It’s hard to see people in lab coats and say, “there goes a superhero.” But that is what I call the people who created the first vaccines for some extremely scary diseases. They took a perilous journey into unknown territory. In early days, before there was a clear understanding of germs and how they spread, hidden dangers lurked. They put themselves and their loved ones at great risk being so close to contagion that had no cure. And they knew very well the symptoms of these diseases because people around them were getting sick, being horribly scarred, and/or dying.
In many developed countries today, we don’t see the results of these extremely dangerous microbes. And because of this, we may have become lackadaisical. We see less death in children and adults now. For example, in 2022 the life expectancy in the United States was 77.5 years , in 1900 it was 47.3 years. [1 ]
Four Diseases and Three Research Heroes
SMALLPOX:
Smallpox was a terrible disease. It had also been around a long time: incredibly, smallpox scars and pustules have been found on mummies who died between 1100 and 1500 BCE. [2] According to an Institutes of Medicine publication, five types of smallpox existed. Its most common form killed one in every three people who were infected (33% of those infected died). Two of the worst types of smallpox were the flat type (around 5% of cases) which killed 97% of people who got it and a hemorrhagic form (about 3% of cases) which killed 100% of those infected. [3] During the last 100 years of its existence, 5 million people died of smallpox every year. [4]
If you survived smallpox, you were often left with horrific scars all over your body. Smallpox also left many survivors blind and infertile. The pattern of symptoms began with high fever, malaise, vomiting, and headache. Then the fluid-filled lesions developed, first in the mouth. They became deep and pustular, like blisters, then they would ulcerate (burst). Most people died suddenly during the second week of the disease [5].
Native American (First People) populations were decimated by smallpox. According to an article from the American Society of Microbiology, “When smallpox swept through Indigenous communities, the aftermath was catastrophic. Devastating mortality rates included 38.5% of Aztecs; 50% lost in the Piegan, Huron, Catawba, Cherokee and Iroquois Nations; 66% of Omaha and Blackfeet; 90% of the Mandan, and the Taíno all but disappeared.”[6]
From 1900 to the 1980s alone—when it was declared eliminated worldwide—smallpox killed 300 million people. [7]
POLIOMYELITIS:
Poliomyelitis (polio, also called infantile paralysis) is another ancient disease. However, polio epidemics did not become evident until the late 1800s and the first half of the 1900s when the epidemics became increasingly severe. [8]
During the summer of 1916, the first large scale outbreak of polio in the United States occurred, focused in the Northeast. It killed 6,000 children and caused paralysis in over 21,000 individuals. [9] Children and adults would feel fine one day, the next they would have an aching neck, fever and be unable to walk and breathe. Iron lungs kept many alive. According to the World Health Organization, by the 1950s, polio occurred worldwide, killing and paralyzing over half a million people every year. [10]
Polio is a disease of the summer. My father, growing up in the early 1950s, spoke of being forbidden to go swimming in the summer for fear of getting polio.
The virus is shed in infected people’s stool for many weeks after a person has had the disease. It enters the body through the mouth, multiplies and destroys motor neurons (muscle nerves) in the spinal cord and brain stem causing paralysis. For adolescents and adults, the disease is usually more severe. [8]
But for some people who contract polio and survive, the virus just isn’t finished. From 15 years to as many as 40 years later, between 25% and 40% of survivors can experience new pain, new weakness and paralysis in a disease called post-polio syndrome. [8]
MEASLES:
Measles is an airborne and extremely infectious disease. Globally, before 1963, 2.6 million people died of measles each year.
Before 1963, In the United States, between 3 and 4 million people got measles each year. Annually, between 400 and 500 people died, 48,000 were hospitalized and 1000 suffering from brain swelling.
For every 20 children that get measles, one will develop pneumonia. The brain swelling of measles can cause convulsions, deafness and intellectual disability.
