Vaccines: How Medical Innovation Changed the World Around Infectious Disease

Rob McCarty (2018) is a biology major at Grinnell from Hudson, Florida with a particular interest in molecular biology. He played football each of his four years and plans to enter research in cancer biology after Grinnell.

It is hard for us today to imagine a time when a child’s first trips to the doctor don’t result in receiving vaccinations. However, from their first discovery it took quite some time for vaccines to fall into common practice. Initially there was huge opposition to using vaccines which subsided with time as the need for them became apparent to safeguard the population. Eventually they became an everyday occurrence and continue to be one of the most common treatments for bacterial and viral outbreaks. This road from new concept to everyday aspect of life was not smooth and met with opposition and shifting attitudes even to date. There are several sources of opposition which are morphed over time to reflect the present societal ideals. The public’s changing position on vaccines can be accredited to the increased knowledge of biological processes, development of safer practices, and increased necessity in the event of outbreaks and epidemics.

Before the introduction of vaccines as we know them today, inoculation or variolation was the common practice. This constituted of smearing the discharge from a sore of a mildly infected person into an incision on the healthy person’s arm. The belief was that this would then make the person immune to that disease. This was especially common with small pox as it ran rampant globally form the late eighteenth into the twentieth century. Inoculation practices made their way from Europe to the United States during the American Revolution [1]. George Washington reportedly ordered the entire colonial army in 1777 to be inoculated after smallpox outbreaks killed more of his men than the enemy and lost Canada. Not everyone agreed to this inoculation but all were forced to receive it. This act however dropped the death rate from fourteen percent of those who were infected with smallpox naturally to just two percent in those that were inoculated. These are the first recorded efforts of mass preventive treatment on American soil.

The first documented vaccine wasn’t created until 1796 in England by a man named Edward Jenner. Mr. Jenner was a practicing physician in Great Britain and was determined to find a cure and or prevention mechanism for small pox. During his work he noticed that milkmaids who had been exposed to cowpox never seemed to catch smallpox. He hypothesized that prior infection with the more benign cowpox would result in immunity against smallpox. To test this theory he inoculated the son of his gardener, eight-year old James Phipps, with cowpox by scraping the pus from a milkmaid’s cowpox sore into an incision made on James’ arm [2]. The key difference between Jenner’s work and the older practice of inoculation is that in vaccination a less virulent version of the infection is introduced to the system rather than the full strength disease. Although there were some adverse side effects such as fever James quickly recovered. Jenner then intentionally subjected James to someone deathly ill will smallpox to which he had no reaction. Seeking to further prove his hypothesis, he inoculated another twenty-three people and then presented his research to the Royal Society. After much deliberation the new practice of vaccination was accepted although it would take many years to enter widespread use in England and globally.

The largest cause for such strict opposition was the dominant medical theory of the time. In these days, humoral theory rained vastly superior to the now common germ theory which emerged starting in the 1850s [3]. As a result, people were extremely reluctant to participate in a treatment that contradicted their entire view of medicine. As battles were ensuing over medicinal theory technological advancements surrounding the administration of vaccines significantly improved the safety of the person receiving them. Vaccinations began using hypodermic needles rather than smearing discharge into an incision [4]. This development eased peoples’ minds as it seemed less invasive than the previous method. Furthermore, the biological basis of germ theory was becoming better known which lead to innovation in vaccines themselves alongside their delivery methods. In the latter half of the century vaccines for prominent fatal diseases such as cholera, rabies, and tetanus were invented [5]. These developments saved countless lives and were the first steps towards protecting entire populations. By the end of the nineteenth century there was a significant enough backing for vaccine use that mandatory infant vaccinations were instated by British Parliament and then became a mainstream treatment in the United States [6]. Opinions were flipped due to a change in the dominant medical theory, the development of safer methods, and by necessity to combat the spread of severe infectious diseases.

Although at this point vaccines had made leaps and bounds to increase in popularity there were still drawbacks in the eyes of the people. Improvements in technology made vaccines much safer than those of the 1800s, though they were not without complication. The needles used were large, unreliable and subject to rust or breaking which perhaps contributed to the reason that it took over 100 years for the smallpox vaccine to be widely used. People today would cringe at the thought of being vaccinated with a rusty needle but in these days they were dependent on them. Aside from the risk potential from using these needles, there were a few instances of contamination in the vaccines themselves. In 1901 a tetanus contamination in diphtheria antitoxin caused the death of thirteen children in St. Louis and later the same year a tainted smallpox vaccine killed nine children in New Jersey [7]. This clearly diminished any confidence the society had in scientists developing vaccines and fueled the distrust of the opposition. The controversy quieted down with the creation of the Biologics Control Act of 1902 and subsequent regulation of vaccines. This new agency boosted safety measures and returned the societal trend towards supporting vaccinations in the United States as they continued to spread.

