Getting the Right Response | History of Vaccines
“The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases”
-Edward Jenner, creator of the first smallpox vaccine
The woman and the boy sat across from him. Her hand was on the table, the sore on her index finger weeping. He took sample of the pus, and moving the boy, put it into the incision on his forearm. The boy hadn’t flinched when he made the cut. He wore a look on his face that showed one-part disgust, and the other interest.
Dr. Jenner closed the incision over the pus, and bandaged the boy’s forearm. He turned to the woman.
“Time will tell,” he said.
She nodded. “It will. I think its story will be the same as it was for me.”
The boy stood up, rubbing his bandage. His father took a step forward and looked at the doctor without saying a word. He took his son’s hand.
“I do not think it will be the same,” the doctor said to the woman. He then turned to the father and son.
“Be sure to report back to me in the next three days if he gets sick.”
The father nodded and the two walked out into the street.
“How do you think the story will change,” asked the woman as she bandaged her wound.
The doctor collected his instruments and began to wash them. He walked to his bag and after drying each piece, put them in their cases.
“I think this story has the ending we hope for.”
Before We Knew It
The science behind vaccines began as early as 200 B.C. In China, smallpox scabs were ground into a powder and inhaled through the nose. Another method was to scratch the matter from a smallpox sore into the skin. This provided an early introduction of the virus to the immune system, sometimes enabling it to begin building a defense. One of the most noted applications of this method was with Chinese Emperor in the late 1600’s, who survived smallpox as a child and had his children inoculated.
Unfortunately, Smallpox, Scarlett Fever, Whooping Cough, and many other maladies would appear throughout history from far east to the North America, causing havoc and death in both children and adults alike. The treatment for these varied depending on the disease, but over time, attempts at inoculation became more and more prevalent.
Variolation was the practice of spreading disease – primarily smallpox – to others in an attempt to introduce a productive, defensive reaction from the body. Created in the 1600s and eventually introduced to the American Colonies in 1706, this practice spread over the next 200 hundred years with both positive and negative effects. This was due to the virus being at full strength during introduction, which resulted in 5-10% death rate. Other methods of treatment were the quarantine of the sick, or using herbs, opium, and attempts to sweat our fevers that came as a result of the infection.
As covered on prior episodes, medicine is based on precedent. Treatments that worked were recorded and tried again, no matter how outrageous. With this in mind, the introduction of inoculation found its use among physicians due to its success rate and enhanced probability in warding off disease.
Edward Jenner & the Small Pox Vaccine
Edward Jenner was born in the town of Berkley in Great Britain in 1749. He began his medical career at the age of 14 when he was apprenticed to the surgeon Daniel Ludlow for seven years. In this time, he gained most of the needed surgical experience and progressed to St. George’s Hospital. It was there that Jenner was introduced to a broader range of medical experience and thought, specifically the concept of “Don’t think; try”. He quickly rose in the prominence in medical circles.
In 1796, Jenner was visited by a milkmaid who had contracted cowpox during the course of her work. Cowpox caused many of the same symptoms as smallpox but in much less severity. Instead of being bedridden for weeks, subjects with cowpox would be sick for a few days and then recover. While she went there for treatment, Jenner used the opportunity to test the theory that those who had exposure to cowpox were immune to smallpox. Several physicians both in England and Germany had successfully infected subjects who recovered from cowpox with the smallpox. None of them went on to contract the smallpox illness.
To test this further, Jenner took pus from one of the woman’s wounds and used it to inoculate several subjects, most notably his gardeners eight-year-old son, James Phipps. Phipps became sick within a few days of the inoculation, but then quickly recovered. After gaining permission from his father, Jenner then inoculated Phipps with smallpox. Like the previous experiments across Great Britain and Europe, the boy did not get sick. Jenner then continually inoculated him, sometimes on both arms to make sure the virus was properly introduced. Phipps never grew ill from smallpox.
Jenner went on to publish his findings and was met with predictable resistance. But by 1800, Jenner’s work had been published across Europe and introduced into the new world, prompting wide-spread practice and application. Future iterations of the vaccine would make it more effective and most important, easier and cheaper to produce to the point that in 1967, the World Health Organization set out to eradicate Smallpox across the globe. By 1979, they had accomplished their mission and smallpox became the first virus in history to be completely eradicated.
Polio
The Poliovirus is a contagion that targets the nerve cells in the spinal cord causing muscle wasting and paralysis. Particularly affecting children, it caused flu-like symptoms but in some, created more serious complications including death. Its plagued societies over the centuries and as a result, was identified as an opportunity for which to create a vaccine. Unlike the smallpox vaccine, the process of creation and application was met with significant failure and tragedy. This resulted in widespread oversite of vaccine manufacturing and production.
In 1935, teams began the development of the first polio vaccine and presented their findings in November of that year. The results were disastrous. John Kolmer, a published and respected MD spoke first. He used no test groups, trial periods or primary safety measures associated with vaccine trials. As a result, of the 10,000+ children he infected, five died of the disease, with 10 more becoming paralyzed. Maurice Brodie, a young researcher and doctor spoke second, and though he used all proper procedures and was able to show his vaccine to be 88% effective, the room was so soured by Kolmers ineptitude that his findings were discarded.
