Lyme Disease Vaccines: A Cautionary Tale 259 Dr. Robert Schoen, a physician and LD researcher. Schoen stressed LD’s seriousness, arguing that the disease was analogous to syphilis. The eti- ological spirochete can “lurk or secrete itself in certain areas of the body, perhaps the central nervous system or perhaps the joint spaces, only to reappear months or maybe years later in the form of late stages of illness, which are harder to diagnosis and treat.” He went on to show pictures of a patient with Bell’s palsy and describe a patient with heart block, both real but rare LD complications. SKB’s message was clear—the chronic complications of LD were serious and difficult to diagnose and treat. Be- cause this message was consonant with the heterodox view of LD, it was understandable that SKB might have expected significant enthusiasm in the LD advocacy community for an effective vaccine. Yet the vaccine’s social and psychological efficacy—the work it does or might do for potential consumers besides blocking B. burgdorferi in the tick’s midgut—turned out to be complex and contradictory. From SKB’s perspective, the vaccine promised to restore a sense of control and reduce the fears of many people living in an LD-endemic area. This work was crucial to developing a market larger than the relatively small numbers of individuals at high risk for B. burgdorferi infection. And even those at high risk needed additional reasons to take the vaccine, given the concerns about its cost, side effects, boosters, and incomplete protection. But there were a few too many missteps and misunderstandings. More than putting pressure on scientific authorities to be included in the investigator-initiated research, LD advocates focused on garnering support and attention for their alternative picture of the disease as chronic and protean and often requiring prolonged treatment. Everything else was secondary. As the prominent LD researcher Alan Barbour wrote in an op-ed about LD advocacy at the very onset of the LD vaccine controversy, “Most of the lobbying has focused on what Lyme disease is rather than how to prevent it” (1997, 23). Also absent from the heterodox opposition to the LD vaccine was any overt linkage to the long tradition of antivaccination campaigns in the United States in any of its guises: libertarian, religious, homeopathic, antimedicalization, and the like (see Colgrove 2006). A contentious point about “what Lyme disease is”—whether it was easily treated with oral antibiotics—remained. Dr. Dixie Snyder, an FDA advisory panel member, recalled that the VRBPAC’s earlier “rather benign” observation that most LD cases were treatable with antibiotics