(2021) In the pantheon of great human inventions lies the greatest of all life-saving inventions – the vaccine. No other medical invention has relieved human suffering to the extent vaccines have. Vaccines have had the single biggest impact on reducing child mortality rates as well as preventing lifelong disabilities.
Inoculation against smallpox, one of the worst diseases to afflict humanity with a 30% kill rate (not to mention others that were left blind or scarred) was already practiced in parts of China, India, Turkey and North Africa, going back many centuries before the practice made its way from Constantinople and into Europe in the 1700s. By 1796, Edward Jenner had perfected the technique. Jenner thought it was a good idea to scrape some puss off a milk maiden’s cowpox-infected-hand and apply it on to a boy’s open cut. Cowpox is similar to smallpox but far less lethal or contagious. It turned out to be a fantastic idea! Six weeks later, when the boy was exposed to smallpox (and 20 times more later) he was fully immunized. Thus the word vaccine was derived from the Latin word vacca meaning cow. His method was perfected further and by 1980 the WHO declared smallpox officially eradicated – the only disease to be eradicated so far. The last remaining samples are held in labs in Russia and the US.
One can’t discuss the history of vaccine’s without mentioning Louis Pasteur or Maurice Hilleman. Pasteur of course was the French biologist who in 1885 saved the life of a boy who had been bitten by a rabies infected dog. Over the next 2 weeks he injected the boy with a weakened form of rabies. The boy developed an immunity, and so was born the first non-smallpox vaccine, the ‘rabies vaccine’. Vaccines were then developed for the most common childhood diseases: whooping cough by 1914, diphtheria by 1926, tetanus in 1938, influenza in 1945, mumps in 1948, polio in 1955, measles in 1963 and rubella in 1969. By 2000 huge progress had been made with the biggest obstacle to universal vaccine coverage being the cost of vaccines for developing countries. This financial hurdle has been greatly diminished by philanthropic organizations like The Bill and Melinda Gates Foundation. The drive to create access to vaccines in the developing world has been highly effective. There are now also major Private-Public partnerships like CEPI to develop and accelerate vaccine development for new and emerging threats. CEPI was created at Davos in 2017 (out of necessity) shortly after the Ebola outbreak.
Maurice Hilleman doesn’t have the name recognition of Pasteur (yet) but what an extraordinary man. Born on a farm in Montana in 1919, his contributions to vaccine science are staggering. By the time of his death in 2005 he had developed more than 40 vaccines! It is highly probable that you have received a vaccine he developed. 8 of the 14 vaccines recommended on the current US vaccine schedules were developed by him and his team. He developed vaccines for Japanese B encephalitis during WW2, the measles, the mumps, hepatitis A, hepatitis B, Streptococcus Pneumonia, rubella and meningitis to name just a few. He was not just a brilliant microbiologist; he also understood the politics, bureaucracy, and the business of vaccine production. It was through work in the private sector that he was able to get his vaccines to market. He famously quipped that it was politics that determined what breakthroughs were brought to market.
In Canada, immunization is not mandatory but in Ontario, New Brunswick, and Manitoba (to a lesser degree) schools require immunization proof for kids to attend, although this requirement can be bypassed for ‘ideological’ reasons. If there is an outbreak the non-vaccinated kids can be refused entry into the schools. Fortunately, vaccine compliance is quiet high in Canada (84-92% of kids in Ontario for example). Vaccine legislation falls under the purview of the provinces and so there is no one law of the land. In Alberta for example, health care workers working with babies, and new or expecting mothers must be immunized against rubella. And certain private sector health care sectors like long term care homes have mandated certain vaccines as a condition of employment.
In the rest of the world, there are as many different requirements as there are countries. Vaccine compliance is high in most of the world with the global average standing at over 80% for 1 year olds being vaccinated.In the US, States legislate on vaccine requirements for kids and require vaccinations for children to attend school; but religious exemptions are accepted in almost all states. Many states however will not recognize ‘philosophical’ objections, only religious ones. It should be noted however that a landmark ruling in 1905 over vaccines has withstood the test of time. The ruling essentially allowed the state (and therefore its police powers) to mandate vaccinations above and beyond any religious or other objections in the case of an epidemic as the health and welfare of the state trumps religious or other ‘freedoms’. Basically, when push comes to shove the law can and will mandate compulsory vaccinations. This does not mean the state would conduct forced vaccinations (an impossible task in open societies); but it does mean it could enforce rules that exclude non-vaccinated individuals from societal participation, including accessing certain services or transport, certain public events, activities, schools, work and so on. In certain US states, whenever there have been outbreaks, the State has moved in to repeal religious or other objections. History repeatedly shows that even in open societies when an epidemic is underway and lives are threatened, individual rights will not trump the well being of society at large.
Depending on the vaccine, a certain percentage of people need to be vaccinated for herd immunity to be effective. If the percentage of immunized slips, herd immunity decreases, leaving a population more exposed. Herd immunity varies by vaccine, for example 92-95% for measles versus 33-60% for Ebola. Essentially, the vaccinated protect not just themselves but also the non-vaccinated. The non-vaccinated, while remaining at risk in ordinary times, run into real danger when herd immunity falls below the acceptable threshold, because they are far more likely to contract a disease or to pass it on to vulnerable persons or those who cannot be vaccinated.