As the American public began to place trust back in vaccines, they became the dominant treatment for the worst diseases of the twentieth century. From 1900 until 1929, smallpox vaccine use grew and brought with it a corresponding significant decline in the astonishingly high number of reported cases [8]. This continued to decrease until an outbreak in the 1940s and the last case of smallpox in the United States occurred in 1949. As small pox was becoming a memory, polio began to run rampant with the worst period spanning from 1951 to 1954. Similarly, the measles began to grow in America between 1958 and 1962. The vaccines for both of these diseases became available subsequently in 1962 and 1963 respectively and saw similar decreasing prevalence as small pox. Small pox was completely eradicated on the global scale in 1977 and polio was eradicated in the western hemisphere with an average of eight cases globally per year [9]. These three vaccines alone remarkably increased the state of America’s public health and safeguarded the population to the level it is at today.

Currently in the US vaccination use is at an all-time high and is supported by a vast majority of the population. There have been over 99 percent reductions in the prevalence of polio virus, measles, diphtheria, smallpox, and several other life-threatening diseases since the introduction of their vaccines [10]. Despite the obvious benefits from regular vaccine use, there are still some people that are either hesitant or refuse to receive vaccinations. There are several origins for this opposition in the present day. One of the largest barriers to using vaccines is the affordability. Older vaccines tend to be fairly cheap but those recently created typically incur the expensive research and development costs. However many vaccinations are either government funded or subsidized. Examples of this include the annual flu shot which is typically free at a local pharmacy and the CDC’s Vaccines for Children Program (VFC) which supplies free vaccines to families in need. Religion and Politics both play into opposition to vaccine use. Some religions do not allow their followers to receive them because of their beliefs. Additionally, some people feel mandatory vaccine use infringes on their personal liberties leading them to oppose it as a whole. With any vaccine there is a risk of side effects as demonstrated by many people becoming temporarily ill after receiving the flu shot. Similarly, some people have a fear of needles which prevents them from benefiting from having the vaccination. Perhaps one of the most dangerous sources of opposition is when someone thinks that the illness will never happen to them. People who do not receive the vaccine may not come in contact with the pathogen and truly be okay. However, not all are this lucky such as those who do not receive the meningitis vaccine prior to attending college.

The primary obstacles around vaccine use have changed over time and range from dominant medical theory to unsafe practices to affordability. Though these vary greatly, the factors that bring support to vaccinations are fundamentally similar. The largest cause of an increase in vaccine use is scientific discovery and the development of safer practices. As scientists understand how the body works and the way illnesses spread, the more effective treatments become and in turn the more likely people are to use them. Furthermore in the event of an outbreak or epidemic people are more likely to turn to vaccines to protect themselves from the spread. This became true in the battle against smallpox and remains true into the modern era. The social climate of the country also plays a role in how people respond to vaccines. If the society shifts their focus to the welfare state of people, vaccination use is likely to increase in an attempt to terminate such diseases.

Notes

[1] F, Amy L. “George Washington and the First Mass Military Inoculation.” Science Reference Services. February 12, 2009. Accessed May 14, 2018.

[2] Riedel, Stefan. “Edward Jenner and the History of Smallpox and Vaccination.” Advances in Pediatrics. January 2005. Accessed May 14, 2018.

[3] Harvard University Libraries. “Germ Theory.” Open Collections Program: Contagion, The Yellow Fever Epidemic in Philadelphia, 1793. 2018. Accessed May 14, 2018.

[4] Smithsonian. “History of Vaccines.” The American Epidemic. February 01, 2005. Accessed May 14, 2018.

[5] “Vaccine Timeline.” Immunization Action Coalition. December 30, 2016. Accessed May 14, 2018. http://www.immunize.org/timeline/.

[6] Wolf, Robert M., and Lisa K. Sharp. “Anti-vaccinationists past and Present.” BMJ 325, no. 7361 (2002): 430-32. doi:10.1136/bmj.325.7361.0.

[7] Dehovitz, R. E. “The 1901 St Louis Incident: The First Modern Medical Disaster.” Pediatrics 133, no. 6 (2014): 964-65. doi:10.1542/peds.2013-2817.

[8] CDC. (1999). “Impact of Vaccines Universally Recommended for Children- United States, 1900-1998. ” Morbidity and Mortality Weekly Report,281(48), 243-248. Retrieved March 3, 2018

[9]Ibid

[10] Ventola, C. Lee. “Immunization in the United States: Recommendations, Barriers, and Measures to Improve Compliance.” Pharmacy and Therapeutics 41, no. 7 (July 2016): 426-36.