The History of Vaccination: Top 10 Things to Know

Outbreaks of measles across the globe have
once again set off the great debate over vaccination. Since 2014, hundreds of thousands of cases
of measles have appeared across the planet and the World Health Organization recently
called for increased vaccination campaigns. In the U.S., measles outbreaks
have become more frequent, leading to calls for mandatory vaccination. The development of vaccines and extensive childhood vaccination campaigns are among
the most important public health achievements of the past 200 years. They have saved millions
upon millions of lives each year and in some cases eradicated dangerous diseases not only
locally but globally. The Earth was declared smallpox-free in 1980; in 2000, the United
States asserted itself rid of measles. Despite these successes, the anti-vaccination
movement has been gaining traction in recent years, spurred on by religious opposition
to vaccines and by the concerns raised by now-discredited studies that linked vaccines
and autism. And as vaccination rates decline, the spread of these previously controlled
diseases is on the rise. As we discuss and debate, Origins offers the
Top Ten things you should know about vaccines and vaccination efforts. Number 1. Life Before Vaccines: Nasty, Brutish, and Short Throughout most of history, human populations have lived in an unvaccinated state. They
have been extremely vulnerable to endemic and epidemic infectious disease, especially
if they had no previous exposure to a particular disease. This was most spectacularly seen
with smallpox in the Americas in the early modern period. Spanish invaders, themselves
possessing acquired immunity to smallpox, introduced the disease to indigenous populations,
with devastating results. By 1568, the Central American population had fallen to around 3 million, which was around one-tenth of its original population. Before the nineteenth
century, the most efficacious way of dealing with epidemic disease was quarantine: the
European landscape was littered with pest-houses and lazarettos. Life expectancy was correspondingly
low. Global life expectancy was between 25 and 30 years as recently as 1800, and fewer
than 5% of most populations survived until sixty-five. People rarely lived to be old. Number 2. Variolation and the Scourge of Smallpox
The origins of vaccination lie in the practice of variolation, which was used to protect
against smallpox (a disease that killed annually an estimated 400,000 people in Europe alone
in the eighteenth century). Variolation involved transferring disease material from the pustules
of an infected to an uninfected person. It was practiced in numerous parts of the world
from the early modern period: in China, Africa, the Near East and South Asia. It was introduced
into Europe by Lady Montagu, who observed the practice in the Ottoman Empire. Her son
was inoculated in 1718 and her daughter, Mary, in 1721, the latter being the first person
to be variolated in England. Variolation was brought to New England by Cotton Mather and Zabdiel Boylston in 1721. Following the development of the newer practice of vaccination, variolation declined and was ultimately banned. The British, for example, banned it in 1842. And the practice of variolation was eliminated along with the smallpox virus itself
in 1980. Number 3. What We Owe to the Cows
The term vaccination comes from variolae vaccinae, or “smallpox of the cow,” otherwise known
as cowpox. The close relationship between smallpox and cowpox was common lore in the
eighteenth century. We have accounts of individuals inoculating their children with cowpox pus,
for example Peter Plett in Husselburg in 1791. There is also evidence that the practice was
known in South Asia and in Persia. In 1796, Edward Jenner took cowpox material from the hand of the dairymaid Sarah Nelmes and inoculated James Phipps, the eight-year-old son of Jenner’s
gardener. He then published his results in 1798 An Inquiry into the Causes and Effects of
the Variolae Vaccinae, a Disease Discovered in Some of the Western Counties of England,
Particularly Gloucestershire, and Known by the Name of the Cow Pox. Jenner did not discover vaccination, but he publicized the technique and proved its effectiveness to doctors. Number 4. Edward Jenner and the Arm-to-Arm
Method Jenner was, however, immediately faced with
a basic problem. Cowpox was a seasonal disease, common only in the spring, and it was hard
to maintain a constant supply of cowpox matter. Hence Jenner developed the so-called “arm-to-arm”
method. After vaccination, pustules would erupt on the arm. This pustular material could
then be used as a reservoir for another vaccination: it could be extracted from the arm and rubbed
into the skin of another patient following mild laceration with a lancet or needle. Jenner could thus maintain a permanent supply of vaccine. The technique spread rapidly: Hanover
became the first Continental European vaccine center, in 1800. Vaccination spread to the
United States also in 1800, to Russia in 1801 and Japan in 1824. Some states made vaccination
of all children compulsory, for example Bavaria in 1807, Denmark in 1810, and Sweden in 1814.
