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  • Writer's pictureWilliam Miller, MD

To Vaccinate or Not to Vaccinate? - Part 1

Updated: Jul 14, 2021

This will be a two-part series. Part 1 will briefly explore the history of vaccinations as well as touch on the beginnings of fears around vaccination safety. Part 2 will then go on to address specific modern-day concerns being raised about the COVID vaccines.

Vaccines have clearly been one of the most important scientific breakthroughs in the fight against infectious disease in humans; along with improved sanitation and the development of antibiotics. Prior to vaccines and antibiotics, it was common for people to die of pneumonia in their 30’s, young people to be crippled due to polio and the elderly to die from influenza. Tetanus, rabies, and diphtheria were also serious problems that were often fatal. Even measles would show up with a more virulent strain every few decades causing deadly epidemics. COVID is hardly the first widespread viral illness to challenge us.

The history of vaccination begins in the 1500’s when Chinese physicians started using the dried fluid from smallpox pustules from ill patients who had milder cases of the disease to inoculate healthy people. This process, called variolation after the Latin name for smallpox variola, involved inoculating the recipient by either scratching the dried pus into the skin or blowing it into the nose. This caused a mild case of smallpox after which the person was immune to getting a more serious case later.

Smallpox epidemics were a big worldwide problem by the 1700’s with outbreaks occurring throughout Europe every few years. In some outbreaks, as many as 60% of the population got the disease which carried a 20% mortality, ten times more fatal that COVID. Patients who did survive were often left with terrible scars on their faces. Variolation was used at the time in Western and Eastern countries to try to prevent these epidemics. The problem was that since variolation involved the actual smallpox virus, about 2% of recipients developed the more serious illness from the inoculation.

Edward Jenner, an English physician considered to be the father of vaccination, noted that milkmaids who got a similar illness called cowpox on their hands from milking cows, were immune to smallpox. Cowpox, caused by a close relative to the smallpox virus, did not cause serious illness in humans and did not leave scarring of the skin. Jenner and others began to experiment with inoculating healthy subjects with extracts from cowpox pustules instead of smallpox pustules. They showed that the subjects thus vaccinated were immune to smallpox. Since cowpox does not cause a serious illness in humans, this was much safer. The term vaccination derives from the Latin word for cowpox, vaccinea, with the root word vacca meaning cow.

The controversy around vaccine safety began around the same time because of concerns that variolation could cause smallpox in a small portion of people, the very disease it was intended to prevent. When Jenner’s cowpox vaccine was introduced, some people began to fear that the vaccine would cause cow shaped deformities at the inoculation site. While this fear may sound absurd, it was fiercely believed by many in society who did not understand the science. It also sounds similar to current day fears that the COVID vaccine will alter the recipient’s genetics.

The controversy was made worse when the English Parliament passed the Vaccination Act of 1853 which required all infants to be vaccinated. Parents who refused to vaccinate their children could be fined and if they didn’t pay the fine they could be imprisoned. This greatly heated up the passions of the debate. While the Vaccination Act was repealed in 1907, distrust of the government requiring people to submit to an injection that is feared by some to potentially alter one’s body remained strong. In the United States, arguments of personal liberty were advanced against vaccination mandates and many states in the US passed laws prohibiting mandatory vaccinations.

Opposition to vaccination on religious grounds also began early on with the argument that disease is God’s punishment for sins and for science to intervene to prevent disease was thwarting God’s will. Similar arguments have been put forward around treating many illnesses stating that illness is a test of faith and that true faith and the strength of prayer will overcome illness. In this context, to rely upon medical treatment may be seen as a lack of faith.

The next big breakthrough in vaccines occurred when Jonas Salk developed the first effective polio vaccine in 1955. Polio was a terrible illness caused by poliovirus. Like COVID, most people (70%) who got infected either had no symptoms or only mild ones. However, about 5% developed serious muscle weakness and in children this often left the child permanently crippled. In adults who developed the more serious illness about 1/3 died of respiratory failure, hence the use of the “iron lung” in the 20th century. Polio may have been around since ancient times, but started to cause widespread pandemics by the early 1800’s.

During the mid-twentieth century, the World Health Organization campaigned to completely eradicate smallpox and polio worldwide through vaccination programs. The last case of smallpox was recorded in 1978 and it was declared eradicated in 1980. Polio is close to being eradicated and currently only persists in certain Islamic countries where the Taliban have forbidden vaccination out of concerns that it is a plot by Western governments to control the population.

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