Measles is also a disease that can return. Seven to ten years after having fully recovered from measles, a very rare but fatal disease of the central nervous system, called subacute sclerosing panencephalitis, can occur.[11]
Moreover, it has been discovered that measles suppresses the immune system, specifically B-cells and T-cells, for up to 3 years after having measles. This means that people who get measles are more likely to get other illnesses during that time. [12] One study found that children who had measles developed antibodies to measles but that the antibodies they had developed to fight other diseases—their antibody memory— dropped between 11% and 73% with an an average loss of 40%. The loss was greater depending on the severity of their case of measles. [13] With this drop in antibodies, survivors of measles are immunocompromised and much more likely to contract other infections.
RUBELLA:
There were 12.5 million cases of rubella (german measles) in the US during the 1964-65 rubella epidemic. Rubella is particularly dangerous to unborn infants. If a mother-to-be gets rubella during her pregnancy, a variety of birth defects can occur. During the 1964-65 epidemic 20,000 babies were born after their mothers were exposed to rubella. Over 11,000 of the babies were born deaf, 3,500 were blind and 1,800 were intellectually disabled. Over 2000 newborns died and over 11,000 spontaneous abortions occurred. [14]
Out of Sight, Out of Mind
These diseases are real. Only one of them — smallpox — has been eradicated worldwide. The rest of the germs that cause these diseases exist in the air, water, and soil of the earth. Even smallpox exists in two labs. These microbes can be present, mutate, and thrive in unvaccinated people around the world today.
The fact that many of us are not still getting terribly ill, becoming scarred, or even dying because of these microbes is due to vaccines. Polio, smallpox, measles and rubella are just a few of the diseases that have been controlled by vaccines.
Remembering Heroes
When I think of heroes, I think of people who created the vaccines that have saved us from these horrific diseases. As one of my heroes, Dr. Jonas Salk said, “Hope lies in dreams, in imagination, and in the courage of those who dare to make dreams into reality.” [15]
Smallpox vaccine: Dr. Edward Jenner
Since 200 BCE, people have been using variolation, a type of inoculation, to control smallpox. The practice involved putting matter from smallpox sores onto healthy people. Those people would get a less virulent smallpox infection and were less likely to die than if they got smallpox naturally.
In 1796, Dr. Edward Jenner, having heard that milkmaids who got cowpox were immune to smallpox, inoculated an 8-year-old boy, James Phipps, with cowpox. Cowpox is a much less virulent disease than smallpox. After the child had a mild case of cowpox, Jenner exposed Phipps to smallpox. Phipps did not get sick. Thus began vaccination with a “less dangerous viral source,” and the beginning of the end for smallpox. In May, 1980, smallpox was declared eradicated. [16]
Polio vaccine: Dr. Jonas Salk
Dr. Jonas Salk was the first member of his family to attend college. After completing medical school, in 1941 he began working with Dr. Thomas Francis, the discoverer of influenza viruses, at the University of Michigan. One of Dr. Francis’ chief innovations was vaccinating with a killed virus.
In 1947, Dr. Salk started work at the University of Pittsburgh Medical School on polio, identifying its three different viral forms. With funding from the National Foundation for Infantile Paralysis (now known as the March of Dimes Birth Defects Foundation) Dr Salk, along with colleagues from his days at the University of Michigan, created a vaccine for polio using the killed virus of all three types. He tested the vaccine on himself, on his wife and children. No one experienced any contrary reactions. [17]
Drs. Salk and Francis started a clinical trial in 1954. On April 12, 1955, at the University of Wisconsin, they announced the successful results of the Polio Pioneers study, a study involving one million children. [18]
The Salk Institute states it best, “In the two years before the vaccine was widely available, the average number of polio cases in the U.S. was more than 45,000. By 1962, that number had dropped to 910. Hailed as a miracle worker, Dr. Salk never patented the vaccine or earned any money from his discovery, preferring that it be distributed as widely as possible. ” [19] Because of vaccines, the last case of “wild” polio in the US occurred in 1979.
Measles and Rubella vaccines: Dr. Maurice Hilleman
Maurice Hilleman’s story begins with tragedy: his mother and twin sister died during childbirth. His mother’s dying wish was for Maurice to be raised by his aunt and uncle, who were childless. They lived nearby, so Maurice grew up on their small farm in Montana.