The arm-to-arm method, however, disappeared with the rise of animal vaccines in the 1860s. Number 5. From Cows to Test Tubes: Producing Vaccines in the Lab Later in the nineteenth century, scientists began to manipulate pathogens with the aim
of reducing their virulence, thereby producing safer and more effective vaccines. This process
is particularly associated with Louis Pasteur, who created the first laboratory-produced
vaccine in 1879, for chicken cholera. Although the vaccine was rather ineffective, it heralded
a new age of disease control. Jean-Joseph-Henri Toussaint produced an anthrax vaccine in 1880, an invention for which Pasteur later claimed credit. Neither vaccine, however, was used
on humans. This changed when Pasteur developed a rabies vaccine after long experiments with
attenuation. His vaccination of Joseph Meister in 1885, using material harvested from the
spinal cord of rabbits, demonstrated that it was possible to cultivate vaccines to protect
against human diseases. Number 6. From Hot Irons to Vaccines: Treating Diphtheria Diphtheria was a major killer of children,
and treatments were often desperate: sometimes physicians tried to burn away the disease’s
characteristic throat pseudomembrane with silver nitrates or even hot irons. Following
the discovery of the diphtheria bacterium in 1883, the microbial activity causing the
disease was understood. Émile Roux and Alexandre Yersin identified the toxin produced by the
bacterium in 1889, and in 1890, Shibasaburo Kitasato and Emil von Behring successfully inoculated guinea pigs with an attenuated, heat-treated diphtheria toxin. Human antitoxins were then successfully utilized, and contributed to the dramatic fall in the disease’s incidence
by World War One. After the war, a totally inactivated antitoxin was developed by Gaston Ramon and Alexander Glenny. The combined diphtheria, pertussis, and tetanus shot (DPT) dates from 1948. Today, diphtheria has been practically eliminated from the United States and many
other parts of the world. Number 7. Paralyzed or Worse: Polio Until the early twentieth century, poliomyelitis was an endemic infantile disease, and it became
increasingly common as living standards rose. In 1916, a polio epidemic killed 6,000 Americans,
and left thousands more paralyzed. American president Franklin Delano Roosevelt was stricken with polio as an adult and spent the rest of his life wearing painful leg braces. In
1929, the iron lung was developed to help sufferers breathe. The first functional vaccines,
a killed vaccine pioneered by Maurice Brodie and an attenuated vaccine invented by John
Kolmer, were developed in the 1930s. Six of those given the attenuated virus died and
tests were immediately suspended. In the 1950s, however, Jonas Salk’s inactivated vaccine proved successful in trials: it was licensed in the U.S. in 1955. Albert Sabin, meanwhile,
a Russian-born American scientist, pioneered a successful oral vaccine using an attenuated
virus, which was successfully administered to millions of Soviet children in 1959. Sabin’s
vaccine was then widely used in the global polio eradication campaign. Number 8. False Starts: Vaccines that Haven’t Worked Many diseases have, unfortunately, proved refractory to vaccination. In the mid-nineteenth
century, for example, Joseph-Alexandre Auzias-Turenne undertook several experimental “syphilisations”
of patients. His work was furthered by an Italian, Sperino, and a Norwegian, Boeck.
Although some success was claimed, a functional syphilis vaccine has never been developed. Jaime Ferran’s 1885 cholera vaccine was the first to be used against a human bacterial disease. However, cholera vaccines have never been enormously effective, and only confer immunity for a short period. The development of an HIV vaccine is extremely difficult, due to the complexities and idiosyncrasies of the retrovirus. Finally, some vaccines
have been doomed from the start. The German physiologist Wilhelm Weichardt, for example,
attempted to develop a fatigue vaccine in the early twentieth century, and sprayed an
entire school classroom with antikenotoxin solution in 1909. Alas, the fatigue vaccine
did not prove a long-term success. Number 9. Vaccination Has Generated a Backlash
from the Beginning Variolation and vaccination immediately attracted controversy and opposition. In 1722, an English Reverend, Edmund Massey, called variolation “a Diabolical Operation” which “banish[ed] Providence out of the World.” A 1723 Paris
thesis claimed that the technique could be used to kill children. In mid-nineteenth-century Britain, vaccination officers symbolized the power of medical elites and the State. Anti-vaccinators
declared the process a great violation of the bodily freedoms of the individual. And
vaccination seemed singularly counterintuitive. Some parents expressed concern that, following
vaccination, their children might “low and…browse in the fields like oxen.” Others worried
that the passage of infected material from body to body would spread disease or even
transgress racial boundaries, leading to changes in skin color. In 1885, an effigy of Jenner
was hanged and decapitated in Leicester, England, while vaccination officers were pelted with
eggs or rotten fruit. An 1898 “conscience” clause allowed British parents to opt out
of vaccination. In the United States, where vaccinations began as initiatives from individual
states, most states permitted exemptions for “religious” reasons. And they still do.
Muslims in several countries have recently denounced vaccination campaigns as “western”
and “anti-Muslim.” In 2014, public health workers in Pakistan working to immunize people from polio were murdered by anti-vaccination crusaders. Not coincidentally, Pakistan is
now regarded as the global “hot spot” for new polio cases. Number 10. Less Nasty, Less Brutish and Much Longer: Life After Vaccines The overall global effects of vaccination are impossible to overstate. Seven diseases
have been brought under significant control through the use of vaccines: smallpox, diphtheria, tetanus, yellow fever, whooping cough, polio, and measles. Of these, smallpox has been completely
eradicated, saving an estimated 5 million people annually. And polio is currently close
to eradication: there were only 416 cases in 2013. According to the World Health Organization,
the measles vaccine saves around one million lives annually. Along with clean water supplies,
improved nutrition and extensive public health and medical infrastructure, vaccination has been responsible for dramatic declines in deaths from certain infectious diseases. Vaccination is thus a central factor in the epidemiologic transition, to an age where non-infectious
diseases like cancer, heart disease and diabetes, are the major killers. By 2014, global average
life expectancy had risen to 73 for girls and 67 for boys.

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