Another, more successful attempt was made in 1948 when a group was able to grow the poliovirus in a culture. This provided a safe environment where tests could be done against the virus to develop a safer vaccine, the results of which paved the way for full development. For their efforts in this endeavor, the members of the group were awarded the Nobel Prize in Physiology or Medicine. During this time, other important elements of the virus were identified, both in how it presented in the blood prior to paralysis and the identification of three poliovirus serotypes which helped better differentiate the severity of the disease.
Using their work, Jonas Salk and a team of experts developed the first polio vaccine at the University of Pittsburgh – Go Steelers – in 1952. After initial reports of successful testing and application, Leone Farrell created a laboratory technique that enabled mass production of the vaccine. A field trial was conducted by Thomas Francias which included 1.8 million children from Main to California. In this trial, around 440,000 children received one or more injections of the vaccine, about 210,000 received a placebo, and 1.2 million children received no vaccination, serving as a control group. The results were announced in 1955, and showed the vaccine to be at least 70% effective against all three types of the poliovirus. The successful application of the vaccine in the trial prompted mass immunization campaigns, which dropped the number of cases by 84% by the end of 1957.
During this time, the Surgeon General begin receiving reports of paralytic polio from those who had been immunized. After an investigation, it was proved that two companies, Cutter Pharmaceutical and Wyeth did not use proper procedures to fully inactivate the virus in more than 100,000 doses. As a result, the National Institute of Public Health and other health agencies instituted stringent measures of control over the production of the vaccine, but not before public opinion on the issue began to fall.
Another team of scientists, Albert Sabin and Robert Gallo, was working on a vaccine the same time as Salk. Their vaccine was orally administered, and contained all three types of the virus in an attenuated state. After successful trials and applications in Russia, it went into commercial use in 1961 replacing Salk’s injected vaccine. Sabin and Gallo’s vaccine was employed by the World Health Organization from 1988-2000 to successfully eradicate the poliovirus across the globe.
The Science of Vaccines & Herd Immunity
Modern medicine has refined the way vaccines work within the body to better produce the desired result. These two examples show the progression from discovery to the creation of the vaccine itself. The result was a greater understanding of how vaccines work and the body’s response to them.
A pathogen can be a virus, parasite, or bacterium that can cause disease within the body. Each pathogen is made up of small subparts, called antigens. If you don’t know what these are, think of one of the many pictures of the coronavirus. Covering the surface of the wall are rods with small knobs on each end. These are antigens. When first introduced to the body, the immune system has not had time to create antibodies that can connect to the antigens to destroy the pathogen. As a result, we get sick. Over time the body’s immune response creates antibodies that can connect to the antigens and fight them, but again, this takes time.
A vaccine can either be a weakened, non-dangerous fragment of the pathogen and antigen needed to produce the new antibody, or they are literal blueprints for the antigen that instruct the body how to create the right defense. As a result, if and when the pathogen enters the body the immune system is better equipped to combat it.
Unfortunately, a vaccine cannot provide 100% protection from a pathogen. While it does educate the body on how to provide a defense, the body itself is much more able to create a viable defense in response to the specific threat posed by the pathogen. One of these ways is through heard immunity.
Herd immunity happens when a significant portion of the population has either been vaccinated or developed immunity to a disease, reducing the likelihood of infection for those that lack immunity. As covered on an earlier episode, A Time for History, one of the most striking cases of herd immunity can be seen when studying the Spanish Flu. For almost three years the flu spread in waves, causing illness and death until finally it stopped. That particular strain of flu has rarely been seen since and scientists have concluded that the strain was halted by herd immunity.
Learning from History
The practice of medicine is just that, practice. It is not called the science of medicine because doctors are always working to provide personalized treatment for each individual, knowing that every person responds differently to prescriptions, treatments, and procedures. Much of medicine is based on precedent, and as such, precedent has shown that though the science of vaccines is sound, individual reactions may differ. This requires the extensive testing seen in the successful trials of the polio vaccine, and the successful applications of protecting against smallpox.
This precedent has allowed doctors to understand and respond to new pathogens as they appear. Using this knowledge and advancements in technology, modern medicine has been able to identify the source of infections up to 80% faster than any other time in history.
To put this in perspective, if we used the historical timeline from the start of infection to identification of the pathogen, we would just now be understanding the HIV/AIDs virus. Using another, timelier example, it would be at least 10 more years before we would be able to identify the coronavirus and understand its source. Instead, doctors can now not only identify both viruses, but establish specific treatments that extend life and vaccinate against infection.
The human body is a complex, magnificent creation. Medical professionals are constantly learning and understanding more about how to treat and cure the infections that have plagued us since ancient times. Vaccines are but one tool and part of their ever-growing arsenal to unlock the science of disease for the purposes of a better life.