Thanks to a scholarship, Dr. Hilleman was able to attend Montana State College, majoring in chemistry and microbiology. He continued his education at the University of Chicago, obtaining a PhD in 1944.
In 1957, while working at Walter Reed Army Institute of Research, Dr. Hilleman was the first person to predict a pandemic, the Hong Kong influenza pandemic. He created a vaccine which was used in the US. “Public health officials estimate that the number of deaths in the U.S. could have reached 1 million had Dr. Hilleman’s vaccine not been available. For this effort, he was awarded the Distinguished Service Medal from the American military.”[20]
He began working for Merck in late 1957, staying there until his retirement in 1984. He was the first person to combine vaccines into one vaccine and to develop a vaccine to prevent cancer. His developed over 40 vaccines which save the lives of an estimated 8 million people every year. This is a list of some of the vaccines that Hilleman helped create.
- Measles
- Mumps
- Rubella
- Japanese encephalitis (JE)
- Hepatitis A
- Hepatitis B (two versions)
- Influenza
- Chickenpox
- Adenovirus
- Meningococcus
- Haemophilus influenzae type b (Hib)
- Pneumococcus
- Marek’s disease (MDV) – veterinary vaccine [20]
Positive effects of measles vaccine on the economy: An interesting and useful analysis of the long term effects of measles vaccination on the economy was done in 2022. According to this research which compared pre-vaccine years and post-vaccine years, the measles vaccine has positively affected the ability for people to accumulate wealth (human capital). Children who didn’t get measles were healthier and stayed in school longer than those who had not been vaccinated. They earned more money per year that those infected by measles. Vaccination and resulting herd immunity, lowered the probability of living in poverty.
The economic analysis estimated that if everyone (171 million people age 25 to 65 in 2019) had been in a setting where vaccination and herd immunity occurred, “then as much as $76.4 billion in personal income that year could be attributed to productivity gains resulting from the measles vaccine.” [21, 22]
Herd Immunity: Herd immunity means that a significant number of people in a community have the antibodies necessary to fight off disease, stopping the spread of infection. Herd immunity protects those who cannot be vaccinated. For example, this includes people who are being treated for cancer or who have had an organ transplant and are immunocompromised. To obtain herd immunity for measles, because it is an extremely infectious disease spread through the air, the percentage of people in a community who must be vaccinated or have had the disease is 95%. [23]
Arguments Used to Slow or Stop Vaccinations
In a world of misinformation and fake news, it can be hard for people to know what to believe.
Even during the time of smallpox, there were people who didn’t believe in inoculation (a forerunner of vaccines).
Not Natural, Not According to God’s Will
In 1722, Reverend Edmund Massey preached, “Let us not sinfully attempt to alter the Course of Nature,” He stated that, “Diseases are sent…if not for the Trial of our Faith, for the Punishment of our Sins.” [2] Inoculations and vaccines save lives, but Massey believed that saving lives — allowing people to live longer, to do good during longer, healthier lives — wasn’t God’s plan.
Safety
When my own son was born, I felt concern about vaccines. I had unfortunately heard about and been fooled by media coverage of a hoax played on the journal, Lancet, and on the world.
Andrew Wakefield, the primary author of a journal article accepted by Lancet, was paid to lie by lawyers of parents involved in lawsuits against vaccine manufacturers. He claimed in his “study” of 12 children to have found a link between these children’s vaccinations and autism. This was false. In fact, not only did he fake results but, according to Britain’s General Medical Council which investigated the fraud, Wakefield acted, “unethically and showed ‘callous disregard’ for the children in his study, upon whom invasive tests were performed.”
Once the fraud became public, several authors whose names were on the study had them removed quickly. Follow-up investigations of Wakefield’s study completely contradicted Wakefield’s chief assertion of a connection between measles vaccination and autism. The follow-up investigations found that the children in Wakefield’s study had no antibodies derived from a measles vaccine, meaning they had never been vaccinated. The Lancet finally retracted the article in 2010. [24]
However, this fraud caused a lot of damage. Because of the uproar, fraudulent journal article, and successive years of misinformation, the CDC has taken steps to reassure parents concerning the safety of vaccines. These statements reassure me and I hope they help you as well.
