profile, Steere “has his doubts about the safety of the vaccine” (France 1999, F7). But a less contradictory interpretation of Steere’s actions was that he believed that OspA’s role in autoimmunity was still an unproven hypothesis and that the potential benefits of the vaccine were likely to trump any harm done by treatment-resistant arthritis. Pursuing the mechanism of LD-related arthritis and the efficacy and safety of the vaccine were both valid and important scientific efforts. In any event, the OspA molecular mimicry hypothesis subsequently fell out of favor, and neither clinical trial produced evidence of vaccine-induced arthritis. Yet the theoretical concern about the vaccine causing LD-like damage persisted as the basis for opposition to the vaccine. A well-publicized suit against the vaccine, settled by SKB in 2003, was based on the manufacturer’s liability and responsibility to the class of people at risk for an autoimmune reaction (Shea 2003). Promises were made about the language of a future package insert if the vaccine were ever reintroduced, and attorneys’ fees (but no patient damages) were paid.3 Because the LYMErix trial did not result in greater numbers of arthri- tis cases, treatment sensitive or resistant, SKB did not include any warn- ings about autoimmunity in the LYMErix package insert. What seemed logical to the orthodox camp was evidence of a cover-up or hubris by the other side. At the 2001 VRBPAC meeting, advocate Jenny Marra testified that SmithKline was so concerned with this issue [possible autoimmunity] that they had study participants sign a paper indicating the theoret- ical possibility existed that vaccine might cause arthritis in certain genetically susceptible individuals. Yet SmithKline did not include this information in the product labeling or inform the health care providers of this concern. Had I known this, I personally would not have taken the vaccine. Autoimmunity has long been a fertile imagined space for etiolog- ical thinking about chronic diseases whose etiologies are unclear and