Lyme Disease Vaccines: A Cautionary Tale 269 supporters that “scientific findings” had little to do with the vaccines’ downfall, there is little agreement about which nonscientific factors were at work. Many people have observed that there turned out to be not enough de- mand for the vaccine to be commercially viable. But almost all the factors related to either LD (e.g., it was treatable, nondeadly, and preventable by other means) or the vaccines (potential for inducing autoimmunity, need for boosters) that might have led to low demand were known before extensive investments in clinical trials, regulatory review, and initial marketing. So these disease and vaccine characteristics are better understood as supporting players, while the more fundamental causes are the more contingent and unanticipated actions that occurred in the brief period after clinical trials were finished and before LYMErix was withdrawn from the market. These actions tipped the balance toward the vaccines’ demise. Specifically, we need to understand (1) the origins of the intense heterodox opposition to the LD vaccine and the weak or- thodox support for the vaccines once they were challenged and (2) why the efficacy of a “personalized vaccine” was inherently vulnerable to this opposition. Contingent events external to the LD controversy also influenced the market failure of LD vaccines—especially the controversies surrounding the RotaShield and MMR vaccines mentioned earlier—but I want to focus my analysis on the actors and actions within the developments concerning LD. Other ancillary influences include the theory offered by Sigal (personal communication, July 6, 2011) that the advocacy commu- nity turned against the vaccine when SKB withdrew its financial support and also the claim made by both Offit (personal communication, June 28, 2011) and Plotkin (personal communication, July 18, 2011) that the weak recommendations of the FDA and CDC/ACIP led to physicians’ lack of enthusiasm for the vaccine. The vaccine’s supporters have blamed LD advocates for undermining the vaccine with nonscientific claims of its dangers, and SKB’s vigorous DTCA promotion of LYMErix may have led to backlash and distrust.7 Heterodox groups came to believe that the vaccines’ efficacy supported the orthodox definition of LD and did what they could to undermine the vaccines. These beliefs and actions were neither inevitable nor strictly determined by the clinical and biological characteristics of the disease or the vaccines. Early on in the vaccine story, major LD advocacy groups supported the vaccine. There was a great deal of enthusiasm in affected