There are so many life-saving vaccines in circulation it is hard to remember them all. This web page lists only the first vaccine that targeted a particular disease, and there are 45 of them. There are hundreds of individual vaccines. Maurice Hilleman – an American whom we’ll read more about later – himself developed more than 40 vaccines. From devastating diseases like bubonic plague and polio to more everyday ailments like measles and tetanus, as well as insidious organ-destroying killers like hepatitis, vaccines have triumphed and deserve a good share of the credit for making the world as safe and comfortable as it is (most of the time), including greatly extending average human life expectancy from the 40-ish where it had languished for thousands of years.
Yet the 225-year journey since the testing of the first vaccine has been anything but smooth. Some vaccines have been only marginally effective, some have had significant side-effects and a few have caused multiple fatalities and social unease as they were rushed out to deal with the vast death toll and societal havoc of the raging disease in question. There have also been defective or spoiled vaccine batches that did nothing for patients except raise false hopes. But, in addition to the examples above, vaccines are responsible for drastically curtailing Hong Kong flu, rubella, tuberculosis, whooping cough, shingles, cholera, diphtheria, rabies and, perhaps most famously, smallpox – which was officially eradicated.
These are stunning accomplishments. But they were not without risks, setbacks and crippling or deadly heartache along the way. This history is not only instructive but directly applicable to the current charged atmosphere surrounding the Covid-19 shots. Perhaps because vaccines as a whole have delivered such society-changing benefits – driving down child mortality and helping adults live much longer – or perhaps because so many people are ignorant of history, decline to read in depth and have their “facts” pushed at them by apps and social media, it is easy to forget that many vaccines took a significant human toll before their makers “got it right.” Many of them never have and never will offer total protection.
The current two-dose vaccination for shingles, for example, does not create an unbreachable barrier, often brings side effects, requires a booster down the road and, while greatly lessening symptoms in the large majority of cases, can also be entirely ineffective. In some provinces, it isn’t even covered by public health care. Despite these shortcomings, millions of seniors gladly pay hundreds of dollars to be inoculated against this painful and debilitating virus. This sort of context and perspective are missing from the current “debate” – often more of a shrieking match with threats and bullying – over the Covid-19 inoculations.
Why would the one side deny that these are radical new designs, scantily tested and at least somewhat dangerous, with unknowable long-term effects? Admitting all of this makes them no different than any number of historical vaccines that still proved their value. Perhaps too many people were expecting a panacea; it certainly seemed they were being promised one. So now the shortcomings can’t be admitted for fear of generating mass disillusionment and resistance. Yet all the misinformation, suppression and distortion only intensify suspicion among the so-called “vaccine-hesitant.”
There are eminently solid reasons to decline the Covid-19 vaccine. Having suffered a markedly adverse reaction or permanent damage from a previous vaccine, being in a high-risk group to do so (especially if one is also in a low-risk group for Covid-19), or having recovered from a proven case of Covid-19 infection are three. The widespread bullying and contempt directed at such people are shameful. And yet, why would someone become a dedicated anti-vaxxer simply because the Covid-19 vaccines are imperfect? Perfection in a vaccine is basically chimerical, so this is a non-sequitur that may blind the person to the statistically impressive benefits of getting the shot. The result is poor cost-benefit and risk-reward analysis by the individual.
So let us seek the missing context and perspective.
A Deeply Moral Yet Risky Calling
The history of the making of vaccines shows a clear unifying theme, one that is highly edifying and speaks to the very best of humanity. It is the intense desire among the doctors and scientists involved to save the lives of patients and sufferers.
Few scenes are as stirring as the one in the Netflix series Charité portraying the 1899 International Medical Conference on Tuberculosis in Berlin, one of five such TB gatherings in different cities. When German physician and microbiologist Robert Koch announces that his breakthrough discoveries will very soon be tested on human patients, the 2,000 attendees leap to their feet and cheer long and loud, slapping each other on the back, lift Koch onto their shoulders and pass him around like the groom at a religious Jewish wedding. They are overjoyed at being close to having a vaccine for that horrific bacterial disease that was wasting away millions of people.
But the beginnings go back much farther. The story of humanity’s first vaccine reached its critical chapter in late 18th century Gloucestershire, England. Smallpox had wrought recurring devastation for many hundreds of years throughout Europe – and, more recently, among Indigenous populations throughout the Americas. In some communities it exacted a ruinous 35 percent mortality rate, leaving the “lucky” survivors with often horrible scars. And then along came country doctor Edward Jenner.
