Signs of Fall 11: Vaccines!

Tick that transmits the bacterium that causes Lyme disease. Photo by D. Sillman

(Click on the following link to listen to an audio version of this blog!…Vaccinations

Four years ago while I was still living in Pennsylvania, I wrote a blog that included a brief discussion of the history of anti-vaccination attitudes. My stimulus for that blog centered on vaccines that could protect us against Lyme disease. Lyme disease was, and still is, epidemic across the eastern United States, and Pennsylvania was, and still is, the site of a significant number of cases.  The Center for Disease Control (CDC) estimates that there are over 476,000 cases of human Lyme disease in the United States every year, although less than ten percent of these cases are reported. CDC data also indicates that over the past ten years, between a quarter and a third of the reported Lyme disease cases were from Pennsylvania!

Most people who get infected with the bacterium that causes Lyme disease have an acute, non-fatal, sometimes barely noticed illness. There is, though, an increasing number of “chronic Lyme” patients who are suffering with significant disabilities, sometimes for decades, after their bout with the acute disease. Lyme disease was then, and is now, the fastest growing, vector-transmitted disease in the United States!

Izzy (protected against Lyme disease!)
Photo by D. Sillman

The reason that I was looking into groups that oppose vaccination was that I had been asked why there was a Lyme vaccine for dogs but none for humans? Looking for an answer to this very good question led me to the very surprising realization that not quite 30 years before there was not just one vaccine that would protect people from Lyme disease, but there were two!

In the 1990’s, though, shortly after the first vaccine was released to public, a small group of people claimed that the vaccine caused paralysis. There was no clinical evidence to support these allegations, but this group threatened legal action against the pharmaceutical company that had developed the vaccine and also mounted an extremely effective public relations campaign against the vaccine itself.

Under the weight of these attacks and under threat of skyrocketing legal costs, the company stopped manufacturing the vaccine, and a second company that had developed a different Lyme vaccine decided not to release their product. In the 1990’s the number of Lyme cases in the United States was much lower than it is today, so there was little economic incentive for the pharmaceutical company to continue to make the vaccine.

The very troubling thing about this Lyme vaccine story was the ease with which a group of people, with no medical or scientific data to back them up, derailed the production and use of a vaccine that could have significantly reduced the suffering of millions of people! Financial pressure, hysteria and PR campaigns nullified science, logic and medicine!

SARS-CoV2. Figure by Scientific Animations, Wikimedia Commons

Fast forward to 2020 and the COVID-19 Pandemic. Pharmaceutical companies fast-tracked the development of anti-SARS-CoV2 vaccines only after receiving significant financial support (many billions of dollars!) from governments for the development of the vaccines and for guaranteed contracts for the purchase of the finished product. Also, quite significantly, the pharmaceutical companies were granted extraordinary legal protections that shielded them from almost all liability and litigation regarding their vaccines.

The ghost of the Lyme vaccine debacle from 30 years ago hung over these COVID-19 vaccine pharmaceutical companies. Even though the number of people who potentially could be affected by the virus was astronomically higher than  the numbers of people who had been affected by the Lyme bacterium, and the potential benefit of the COVID-19 vaccine was more than health but a return to a more “normal” life for all of our society, there was still the possibility that some small group of ignorant, superstitious people could derail medical science and throw us all, headfirst, back into the Pandemic!

Why?

The answer to that question lies in outside the realm of science. A consideration of the history of vaccines may help us understand this recurring dilemma.

Edward Jenner by James Northcote, National Portrait Gallery, Wikimedia Commons

Most medical historians start their discussion of vaccines in the last decade of the Eighteenth Century with Edward Jenner and his cowpox inoculations. Jenner noticed that milk maids, who were exposed to the relatively mild virus that causes coxpox, were then immune to the extremely serious and frequently lethal virus that causes smallpox. Smallpox had been a scourge of humanity since the invention of agriculture (10,000 + years!), and it is thought to have been an animal virus that escaped into human populations from either cattle or camels. In Eighteenth Century Europe 400,000 people died every year from smallpox!

Jenner’s observation was an incredibly insightful one, but the idea of vaccination (even though Jenner was the first one to coin the term) had existed for a much longer period of time. Healthy individuals possibly for centuries in India and China had undergone a process called “variolation” to protect them from smallpox. Variolation involved the removal of some of the pus from a fresh lesion on someone suffering from smallpox, and its transfer, subcutaneously, to a healthy individual. The inoculated individual, then, typically, experienced a mild immune reaction (fever, aches, etc.) but developed an immunity to the smallpox virus. The transfer of fresh fluids from a smallpox patient, though, could also sometimes transfer the actual virus causing the recipient of the inoculation to actually develop smallpox. It was, then, a fairly dangerous procedure with a two or three percent mortality rate! In spite of that, variolation was widely practiced across Europe throughout the Eighteenth Century and many stories of aristocratic families inoculating their offspring added greatly to the acceptance of and desire to undergo the procedure. Interestingly, Edward Jenner was variolated against smallpox when he was a small boy!