“Many studies have looked at whether there is a relationship between vaccines and ASD [autism spectrum disorder]. To date, the studies continue to show that vaccines are not associated with ASD.“
An incredibly reassuring sign is that the CDC has partnered with another organization to monitor this:
“CDC knows some parents and others still have concerns. To address these concerns, CDC is part of the Inter-Agency Autism Coordinating Committee (IACC), which is working with the National Vaccine Advisory Committee (NVAC) on this issue. The job of the NVAC is to advise and make recommendations regarding the National Vaccine Program.” [25]
Civil Liberties
A study from 2021 found that 8% of Americans always self-identify as anti-vaxxers, while 14% sometimes do. [26]
Claims that vaccination is a violation of rights and freedom actually came to the US from Great Britain in the late 1800s. In 1879, a British anti-vaccination activist, William Tebbs, came to the US to found an organization against vaccinations. Tebbs even equated the coercion of slavery to being compelled to be vaccinated. But the black press endorsed vaccination for blacks as “an expression of their right to control their own medical care…associating the occurrence of smallpox with the brutality and deprivations of slavery….tak[ing] advantage of a preventive intervention that was sometimes denied to those in slavery—was a greater expression of liberty than the ability to escape vaccination.” [27]
The Supreme Court has made a statement about vaccinations. In 1905, in Jacobson v. Massachusetts, the Supreme Court upheld the authority of states to enforce compulsory vaccination laws.
“The liberty secured by the Constitution of the United States to every person within its jurisdiction does not impart an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good.” [28] What this means is that for the good of all people in a community, there are rules that we live by. In terms of vaccination this means that by requiring everyone to be vaccinated, we are doing something for the good of all. We protect everyone —ourselves, those who cannot be vaccinated due to illness or other factors, and the other vulnerable— from terrible diseases that kill and maim us.
Vaccination Matters
There are everyday heroes doing works for the good of all of our communities and our country, in terms of health and economic outcomes from victories over infectious diseases. This is too easily forgotten in these days as the memory of the times before them fades. Getting vaccinated matters.
REFERENCES
[1] Rappuoli R, Pizza M, Del Giudice G, De Gregorio E. Vaccines, new opportunities for a new society. Proc Natl Acad Sci U S A. 2014 Aug 26;111(34):12288-93. doi: 10.1073/pnas.1402981111. Epub 2014 Aug 18. PMID: 25136130; PMCID: PMC4151714.
[2]Li, Y., Carroll, D. S., Gardner, S. N., Walsh, M. C., Vitalis, E. A., & Damon, I. K. (2007). On the origin of smallpox: correlating variola phylogenics with historical smallpox records. Proceedings of the National Academy of Sciences, 104(40), 15787-15792.
[3]Henderson, D. A. (2011). The eradication of smallpox — An overview of the past, present, and future. Vaccine, 29, D7–D9. https://doi.org/10.1016/j.vaccine.2011.06.080
[4]Institute of Medicine (US) Board on Health Promotion and Disease Prevention. Scientific and Policy Considerations in Developing Smallpox Vaccination Options: A Workshop Report. Washington (DC): National Academies Press (US); 2002. SCIENTIFIC BACKGROUND ON SMALLPOX AND SMALLPOX VACCINATION. Available from: https://www.ncbi.nlm.nih.gov/books/NBK221063/
[5]World Health Organization.History of smallpox vaccination. https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-smallpox-vaccination
[6]American Society of Microbiology.(2023, November 15). Investigating the smallpox blanket controversy. https://asm.org/articles/2023/november/investigating-the-smallpox-blanket-controversy
[7]Mayo Clinic. History of smallpox: Outbreaks and vaccine timelines. https://www.mayoclinic.org/diseases-conditions/history-disease-outbreaks-vaccine-timeline/smallpox
[8] Estivariz, C, Link-Gelles, R, and Shimabukuro, T. Poliomyeltis. Chapter 18: Poliomyelitis, Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book. https://www.cdc.gov/vaccines/pubs/pinkbook/polio.html
[9] Bakalar, N. (2016, March 14). The unfolding of polio. The New York Times. https://www.nytimes.com/2016/03/15/science/the-unfolding-of-polio.html
[10] World Health Organization. History of the Polio Vaccine. https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-polio-vaccination
[11] Centers of Disease Control and Prevention. The history of measles. https://www.cdc.gov/measles/about/history.html
[12] Mina MJ, Metcalf CJ, de Swart RL, Osterhaus AD, Grenfell BT. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science. 2015 May 8;348(6235):694-9. doi: 10.1126/science.aaa3662. Epub 2015 May 7. PMID: 25954009; PMCID: PMC4823017.