The story of Jenner’s development of the smallpox vaccine reads like a wonderous fairy tale – and not only because part of the popular version isfable. Many accounts claim thatin 1796, Jenner noticed that milkmaids working in the countryside near his hometown enjoyed remarkably clear complexions. A curious Jenner ostensibly wondered why “they were never afflicted by the scars of the feared disease smallpox,” writes Owen Gower, manager of a museum located in Jenner’s old house (who knows this part of the story is untrue). Jenner was supposedly told that their work had exposed them all to the related disease of cowpox, which somehow protected them from smallpox. (The fable of the lovely milkmaids with the perfect skin is also debunked here.)
The true story is less romantic – but still arresting. Like many medical practitioners of his era, Jenner was highly curious about the idea of somehow instigating resistance to a disease before it struck. His concept for doing so was to extract pus from cowpox and smallpox blisters and, ethical standards being different back then, putting it to the test by deliberately infecting the eight-year-old son of his gardener with both. Miraculously, the boy did not get ill. “Jenner’s theory had been correct and vaccination was born,” writes Gower. Jenner devoted much of the rest of his life to disseminating his discovery and vaccinating everyone who made their way to his home clinic. He often injected people for free if they didn’t have money to pay him.
In 1980, nearly two centuries after Jenner made his discovery, the 33rd World Health Assembly declared: “The world and all its peoples have won freedom from smallpox,” a disease “that had plagued humanity for at least 3,000 years, killing 300 million people in the 20th century alone.” Many considerthe defeat of smallpox to be the world’s greatest public health achievement.
The campaign against smallpox also had a profound and, for our time, particularly relevant Canadian angle. Our first Prime Minister, Sir John A. Macdonald, played a central role in saving thousands of Indigenous lives from this deadly disease, as related in this C2C essay by Greg Piasetzki. “During Macdonald’s time, the federal government virtually eliminated smallpox among Indigenous people across the West thanks to a comprehensive vaccination strategy,” Piasetzki wrote. “Untold numbers of Indigenous people died throughout the Canadian West prior to the 1870s as a result of smallpox. Yet…the death toll among native Canadians from the disease by the 1880s and beyond was close to zero.”
The 20th Century Dawns, and Vaccine Development Seems to Get Harder
Another signal accomplishment was the vaccine for whooping cough (or pertussis), a bacterial infection once responsible for more child deaths thandiphtheria, scarlet fever, TB or polio. It causes infected persons to make a distinctive “whoop” sound “as their bodies fight the bacteria,” writes freelance journalist Natalie Zarrelli in this article. “In a vicious cycle, the cough spreads the contagion to others, and is so powerful that it can induce shaken baby syndrome. Babies who get it have a high chance of dying.”
Whooping cough once killed at least 6,000 babies and young children per year in the United States – until two former schoolteachers came up with the first effective vaccine. The two were Pearl Kendrick and Grace Eldering, and they were themselves childhood whooping cough survivors. Inoculations against the diseasehad been attempted since around 1914 but, according to Zarrelli’s piece, by 1931 the American Medical Association Council on Pharmacy and Chemistry was pressured to state, “The pertussis vaccines seem to have absolutely no influence.”
Kendrick and Eldering had by the mid-1920s been recognized for their excellence as teachers and university science students and, under the mentorship of a senior U.S. government health official, soon left their jobs teaching high school science. They were able to complete doctorates in bacteriology from Johns Hopkins University and were appointed to head a government research lab in Michigan. By the early 30s they had earned the lab a national reputation for high-quality research.
By day, the two worked on their regular experiments – particularly water and milk analysis – but in the frosty evenings they pursued their personal mission. Carrying specially prepared petri dishes called cough plates, the two women accumulated bacteria by calling on families ravaged by whooping cough. As Zarrelli writes, “By the dim light of kerosene lamps they asked sick children to cough onto each plate, dimpling the agar gel with tiny specks of the bacteria Bordetella pertussis.”
Knowing first-hand the painful scourge they wanted to alleviate, the two women were not dissuaded by scant resources. They began to make real progress and their work caught the attention of higher authorities, including Eleanor Roosevelt, wife of the U.S. president, who visited them personally and helped the pair secure federal funding – a rarity at the time. At a time when lab mice were typically being saved for critical penicillin research, historian Carolyn Shapiro-Shapin explains in the Zarrelli piece, Kendrick and Eldering were allocated some for their work.
