Test Your Vaccinology Knowledge :: A Brief History of the Great Vaccine Debate

Our partners from iCare Emergency Room & Urgent Care sponsored and crafted this blog post and provided historical information on vaccines and their effects on global populations.

In medicine, we like tests — so let’s start this discussion with a quick quiz. Which of the following are true?

1. Edward Jenner — father of vaccinology — was the great, great, great, great grandfather of Caitlyn Jenner.
2. The word “vaccine” is derived from the Latin word for cow.
3. There is some scientific evidence that the MMR vaccine may cause neurologic diseases such as autism.
4. The anti-vaccine movement began in 1830.

Ask any modern healthcare professional to list the 10 greatest achievements of the past century, and vaccinations would have to rank near the top, but there remains a lot of debate about vaccines and their safety. Why is this? Is there something to this? Interestingly, this debate has a long history. To really understand it, we need some context, so let’s take a stroll down a scientific memory lane.

A Condensed Timeline of Vaccine History

• 1796 // Smallpox was a scourge that indiscriminately affected the rich and poor alike. It disfigured and often killed. When Edward Jenner administered the first vaccine in Gloucestershire, England, it was modern marvel, and it made him famous in his own time. He gave the first dose to a 12-year-old boy by exposing him to the harmless but similar cowpox virus. He later proved that this protected the child from smallpox. The name “vaccine” didn’t actually exist at this time. Jenner later named the treatment “vaccine” from the Latin vacca meaning cow — so number two from our quiz is true. It’s important to note that Jenner’s initial experiments were carried out in a pre-germ-theory era that lacked modern methods of quality control and sterilization. His method involved extracting puss from the arm lesions of those recently vaccinated/infected. It was not uncommon for staph, syphilis, and other infections to accompany this inoculum. Many people were rightly fearful of contracting another dreadful disease while getting vaccinated for the first one. One might also find some ethical issues with his testing method of experimenting on unwitting children, but that’s another discussion. 
• 1830 // The 1830s did actually see the birth of the first anti-vaccination movement — so number four from our quiz is true. Seeing the success of Jenner’s vaccine, the English government made his inoculation procedure mandatory for all its citizens. Unfortunately, the mid-eighteenth century English government was not that popular, and this time period also saw the rise of numerous medical quacks and snake oil salesmen. The well-placed mistrust of these quacks and the government forged the foundation of the first movement of anti-vaccinationists. Much of their consternation revolved around the same concerns we have today about government intrusion into our lives and even our bodies.
• 1885 // Louis Pasteur, the inventor of pasteurization, invented a rabies vaccine. He was a student of Jenner’s work and named all such treatments “vaccines” in honor of Jenner. Smallpox vaccination soon became mandatory under most regional laws in the U.S.
• 1920s // As safe and effective vaccines were developed and refined, one by one the standard childhood immunizations were implemented, including diphtheria, pneumococcus, tetanus, typhoid, and pertussis. They would become a requirement for public school attendance.
• 1950s // Thimerisol-containing measles, mumps, and rubella vaccines were developed.
• 1955 // Jonas Salk developed the first safe and effective polio vaccine. 
• Spring of 1955 // Two hundred children contracted polio from a vaccine containing the actual live polio virus — a bad batch manufactured by Cutter Laboratories in California. Five of those children died from the disease. 
• 1963 // A licensed, inactivated measles vaccine was withdrawn because it didn’t work and it predisposed recipients to an atypical measles syndrome if they were exposed to the actual measles virus.
• 1977 // The last naturally occurring case of smallpox was diagnosed in Somalia.
• 1980 // Smallpox was declared eradicated. 
• 1988 // Worldwide, 350,000 cases of polio were still diagnosed, and a more concerted, global effort to eradicate it began. This program successfully drove the number to 483 just 13 years later, and, by 2017, the number of new cases had fallen to just 22. Polio paralyzes one in 200 children infected. That means since 1988, the global initiative saved many lives and almost 1,800 children from lifelong debility.
• 1994 // Polio was fully eradicated in the Americas.
• 1998 // Doctor Andrew Wakefield produced a study showing evidence the MMR vaccine causes autism.
• 2017 // The oral polio vaccine (OPV) is inexpensive and easy to administer. It became the vaccine of choice for controlling polio in third-world countries. In one case per 750,000 vaccine recipients, the attenuated virus in the oral polio vaccine is known to mutate into a form that can paralyze. In 2017, cases caused by vaccine-derived poliovirus (cVDPV) outnumbered wild poliovirus cases. This was primarily due to wild polio cases hitting record lows, but it is still frightening. Most industrialized countries like the U.S. have switched to the inactivated polio vaccine, which cannot revert, but is 100 to 200 times more expensive to produce.