In 1796, Edward Jenner utilized pus from a pustule on a cow (whose name, by the way, was “Blossom”) to inoculate a young boy. The boy experienced a period of fever and immune reaction symptoms but was, then, immune to smallpox. The weaker, cowpox virus “tricked” the human immune system to make the immunological proteins and cells that could destroy the smallpox virus. It was a great victory for both medicine and science and subsequently saved countless numbers of human lives, but not everyone was pleased with the idea of vaccination!

Jenner among his patients. Wellcome Images, Wikimedia Commons

Satirical cartoons from early Nineteenth Century publications showed people developing legs and heads of cows after receiving Jenner’s inoculation. The cross-species nature of the inoculant, and the “un-natural” process of the inoculum transfer, caused many groups to forcefully resist receiving the vaccine. People rioted, attacked the inoculators and were arrested and jailed as a consequence. Jenner, although eventually lauded by many in his professional and social spheres, was the object of widespread ridicule and the recipient of constant death threats. Something deep and primal had been awakened in the superstitious minds of people, and they focused on vaccination as a fundamental invasion of their bodies by forces of government and science.

Sadly to say, this superstitious reaction to vaccination has not gone away. Smallpox, as we should all be grateful, is extinct and the virus now only exists in two extremely secure medical repositories. Almost every other vaccine since, though, has had to face the loud and emotional (and often incredibly ignorant) criticism of the anti-vaccinators. Here is a link to very readable history of the anti-vaccine movements that was published by the College of Physicians in Philadelphia.

Gilbert Stuart portrait of George Washington. Wikimedia Commons

Recently The New York Times published an article that described a “vaccination” program established by one of our country’s Founding Fathers (September 30, 2021 article by David Leonhardt). The Continental Army under George Washington had suffered a defeat at the hands of the British at Quebec. The Continental soldiers in Quebec were debilitated by a smallpox outbreak while the British troops, because they had all been variolated were unaffected by the disease. Washington, then, in 1777 (19 years before Jenner’s cowpox vaccination procedure was developed) ordered all of the soldiers in the Continental Army to be variolated with pus taken from active smallpox patients. From then on, the soldiers were unaffected  by the smallpox virus. Biographers of Washington maintain that this decision to “vaccinate” his troops was as important as any of the military decisions he made during his long and ultimately successful campaign against the British.

In spite of the documented safety and benefits both to the individual and society as a whole of modern vaccines, there are always small groups that protest their application on the basis of individual freedom, a reaction against “socialized medicine” and suspicion of the motives of governmental and scientific organizations. Smallpox, polio, measles, diphtheria, tetanus and more are without a doubt many orders of magnitude more serious, debilitating and fatal than any side effect of their vaccines. The same is true for COVID-19 and all of its vaccines.

Our current outbreak of COVID-19 is an epidemic primarily affecting un-vaccinated individuals. The overcrowded hospitals and limitations that have had to be placed on medical facilities, personnel and supplies due to the surge of COVID cases have put many non-COVID patients in jeopardy. Heart attacks, strokes, inflamed appendices and more have gone poorly treated or not treated at all. Surgeries have been postponed and suffering that could have been relieved continues. Also, the potential for the SARS-CoV2 virus to mutate as it circulates through the thousands and thousands of unvaccinated individuals, possibly transforming into even more deadly forms than the current Delta variant, just because these individuals have chosen not to get vaccinated, puts everyone at even further risk!

In a 1905 Supreme Court ruling against a Massachusetts minister who did not want to receive a smallpox vaccination, Justice John Marshall Harlan noted that the Constitution does not allow American citizens to behave in any manner that they chose. He wrote, “Real liberty for all could not exist” if people could act “regardless of the injury that may be done to others.”

Leonard Nimoy and William Shatner (as Spock and Kirk). NBC Television. Wikimedia Commons

Sometimes fiction can help us see moral positions more clearly. A famous line from Start Trek II: The Wrath of Khan has Spock saying to Kirk, “The needs of the many outweigh the needs of the few.” To which Kirk replies, “Or the one.” And, Spock acting on this brave statement sacrifices himself to insure the safety of his fellow crewmen. Our face masks, social distancing, economic sacrifices and willingness to be vaccinated are much less onerous than Spock’s death from radiation poisoning!

Finally, let’s ignore the fact that the Justice Harlan decision was used to justify some pretty reprehensible, subsequent authoritarian overreaches, and let’s also forget that they flipped the Spock quote around in Star Trek III and made the needs of the one supreme over the needs of the many (they had to bring Spock back after all!). Maybe we should add the word “usually” between “many” and “outweigh” in the Spock quote to give us some room to think!