By 1934 – 20 years after the first failed tests by others – Kendrick and Eldering had a vaccine prototype and were ready to begin full field trials. Droves of parents eagerly volunteered their kids. The results were impressive if not downright amazing. “In the first run of the Grand Rapids trials,” Zarrelli noted, “only three vaccinated children out of 1,592 in the study developed whooping cough, versus 63 non-vaccinated children.” The trial’s three-year period administered the vaccine to nearly 6,000 children (not including the control group), of whom roughly 90 percent remained free of whooping cough.
The whooping cough vaccine became immediately popular among doctors, schools and health authorities in Michigan and was recommended by the American Academy of Pediatrics. Fame and fortune eluded the two, however, as they were overshadowed by the lingering Depression and then the Second World War. Still, writes Zarrelli, the vaccine “vastly increased the U.S. life expectancy for children” and “changed [the] United States so drastically that most living today will never know the horrors of the ‘100 day cough.’”
In the 1940s, with the help of female African-American chemist Loney Gordon, who had joined Kendrick and Eldering several years earlier, the trio’s lab developed the staple “DTP” vaccine combination that most kids still receive today: diphtheria, tetanus and pertussis. These diseases have become so rare that many parents have grown lax about seeing their children inoculated – allowing whooping cough to stage an ironic and worrisome comeback of sorts.
Into the Feared Iron Lung – and Back Out Again
Polio was another childhood scourge of the 20th century and it too would succumb to the jab – eventually. The paralyzing, painful and sometimes lethal condition was a terrifying ordeal for victims and their parents alike. It could disfigure, paralyze, permanently cripple and kill. Indeed, for a time many parents would not let their children attend public swimming pools, even on the hottest days, lest they contract polio. Among the most heartrending images from mid-20th century medicine were those of children or youths confined flat on their backs in the horrifying (yet, in their own way, miraculous) “iron lungs” that mechanically kept them breathing until they either recovered from the disease, died or survived long enough for the introduction of better personal respirators.
The urgency to develop a polio vaccine was obviously acute. But it was a decidedly rocky process. By 1935 vaccines by two teams were being tested – one a killed poliovirus vaccine developed at New York University, the other a so-called “attenuated” (weakened) virus vaccine by a doctor from Temple University in Philadelphia. All told, the trials covered more than 20,000 children (as well as chimpanzees and one of the researchers personally). “The tests proved a disaster,” the History of Vaccines website notes. “Several subjects died of Polio, and many were paralyzed, made ill, or suffered allergic reactions to the vaccines.”
Trouble and tragedy would dog the polio vaccine for more than 20 years. Trials for a new version were conducted in the early 50s, and seemingly held great promise. Yet in 1955, just weeks after a press conference that trumpeted the trials’ alleged success, a doctor in Idaho reported that a vaccinated girl had been paralyzed by polio. Similar reports soon appeared, all noting that the patient’s paralysis did not begin in the legs as was usual for polio – but in the vaccinated arm. Another disturbing detail was that all of these cases were of children inoculated with vaccine produced by Cutter Laboratories in California. The Cutter-produced vaccine had to be suspended.
Despite these setbacks, research continued apace and, in 1960, the world triumphed with an oral vaccine produced by Albert Sabin, a Polish-American researcher who went on to become president of Israel’s Weizmann Institute of Science. Polio, like many other diseases before and after it, was conquered. While polio still rears its ugly head, it is no longer a scourge, remaining endemic in only three countries as of 2017: Afghanistan, Nigeria and Pakistan. In the end, the polio vaccine was a stirring, worldwide success story.
Pandemics Without Lockdowns – But with Rapid Vaccine Rollout
Clearly the immense pressure to save lives – especially when children are the main victims – by quickly getting new vaccines out into large-scale trials can do considerable harm. Clearly as well, while some vaccine development efforts are astounding home runs on their first attempt, the road to success can take years or decades, include multiple blind alleys, and can impose tragic costs on the innocent.
But would it have been reasonable to call a halt in any of these cases? The benefits of widespread vaccine use are incontrovertible; dozens of humankind’s historical afflictions are effectively gone and, when and where they do erupt again, can usually be dealt with decisively by vaccinating and treating the affected population. History shows that, despite some ugly beginnings, it was clearly worth the cost to press on with vaccines. Humankind has triumphed again and again, sparing uncountable millions of future victims.