Today, there are some regions where religion plays a role in the populace avoiding vaccinations. A widespread misconception has arisen in Pakistan that polio vaccine containing haram (forbidden by God) ingredients could cause impotence and infertility in male children. This has led some parents to avoid vaccinating their children. This belief is most prevalent in the Khyber Pakhtunkhwa province and the federally administered tribal regions. Attacks on polio vaccination teams have occurred, hampering international efforts to eradicate polio there, and today Pakistan remains one of the three countries where the virus is still considered endemic.

Gardasil is a new vaccine that actually prevents a certain type of deadly cancer — cervical cancer. This is a disease that can tragically strike down women in the prime of their lives. In 2015, then governor of Texas Rick Perry issued an executive order making Gardasil a mandatory vaccine. His order was overturned by the Texas legislature in response to the concerns of groups like the Family Research Council (FRC). They expressed fears that vaccination with Gardasil might give girls a false sense of security regarding sex and lead to promiscuity. Despite the FRC’s name, there is no legitimate research that supports its position. In my medical practice, I have personally seen women in their 30s on their deathbeds as a result of this disease. It is heart-wrenching, and it is completely preventable. 

Recent Antivaccination Movement

Now that we have some perspective, let’s revisit Dr Wakefield’s study on autism. The flawed findings were published in the Lancet, a widely respected English medical journal. “Flawed” is really an understatement. In short, his study was an outright fabrication. It was so bad, he eventually lost his medical license as the ensuing scandal came to light. It turns out Dr. Wakefield was working for a group of attorneys engaged in lawsuits against vaccine-producing companies. He was basically being paid to falsify data to meet the needs of his employers, and he did just that.

It is amazing how this one individual could publish a minor paper in a single medical journal and have such a reverberating effect. But vaccines, as discussed, had some low points in development. Many of the issues salient in Jenner’s era frequently reappeared and have dominated the discourse surrounding today’s vaccines. So in 1998, just like in the 1830s, the milieu in which we live was ripe for an antivaccination message. Occasional outbreaks of preventable diseases that were all but eradicated are now a growning problem. To this day, scientists and health organizations alike spend significant time and resources fighting the damage caused by what will likely go down as one of the most serious frauds in medical history. So number three from our quiz was also definitely not true. The preservative thimerosal (previously used in diphtheria, tetanus, pertussis, Haemo-philus influenzae type b, or Hib, and hepatitis B vaccines) is not linked to neurological disorders.   

Another concept many don’t consider is herd immunity. Many people rest easy in not vaccinating because we all live under the comfort and protection of herd immunity. For most diseases, when approximately 85–95 percent of the population is immunized, protection is conferred upon the entire group. The problem is that immunity wanes over time. For this and other reasons, many members of our society have diminished immunity. When we get vaccinated, we’re not just protecting ourselves. We’re also protecting them: our grandmother in the nursing home, our neighbor’s newborn baby, or our cousin with leukemia on chemotherapy.

Pro-Vaccine’s Support of the Other Side

Until quite recently, historical studies frequently depicted all antivaccinationists as irrational and antiscientific. As you can see, this is really a mischaracterization. If we interpret anti-vaccinationists in historical context, we can see many behaved as rational actors who were weighing the pros and cons as they saw them at the time. In the case of Jenner’s smallpox vaccine, his treatment spared hundreds of thousands from death or disfigurement. It was the best they had at the time, but one would be right to say the risks of those nineteenth-century methods are not remotely medically acceptable today.

Although antivaccinationists are still often portrayed as a thorn in the side of medical progress, their concerns for safety and willingness to perform the duty of civic oversight are appreciated. This kind of questioning is necessary, as it pushes us forward and forces us to examine whether the way we do things is best. Perspective is the key. A little more than a century ago, one in five U.S. babies died in infancy. Of those who didn’t, another one in five died in childhood. Before the existence of immunizations, infectious diseases such as measles, diphtheria, smallpox, and pertussis routinely killed our babies. We are talking about literally millions of children. 

The bottom line is this: All medical therapies have risks, but in general we all agree we are better off with modern medicine than without it. Statistically, you or someone you love is more likely to be hurt by the diseases vaccines protect us from that the from the unseen or underappreciated risks of the vaccines themselves. One day, society may develop something better. We may look back and revel in the superior safety and efficacy of modern therapies. Until that day, our modern vaccines are pretty good, and they do truly save lives. 

Finally, if you were wondering, Edward Jenner has no relation to Caitlyn Jenner — so number one was also false.

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