The Covid pandemic has brought vaccines back into the limelight and a review of the history of vaccination seems timely.

Current day vaccines have saved millions of lives but a vigorous anti-vaccine movement has led to a culture war of sorts.  The anti-VAXXers in the US have joined forces with right wing Republican politicians such as Eric Trump, son of the ex-president, Roger Stone, and others including Democrat Robert F. Kennedy Jr., the son of the late Democratic Sen. Robert F. Kennedy.   The main gripe of anti-VAXXers seems to be the perceived infringement on individual rights, or the right to refuse medical treatment.  For example, Pastor Mark Burns, who is running for Congress in South Carolina, likened the choice about vaccination to smoking: “Cigarettes kill people every day, but yet you can go to the supermarket right now and buy it with no issue, that’s their choice. If they want to go put cancer into their lungs, they have a right to do so.” He felt his position would help him win the primary in the conservative district where he hopes to be elected.

There is a difference, however. Smoking is prohibited in many public spaces because passive exposure to smoke also leads to cancer.  Your smoking is dangerous to me and my smoking is dangerous to you. Likewise, Covid outbreaks endanger all of us, including those that have kept up with vaccinations and booster shots.  That is because outbreaks anywhere on the planet can lead to the emergence of new subvariants (Omicron f.ex.) and some of these could be resistant to treatment and to vaccines

Mandates for vaccination are not new in America. For example, children enrolled in public schools must show proof of vaccination, although the rules are different from one state to the other. Persons working in healthcare can endanger their patients if they have an infectious disease. Having had a career in medicine, I am well acquainted with yearly Tb testing mandated for all hospital staff myself included!

It’s interesting that a new analysis by NPR suggests that Republicans are probably dying at a higher rate as a result of their much lower vaccination rate. A nationwide comparison of 2020 presidential election results and COVID-19 death rates since vaccines became available for all adults, found that counties that voted heavily for Trump had nearly three times the COVID-19 mortality rate of those that went for Joe Biden. Those counties also had far lower vaccination rates.

To understand the reluctance of Republicans to get vaccinated you really need to look at the excellent analysis by Joss Fong:  How American conservatives turned against the vaccine: The partisan pandemic, explained in 15 charts. Joss Fongjoss@vox.com Feb 23, 2022, 3:04pm

It boils down to a sentiment that took hold even before vaccines were available, namely that Covid wasn’t that serious, i.e. similar to the flu, and that it was hyped up as a threat for political purposes by Democrats. If Covid isn’t serious, why even bother with an “unproven” vaccine?  This argument was repeated by then Pres. Trump, and disseminated on Fox News and social media.  After Trump was hospitalized for Covid he triumphantly returned to the White House and refused to wear a mask (when he was still likely infectious) trying to make the point that we can lick this “China virus” and that Covid is not that serious at all, i.e. nothing to be afraid of.

Currently, we have a sorry state of affairs with Republicans losing faith in other vaccines, including stalwart vaccines against measles, mumps and rubella as per data discussed in the analysis by Joss Fong

In order to make some sense of all this, I took a look at the world history of vaccination, based largely on a publication by Stefan Riedel MD PhD, at Baylor Univ. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/

An English doctor named Edward Jenner gets credit for the procedure of vaccination based on his publication in 1798. He took material from the hand lesions of Sarah Nelms, a milkmaid afflicted with Cowpox, and injected this crude preparation of cowpox into an 8-year-old boy, James Phipps, the son of his gardener. The boy developed mild fever and discomfort in the axilla, but 10 days later felt good again.  Two months later Jenner inoculated the boy again, but this time with matter from a smallpox lesion.  No disease developed and Jenner concluded the boy was protected, or “vaccinated”, vacca meaning cow in Latin. Similar protection was observed in other patients vaccinated with cowpox.  It took quite a few years before the medical community accepted the new treatment.