Unfortunately, social media has played a big role in giving a voice to false facts relating to vaccines. Conspiracy theories, lies, and disinformation have all helped create factually false narratives, but as we have witnessed during Covid 19, during a pandemic, initial Vaccine hesitancy diminishes with time as vaccines became more widely available. Fringe ideas, fake news, and conspiracy theories can now get as much airtime on social media and ‘news’ platforms as factual accurate reporting and information. Fortunately, the tech giants are now taking some responsibility for what they allow on their platforms. This however brings into question censorship and the role of big tech. It is a slippery slope trying to regulate what can and cannot be posted. We need to vehemently defend free speech, but we need to do more to call out fake news and false information.
There is a difference between the vaccine hesitant crowd and the dead-set-antivaxxers crowd. Whereas the ‘hesitants’ may change their minds, it is not possible to reason with people that ignore facts, mistrust science (and doctors) or believe that the government has a nefarious agenda. There are of course risks to taking vaccines but antivaxxers miscalculate the risk-to-reward ratio of getting a vaccine versus catching a debilitating disease. Like anti-maskers, and climate change deniers, most of their opposition is due to misconceptions. More bluntly, they are grossly misinformed – they use incorrect data (if at all) to do a proper risk-reward calculation. Whether it is a belief in only using homeopathic medicine or that vaccines cause autism (which has been soundly debunked) it is everyone’s right to believe whatever they want (right or wrong) but as that 1905 smallpox Jacobson Vs Massachusetts ruling in the US has demonstrated, society won’t tolerate a return to a pre-vaccine world. In the UK in the 1700s, prior to the small pox vaccine, 3000 per million died of small pox; by the mid-1800s with ‘optional vaccination’ 417 per million died. A few years later with ‘compulsory vaccination’ that number dropped to 214 per million. By the time vaccines were ‘enforced’ in the 1890s, that number dropped to 10 per million!
Measles, a potentially deadly disease was declared eradicated in the US in 2002. In 2014, however a measles outbreak of over 600 people was directly attributed to parents refusing to vaccinate their children. Anti-vaccine parents, some of whom are otherwise quite educated, have helped fuel mumps, measles, and other outbreaks around the world. Fortunately, if an epidemiological threat is serious or there is an outbreak, the state, and the public acts. This is thanks to the majority position that uphold the view that vaccines are necessary.
- The seasonal flu kills .01% to .02% of infected individuals. Covid 19 kills significantly more. In Mexico for example 9% of recorded Covid cases died as of 2021
- Ukraine is the most anti-vaxxer country in the word. Only 29% of Ukrainians think Vaccines are safe. As a result, Ukraine had 57,000 measles cases in 2019 (a disease eradicated in most European countries since 2002). Cases of diphtheria and Polio have also been reported. Georgia (the country) is not far behind.
- The 1968, the Hong Kong Flu Pandemic killed 15% of Hong Kong’s population (500,000) and between 1 and 4 million people globally. Maurice Hilleman developed the vaccine for this that would save countless lives. His team also developed the vaccine from the previous Asian Flu Pandemic of 1957.
- You have heard about the Bubonic Plague (black death) of 1346-1353, but the Plague of Justinian (same bacteria as the Bubonic Plague) in 541 CE was equally horrific. It decimated the Byzantine Empire. It’s possible that 40 to 50% of the population of Constantinople alone died. The geopolitical implications were massive. The deaths were so numerous that land could not be farmed, nor grains transported. The economy was ruined, and tax revenue severely diminished. Reunification with the Western Empire likely would have lasted longer had the plague not struck. Certainly, history and the present would look quiet different.
- We are close to eradicating Polio.
- Pasteur injected old weaker strains of cholera bacteria into chickens. By chance he discovered that when he injected them with the new bacteria the chickens had developed immunity.
- Viruses are not living organisms, but bacteria are. Viruses lay dormant and require a host cell before they ‘live’ and reproduce. Bacteria are gigantic compared to viruses. Viruses are sub microscopic and so an electron microscope is required to view viruses. Viruses can actually infect bacteria. Pneumonia, Tuberculosis, Tetanus, and food poisoning are bacteriological. Aids, measles, influenza, and Covid are viral.
- By 1800 Tuberculosis had killed 1 in 7 people that had ever lived.
- HPV, Hepatitis A and B are the only STIs that can be prevented by vaccines. Fortunately, antibiotics and penicillin have been effective in treating STIs.
- After China published the genetic sequence for Covid19 on January 11, 2020, Moderna and the National Institute of Health were able to design a highly effective vaccine by January 13th – 2 days later! Getting the vaccine approved plus the manufacturing, etc. is what took time. The FDA had never approved an mRNA vaccine before.
- In 1974 only 5% of the world’s children were immunized against the 6 common killer disease. Today 86% are immunized.