What is the history of vaccinations

With the recent news of the Covid-19 vaccination, this marked the fastest time between the development and formal acceptance of a vaccine by authorized medical authorities in recent history. However, vaccinations have now been with us for more than 200 years and ever since the discovery that there were ways to vaccinate against some infectious diseases there have also been some who resisted the idea of being vaccinated.

The Earliest Vaccines

There is evidence of early attempts at vaccinations in the Near East and China in the early Medieval period. In fact, people who survived disease such as smallpox were often asked to treat those afflicted, as people noticed that once you caught an infectious disease often it did not return. Early vaccination attempts mainly involved giving the infected individual small amounts of the disease. The method of variolation was widely practiced in the Ottoman court and, in fact, Western travelers in the 18th century noticed this practice of transferring small amounts of an infected area to another individual in the hopes it creates immunity. Lady Montagu, the wife of the English ambassador in the Ottoman Empire, and who learned and noticed this practice in the Ottoman court, helped bring the practice to England. This method, in the 18th century, was learned by others and eventually it spread variolation practice within the American colonies, where one of the earliest examples of its practice in the Americas comes from 1721 in Boston. Most of these attempts to inoculate using variolation were for smallpox. Tracing the history of variolation, the earliest evidence for this pracitce comes from the fifteenth century in China, where small amounts of the smallpox infection would be placed into the nose of an uninfected individual. Similar practices have been known in India and Sudan. Additionally, in Asia there are reports of monks and individuals who would swallow snake venom to create a form of inoculation.

In the West, the history of formal vaccination attempts is often traced to Edward Jenner in 1798 (Figure 1), an English physician, who took Variolae vaccinae (cowpox) and used that to inoculate a 13-year old boy from smallpox by injecting him. This is often seen as a watershed moment in the West, as it begins the long history of vaccinations and, in fact, this single event is often credited with saving more humans than any other action, given the countless other vaccinations and subsequent generations this initial round of vaccinations saved. The term vaccination, in fact, derives from the virus that causes smallpox, given the importance of that disease in the history of vaccinations. Among all diseases, smallpox represents the longest history of attempted vaccinations, with the disease mostly eradicated by 1979, nearly 200 years after the first vaccination by Jenner and hundreds of years after variolation had begun.

Figure 1. Edward Jenner administering his first vaccine.

Later Developments

Throughout the 19th century, in regions as diverse as England, India, and Nepal, formal vaccination programs were carried out. By 1807, over a million Indians and Sri Lankans were vaccinated for smallpox. In 1816, Sweden became the first country requiring vaccinations for children under the age of 2 for smallpox. In England, in 1853 compulsory vaccinations were passed in that year. In the United States, by the late 19th century and early 20th century, vaccination laws were developed throughout the country and by different states. Since 1906 in the United States, the Food and Drug Administration has attempted to regulate drugs and vaccines, increasingly improving their scientific methodology for testing the efficacy of vaccines. For influenza, another major infectious disease, vaccines began much later as it was assumed for decades that the disease was bacterial. The virus for creating influenza strains was only formally noticed in the 1930s and it took Sir Frank Macfarlane Burnet and Wilson Smith in 1935 to formally understand that antiobodies can be used to fight influenza. By the late 1930s, the first tested influenza vaccines were developed. Initially, they were tested on the military. It was not until 1945 that influenza vaccines for civilians were licensed, leading to formal campaigns to vaccinate populations to seasonal influenza. Increasingly, after this time, that many infectious disease could potentially be vaccinated against. By 1974, the World Health Organization (WHO) begins a global vaccination program. Their goal was to eradicate at least six common and infectious diseases in children, specifically: measles, poliomyelitis, diphtheria, whooping cough, tetanus, and tuberculosis. While in the 1970s and 1980s there was great optimism that such infectious diseases could be eradicated, it became clear that it was not so simple. Mainly, the WHO realized that public health programs had to be supported at the same time as inoculation campaigns. For instance, improving sanitation infrastructure helped to improve the spread of measles. For the common required vaccines in the United States, today vaccination rates vary between 82-99.6% among children.

Resistance to Vaccinations

From the beginning of early vaccination attempts in the 19th century, resistance to vaccinations began, particularly in England and the United States. Early protests against Edward Jenner were voiced soon after he began his vaccination attempts of smallpox. Objections ranged from reasons involving sanitary conditions of the injection, religious reasons against vaccinating, with some seeing it as unclean having come from an animal, scientific or at least pseudo-scientific reasons against vaccinating, and political objections. In the early 19th century, personal liberty was increasingly cited as a reason for those who opposed being vaccinated. In fact, with the English Vaccination Act of 1853 ordered for young children, the personal liberty argument became far more pronounced. Interestingly, anti-vaccination movements often emerged as being relatively strong in specific regions. In the United Kingdom, the town of Leicester emerged in the mid-19th century as a hotbed of anti-vaccination rallies. As vaccination laws came into effect in the United States, similar reactions against vaccinations emerged, with personal liberty increasingly cited as the main reason why someone objected to vaccinations. In the United States, the Anti-Vaccination Society of America became established in 1879 after William Tebb, a leading British anti-vaccination activist, visited. By the late 19th century, vaccination laws in California, Illinois, and Wisconsin were all challenged in courts. A landmark U.S. Supreme Court case in 1905 ruled that states did have the right to instigate required vaccination campaigns, limiting state-level anti-vaccination movements (Figure 1).

By 1962 in the United States, new laws forced the Food and Drug Administration to have stringent guidelines as to formally approving drugs and vaccines. Nevertheless, in the 20th century anti-vaccination movements became more sophisticated as they began to try to use scientific reasons as to why vaccinations should not be forced. Some cases of deaths or strong allergic reactions were sometimes used as supporting evidence. In the 1970s, Gordon Stewart, an outspoken physician, supported the anti-vaccination movement by writing several case reports that attempted to link neurological disorders to vaccinations again diphtheria, pertussis, and tetanus. In the United States, media attention and documentaries have helped to fuel the debate. A well-known documentary, DPT: Vaccination Roulette, was aired in 1981 and attempted to discredit diphtheria, pertussis, and tetanus using arguments given by Stewart. In the 1990s, the anti-vaccination movement also began to criticize the measles, mumps, and rubella vaccines, with British doctor Andrew Wakefield arguing that there was a possible relationship between bowel disease, autism, and the vaccines for these diseases. In the 2000s, anti-vaccination campaigns have also focused on compounds used to preserve vaccines, such as Thimerosal which contains small amounts of mercury. Some have argued that these cause harm; however, similar to Stewart's and Wakefield's arguments, no proof has emerged from the scientific literature supporting that these substances cause direct harm. However, some individuals could be allergic to compounds within vaccines, which could explain some observed negative reactions.

Figure 2. A 19th century anti-vaccination carton used to scare people from taking smallpox vaccines.

Summary

Generally, vaccines have been seen as a key triumph by humanity and has been one major reason given to explain the large population growth witnessed since the 19th century as inoculation campaigns were developed. Vaccines have been informally or formally developed by different cultures for centuries. With the advancement of medicine in the 19th and early 20th centuries, a variety of disease were soon limited. Anti-vaccination movements have become prominent in some Western countries, particularly in the United States and Britain. While a variety of reasons have been given, common reasons today for why people do not want to be vaccinated included personal freedom or fear that the vaccine can cause bodily harm. For most diseases and vaccines available today, almost no scientific studies support reasons why the general population should not take a vaccine, although individual cases and reasons do exist such as allergic reactions.