It helped that Lady Mary Wortley Montague (1689-1762) was a big advocate for variolation in England.  Variolation was the procedure used prior to vaccination: healthy persons were inoculated with smallpox itself (rather than cowpox). Variolation was thought to be protective, but 2-3% of variolated persons died of smallpox! And many others had disfiguring smallpox or became the source of another epidemic. Nevertheless, European royals were so terrified of smallpox that many chose to get variolated including the Empress Marie-Therese of Austria, her children, and grandchildren, Frederick II of Prussia, Louis XVI of France.  Frederick II inoculated all of his Prussian soldiers!  (A mandate for sure.)  There was a reason to protect your army. American soldiers under George Washington were unable to take Quebec from the British troops, because of a smallpox epidemic among the American soldiers. All the while, the British troops were all variolated giving them some degree of protection!

As far back as 430 BC survivors of smallpox, presumably with a degree of immunity, were used to nurse the afflicted.  Therefore I assume that the idea of immunity is age-old.

In England, cowpox vaccination gradually replaced variolation (which was prohibited in 1840). In America, Thomas Jefferson supported the vaccine effort and founded the National Vaccine Institute.  Although Jenner was honored by the British Parliament and received prizes and cash, he was subjected to attacks and ridicule from the anti-VAXXers of the time. In many countries vaccination against smallpox became mandatory.  Now, as a result, smallpox has been eradicated throughout the world. In 1980 the WHO announced that smallpox was eradicated worldwide.

Vaccination is arguably the biggest success story in modern medicine.  It is also the basis of a whole new field of medicine: Immunology. 

Vaccines currently cover many diseases: Tb (88% of one-year-olds vaccinated worldwide), Polio (eradicated), Diphtheria, Tetanus and Pertussis (85% of one-year-olds vaccinated worldwide), Hepatitis B (85% of one-year-olds vaccinated worldwide), Influenza type B (72%of one-year-olds vaccinated worldwide), Measles (71-85%of one-year-olds vaccinated worldwide), Rubella (71% of one-year-olds vaccinated worldwide), Pneumococcus (48% of one-year-olds vaccinated worldwide), Yellow fever (46% of one-year-olds vaccinated worldwide), Rotavirus (39% of one-year-olds vaccinated worldwide).

This graph on measles cases is perhaps most instructive. The measles vaccine was first introduced in 1963:  

  

WHO estimates (conservatively) that 2-3 million deaths are prevented every year just from vaccines to Diphtheria, Tetanus, whooping cough, and measles.  But WHO also estimates that vaccine-preventable deaths are still responsible for 1.5 million deaths per year. Higher vaccination rates would help prevent these deaths.

Subsaharan Africa is a geographical location notorious for poor vaccination rates, thought to be due to economic factors.   Essentially, poor countries have poor vaccination rates and as a consequence, children die.

There is a lot of data on this site:  https://ourworldindata.org/vaccination#not-every-child-who-should-be-vaccinated-is-vaccinated

It includes data on how people support vaccination across the world.  While the large majority of the world supports vaccines, there are curious pockets of distrust.  People were asked “are vaccines safe?  are they effective?”  Usually, 90% or more approve of vaccines in these surveys. An interesting outlier is France.  Over 30% of the population disagree that vaccines are safe! And 20% don’t think they are effective.  However, this does not translate into low vaccination rates or into distrust in nurses and doctors among the French!

It is not a perfect world out there. The planet itself could be considered “endangered”.  The following is a recent Nature article from 28 February 2022:

Climate change is hitting the planet faster than scientists originally thought

But, somehow humanity’s lot has improved over the last 5000 years.  It is perhaps of interest that the world’s population hardly increased between 10,000 and 5,000 BC and this was primarily because of a succession of pandemics with high mortality (see James C. Scott, “Against the Grain”).  If anything, the Covid pandemic reminds me that we are a fragile species living on a fragile planet.  Vaccination could help save the species.