[13] Mina, M et al.,Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens.Science366,599-606(2019).DOI:10.1126/science.aay6485
[14] Centers of Disease Control and Prevention. Rubella (German Measles). The history of vaccines.https://historyofvaccines.org/diseases/rubella-german-measles
[15] Brainy Quote: Jonas Salk. https://www.brainyquote.com/quotes/jonas_salk_389658
[16] World Health Organization . History of the smallpox vaccine. https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-smallpox-vaccination
[17] Salk Institute of Biological Studies. History of Salk: About Jonas Salk. https://www.salk.edu/about/history-of-salk/jonas-salk/
[18] Laurence, W. (1955, April 13).Salk polio vaccine proves successful. The New York Times. https://timesmachine.nytimes.com/timesmachine/1955/04/13/79387400.html
[19] Estivariz, C. Link-Gelles, R. & Shimabukuro T. Poliomyelitis. Chapter 18. The Pink Book. Centers for Disease Control and Prevention. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-18-poliomyelitis.html
[20]Hilleman: A Perilous Quest to Save the World’s Children. About Dr. Hilleman. https://hillemanfilm.com/dr-hilleman
[21] Leith, L. The positive effects of the measles vaccine on long term labor market outcomes. Monthly Labor Review. US Bureau of Labor and Statistics https://www.bls.gov/opub/mlr/2022/beyond-bls/the-positive-effects-of-the-measles-vaccine-on-long-term-labor-market-outcomes.htm .Referencing:
[22] Atwood, Alicia. 2022. “The Long-Term Effects of Measles Vaccination on Earnings and Employment.” American Economic Journal: Economic Policy, 14 (2): 34–60.DOI: 10.1257/pol.20190509
[23] Desai AN, Majumder MS. What Is Herd Immunity? JAMA. 2020;324(20):2113. doi:10.1001/jama.2020.20895
[24] Eggertson L. Lancet retracts 12-year-old article linking autism to MMR vaccines. CMAJ. 2010 Mar 9;182(4):E199-200. doi: 10.1503/cmaj.109-3179. Epub 2010 Feb 8. PMID: 20142376; PMCID: PMC2831678.
[25] Centers for Disease Control. Frequently asked questions about autism spectrum disorder. https://www.cdc.gov/autism/faq/index.html
[26] ]Motta, M., Callaghan, T., Sylvester, S., & Lunz-Trujillo, K. (2021). Identifying the prevalence, correlates, and policy consequences of anti-vaccine social identity. Politics, Groups, and Identities, 11(1), 108–122. https://doi.org/10.1080/21565503.2021.1932528
[27] Colgrove J, Samuel SJ. Freedom, Rights, and Vaccine Refusal: The History of an Idea. Am J Public Health. 2022 Feb;112(2):234-241. doi: 10.2105/AJPH.2021.306504. PMID: 35080944; PMCID: PMC8802588.
[28] Jacobson v. Massachusetts, 197 U.S. 11 (1905) No. 70 Argued December 6, 1904 Decided February 20, 1905. https://supreme.justia.com/cases/federal/us/197/11/
