Long before the pandemic associated with the 2019 novel coronavirus, opposition to vaccination existed. In fact, outspoken criticism to vaccines has been around for as long as vaccinations have been. Today, managing vaccine-related hesitancy requires partnering with the public in taking a pro-vaccine stance regardless of the religious, sanitary, scientific, or political objections.
For centuries, different cultures searched for ways to protect their villagers against deadly diseases. While the practice of variolation originated in China, this intentional exposure to disease quickly spread to other parts of the world. Around the 15th century, physicians intentionally exposed healthy individuals to material from smallpox pustules by either inhaling it or through scratches to their skin.
Variolation was eventually replaced by the smallpox vaccine, which led to the field of immunology, that was launched by an English scientist named Dr. Edward Jenner in 1796. Locally known for his “Shots of Hope,” Jenner created the world’s first vaccine to protect multitudes of people against smallpox. The English physician had observed milkmaids, who contacted a rare zoonotic disease with simple pus-filled skin lesions called cowpox, but were then immune to smallpox.
How cowpox led to smallpox immunity…
Early practitioners in Asia inserted dried smallpox scabs into the nose of a patient who then contracted a mild form of the disease. While variolation offered protection against the deadly disease for some, it was not without risk. For example, this exposure could lead to the transmission of smallpox to others and some died from the intentional exposure. However, those individuals who recovered were permanently immune to smallpox.
Like other doctors of his time, Jenner used variolation to protect his patient but had always been intrigued by local folklore that suggested those who caught cowpox didn’t catch the more deadly smallpox disease. While humans first thought the cowpox virus affected cows, the natural reservoir for the virus was actually wild rodents that transmitted the disease to other animals like cats, especially through contact with their droppings or urine.
“Cowpox is usually self-limiting and was somewhat rare in humans,” explains Dr. Hans Wolf, the founder of WOLFPACC’s USMLE & COMLEX Prep Courses. “Typically, this mildly eruptive disease is localized to the skin and presents with blisters, a mild fever and swollen glands, but when transmitted to healthy humans, it did produce immunity to smallpox.” Now, a distinct orthopoxvirus (the vaccina virus) is used in modern smallpox vaccinations, but the original variola virus might have infected humans over 10,000 years ago.
The Rise of Anti-Vaccine Leagues
Although some sources say the practice of variolation may have taken place as early as 200 BCE, records show global attempts around the 15th century of intentionally exposing healthy people to smallpox in order to prevent the spread of this deadly disease. Jenner’s novel idea (of infecting a community of healthy people with lymph from a cowpox blister in the early 1800s was later was recognized as one of medicine’s most historical achievements) was met with criticism both at home and abroad.
Vaccination controversies were quick to question both the safety and efficacy of the growing number of immunizations, even including Louis Pasteur’s post-exposure inoculations for rabies. So, anti-vaccinationists waged courtroom battles in both England and the United States to repeal both state and federal laws.
In Vitro Techniques – During the 1960s, scientists identified the cells (called lymphocytes) in the human body that are responsible for immune reactions. This led to the development of “in vitro” techniques that allowed for more controlled and detailed studies of the human immune system.
By the beginning of the 20th century, the first U.S. Supreme Court case in America ruled against a Massachusetts man who argued for his right to care for his own body. As the science of immunology grew worldwide, media attention continued to spark public interest in the potential risks and consequences. Internationally, immunizations for diphtheria, tetanus and pertussis (DTP) as well as measles, mumps and rubella (MMR) drew public attention to the controversy of compulsory laws for mandatory vaccinations.
Do childhood vaccines cause autism?
Although centuries of time have passed since Dr. Jenner introduced his groundbreaking cowpox vaccine, emotions and deep-rooted beliefs that underlie vaccine opposition have remained consistent. Nonetheless, despite recent decades of scientific studies regarding the development of autism to assess the safety of the MMR vaccine, none were able to document a scientific link between compulsory immunizations and autism. However, since autism tends to run in families, studies related to both genetic and environmental causes will always be needed to ensure the development of the safest possible options for ongoing disease prevention in today’s more dynamic global village.
From Dr. Jenner to Dr. Fauci…
For centuries science-minded humans have searched for ways to protect themselves and others by strengthening the body’s natural defenses to be immune to a specific disease or disease-causing organism. After all, medical protection is never perfect and every “body” is a little different. So, public acceptance of vaccine-related adversity has and will continue to require humans to acknowledge and cope with the medical setbacks and individual challenges associated with any questionable vaccine uptake.
Whether philosophical, political or spiritual, vaccine opposition has remained relatively consistent from Dr. Jenner’s introduction of the first “vaccination” through Dr. Anthony Fauci’s 38-year tenure as director of the National Institute of Allergy and Infectious Disease at the NIH. “Despite the re-emergence of vaccine-preventable diseases in America, vaccine acceptance in our communities remains suboptimal,” adds Dr. Wolf. “So medical students today face many of the same challenges of the past and need to build trust and transparency regarding this centuries-old infodemic related to disease prevention by better managing vaccine-related hesitancy.”
According to a 21st century article published by the National Center for Biotechnology Information, vaccine acceptance across one’s lifespan definitely has global public health importance, but millions of children remain vulnerable to vaccine-preventable diseases because they are unvaccinated. Moreover, even though they are often reluctant to voice their concerns, there are healthcare workers who suffer with vaccine hesitancy. Rather than relying on presumptive vaccine campaigns, these vulnerable populations may require more individualized communications.
Everyone Has Historically Had an Opinion
For centuries before the Internet even existed, opinion columns in newspapers and taunting documentaries were a hallmark of daily public opinion. “Everybody has an opinion,” says Dr. Wolf. “But not everyone has an informed opinion.” Nonetheless, in most circumstances and especially in the world of ongoing scientific development, addressing differing opinions is considered healthy and often leads to very positive and uniquely productive outcomes. Just remember that having the freedom not to do something doesn’t mean you’re right.
According to the Centers for Disease Control and Prevention, a person who is immune can resist the bacteria and viruses that cause a particular disease, but the protection is never perfect. But, immunizing agents like immune globulin contain antibodies that can make a weaker immune system stronger to help prevent or treat the disease. In fact, smallpox and polio were highly contagious viruses that were almost eradicated through worldwide vaccination efforts. Plus, herd immunity for illnesses like measles occurs after most of the people get vaccinated.
Vaccine acceptance today sits on a spectrum that includes those who adamantly refuse all vaccines to those who are outspoken advocates. However, today’s medical student should know research has confirmed that a medical provider recommendation to vaccinate is one of the crucial drivers for vaccine uptake. Both strong community engagement and the input of vaccine champions (like one’s doctor) plays an important role in addressing vaccine hesitancy. So, vaccine champions can have a very positive impact on building community confidence in a vaccination strategy.
Photo credit Kaboompics.com
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Dr. Hans Wolf devoted decades to developing WOLFPACC’s “The Power 5” Methodology for helping medical students understand how to apply the basic sciences that they learned in medical school to the practice of medicine. If you’re ready to be the best physician you can be, contact us today to schedule a USMLE prep course or COMLEX-USA review program. Dr. Hans Wolf and his team of professionals look forward to working with you as our next success story.