The lessons from the Asian flu are also instructive. First reported in Hong Kong in the winter of 1957, this global pandemic killed an estimated 1.5 million worldwide – a death toll proportionately similar to the outcome to date of Covid-19. Unlike Covid-19, the Asian flu (not to be confused with the Hong Kong flu of 1968) tended to hit young people. Despite the toll, there was no lockdown, shutdown, economic devastation or mandatory distancing – let alone brutally enforced and recurring mask mandates, as are creeping back in Canada even now.
“The policy response from President Dwight Eisenhower could hardly have been more different from the response of 2020,” historian Niall Ferguson wrote in a Wall Street Journal column in April. “Eisenhower did not declare a state of emergency. There were no state lockdowns and, despite the first wave of teenage illness, no school closures. Sick students simply stayed home as they usually did. Work continued more or less uninterrupted.”
A noteworthy similarity between the 1957 Asian flu and Covid-19 pandemics was the rush to find a vaccine. In the former case, however, it was almost literally a one-man race: Maurice Hilleman, Chief of the Department of Respiratory Disease at the U.S. Army Medical Center. Alerted to the possibility of a new flu virus, as Ferguson recounts, Hilleman and a colleague “worked nine 14-hour days to confirm that this was a new and potentially deadly strain of flu.” Then he got to work on producing a vaccine. By July 26, not quite four months after the first reports of the new Hong Kong flu, doctors at the Fort Ord, California army base commenced inoculations.
While the Asian flu vaccine was only 60 percent effective and only 17 percent of Americans ultimately got this shot, it was another noteworthy triumph of medical science. According to Britannica online, “The rapid development of a vaccine against the H2N2 virus and the availability of antibiotics to treat secondary infections limited the spread and mortality of the pandemic.” Also noteworthy was the incredible timeline – four months from detection to vaccine roll-out.
A decade later, the death rate from the next big influenza wave – the 1968 Hong Kong flu – was lower than for most other 20th-century pandemics. According to Wikipedia, quoting the 2013 WHO Pandemic Influenza Risk Management Guide, the “World Health Organization estimated the case fatality rate of Hong Kong flu to be lower than 0.2%. The disease was allowed to spread through the population without restrictions on economic activity.” And for the second time in just over a decade, Hilleman and his team rolled out a new vaccine just four months into the pandemic.
Among the criticisms levelled at the Covid-19 vaccines (some of which are not traditional vaccines, but forms of gene therapy) is that they were rushed through development and were insufficiently tested over an unprecedently short period. While they clearly were done faster than the norm of the past 20-30 years, these lengthy testing periods are themselves largely due to a regulatory burden, liability concerns and public risk-aversion that were previously unknown in Western democracies.
In fact, vaccine development was done rapidly whenever possible – and was twice achieved in under four months, as we have seen. When it took much longer, this was considered a troubling failure. Setbacks were lamented, but accepted. It is to the great credit of former U.S. President Donald Trump that he approved Operation Warp Speed, a $10 billion public/private partnership announced in May 2020 that bypassed some of the standard regulatory process and accelerated the creation, testing, manufacture and distribution of Covid-19 vaccines and related therapies.
Worthwhile in the End
In should be clear that the risks and shortcomings of vaccines are real – but also that vaccines have saved hundreds of millions, perhaps billions of lives in all continents and countries and have immeasurably improved society and life for the individual. Starting with smallpox, vaccines have proved an indispensable tool for humanity – whether the goal is merely to improve the quality of life mostly of seniors (as with the shingles vaccine), to deal with a generally avoidable toxin (tetanus), to save thousands of children from an often fatal disease (whooping cough), to save millions from crippling damage (polio), to work alongside inexpensive drugs in relieving mass-suffering in poor countries that cannot afford a modern health-care system, or to help end a global pandemic.
Whether they are developed over decades or miraculously produced in only four months, whether they deliver an instant cure or require many sacrifices and create many victims to work out the complications, whether their efficacy is 95 percent or, even after fine-tuning, only 60 percent, vaccines are the best vehicle to steer us back towards normality.
End of Part One. In Part Two: Can we really inject our way out of this pandemic?
Lynne Cohen is a journalist and non-practising lawyer from Ottawa. She has four books published, including the biography Let Right Be Done: The Life and Times of Bill Simpson.
Source of main image: Shutterstock.