To Vaccinate or Not To Vaccinate?

That is the question.

Even if you’re one of those people who are in the habit of sticking your head in the sand to avoid seeing and hearing things, (just kidding, no one really does that!) you’ve probably found yourself on one side or the other as to whether vaccinations are a good thing.

In my family, when I was growing up there wasn’t even a question about it; you got vaccinated for polio, measles, mumps, rubella, tetanus, influenza and a few others. And as you’ll learn below, there were people who protested against it but I never heard about them.

However, times have changed and nowadays people with questions, opinions, and firm convictions have access to the internet so you can’t avoid hearing about stuff even if you wanted to!

So….I’m not here to put you on the spot.

And this article is not designed to try to support or dissuade whatever decision you have come to.

What I want to do is introduce you to the discovery and history of vaccines and the movements that arose against vaccination. We’ll look at some of the benefits and harms of vaccination. I’ll also talk about various side effects and recount some of the unfortunate episodes where vaccines were not properly formulated and administration of them caused harm.

So without any further introduction, I’ll take my best shot and see what comes of it.

The First Vaccine

If you thought the first vaccine was going to be in the early 20th century, think again!

Remember smallpox?

What? You never heard of smallpox?

Maybe there’s a reason for that.

Smallpox

Smallpox has been around for several millennia and it is not a nice disease! On average, 3 out of every 10 people who got it died. The survivors usually had scars that were often quite severe.

We now know that it is caused by either of 2 viral variants, Variola major or Variola minor. Variola virus is one of the Orthopoxvirus species, a genus that infects vertebrates and which also has viruses that cause horsepox and cowpox. Humans, other mammals and arthropods can all be hosts of Orthopoxvirus.

It turns out that smallpox was one of the first diseases that has records for how it was treated. In fact, rashes that look very much like those one gets from smallpox have been found on the head of the 3000-year-old mummy of the Egyptian Pharoah Ramses V!

Sometime in the 4th century AD, written descriptions of a smallpox-like disease surfaced in China. Similar descriptions also were found in India in the 7th century and in Asia Minor in the 10th century.

That’s when efforts to protect against it were first noted.

Over 1200 years ago, around 1000 AD, Chinese medical practitioners employed two methods in their attempts to protect people from contracting smallpox.

One method involved taking smallpox scabs from an infected person, grinding them up and then blowing the material into the recipient’s nostrils.

Eeeew!

The second method was to take small amounts of smallpox sores or scabs and use a sharp object to scratch them into the skin of a healthy person.

Ouch!

In more modern times, this method of control came to be known as variolation, derived from the name of the virus.

And it was pretty effective. The people who were variolated commonly developed smallpox symptoms such as fever and rash but many fewer died than those who contracted it naturally.

That’s how things were up until the end of the 18th century.

The First Smallpox Vaccination

Like some other infections we know of today, other animals also had a similar disease; cows and horses. And of course, it was called cow- or horsepox.

Cowpox is an uncommon, usually mild illness in cattle, that can be spread from a cow to humans via sores on the cow. During an infection, dairy workers may have pustules on their hands. Sufferers can spread the infection to other parts of the body.

In the mid-1770s, (250 years ago!) farmers in the North Dorset region of England including Benjamin Jesty, had already observed that farmhands infected with cowpox seemed to resist getting smallpox. Jesty persuaded his wife and 2 sons to be deliberately infected with cowpox. He used a stocking needle to transfer the material from a cow to a scratch made on each of their arms.

Although these were the first recorded vaccinations, not much interest seemed to come of Jesty’s inoculations and if they were used by others in Dorset or surrounding areas, there was no publicity attesting to this.

However, 22 years later, in 1796, Edward Jennings, a British physician duplicated Jesty’s vaccinations.

On May 14, 1796, Jenner inoculated the son of his gardener, eight-year-old James Phipps, with material from a cowpox sore on the hand of milkmaid Sarah Nelmes. Phipps suffered a local reaction and felt poorly for several days but made a full recovery. Three months later, in July, Jenner inoculated Phipps with matter taken from a fresh human smallpox sore, as if he were variolating the boy, in an attempt to challenge the protection from cowpox. Phipps remained healthy. Jenner next demonstrated that cowpox matter transferred in a human chain, from one person to the next, provided protection from smallpox.

Jenner was not precisely sure about the nature of the cowpox material he used. He suspected that cowpox actually came from horsepox; in other words, he speculated that cows became infected with the same agent that caused a similar disease in horses. Recent genetic analyses of old samples of the smallpox vaccine have revealed that the samples were more closely related to the horsepox virus than the cowpox virus. From this site.

In any case, in 1801 he presented his work “On the Origin of the Vaccine Innoculation” to the Royal Society of London which summarized his discoveries and hoped that vaccination would result in “the annihilation of smallpox, the most dreadful scourge of the human species…”

As a result of this publication, Jenner was credited with being the first person to confer scientific status on the procedure and was chiefly responsible for it becoming popular. And in 1805, Benjamin Jesty was presented with 2 lancets mounted in gold and a document acknowledging that in fact, he was the person that actually discovered vaccination.

Of interest is that Jenner was actually allowed to do the original experiment. With today’s ethical standards for having patients participate in a clinical trial, which this essentially was, a lot more testing would have been required before it would even be considered appropriate.

But that was then.

Interesting note: At the first meeting of the Royal Jennerian Society, Edward Jenner insisted that the origin of the term vaccination, from the Latin for cow (“vacca”), be credited to his friend and fellow physician, Richard Dunning.

Jennings method had 2 things going for it — There was little to no risk of transmitting human smallpox and the method of inoculation was much safer than that used for variolation. As a result, this procedure came to be known as vaccination and was used for over 200 years. It finally resulted in the complete global eradication of smallpox.

In the 1800s, a preparation of “live” vaccinia virus replaced the cowpox virus. It is similar to the variola virus and in the same family but is genetically distinct.

“In 1801 Benjamin Waterhouse, physician and co-founder and President of Harvard Medical School, began using the “Cowpox Vaccine,” leading to Massachusetts becoming the first US state to promote the use of vaccination.

But did everyone want to get vaccinated to protect against smallpox?

Vaccine Mandates and the rise of Anti-Vaxxers

In 1809 the town of Milton, Massachusetts became the first US town to offer free smallpox vaccinations.” Later that year Massachusetts passed a state law requiring the smallpox vaccination and in 1855 the state mandated that all schoolchildren must be vaccinated.”

Over the next 115 years, by 1970, another 29 states would pass laws requiring children to be immunized to attend public schools.

So it shouldn’t surprise you that even starting in the mid-1800s there was a fair amount of skepticism and resistance to getting vaccinated for a number of reasons, including the risks and potential side effects, which included death.

From 1840 to 1853, acts passed in Britain made vaccination compulsory. And just as rapidly, anti-vaccination leagues sprung up to challenge these laws. In fact, after the passage of the 1853 law, violent riots sprung up in Ipswich, Henley, Mitford and other towns.

Also in 1853, the Anti-Compulsory Vaccination League of London was founded and ultimately became the hub of anti-vaccination activity. Over the next decade many other chapters were formed and in 1866 Richard Butler Gibbs, with two other members of his family, founded the Anti-Compulsory Vaccination League. His cousin John Gibbs wrote the first anti-vaccination pamphlet.

In 1867 compulsory vaccination was extended to age 14 and older with cumulative penalties if you didn’t get vaccinated. By 1871 the Anti-Compulsory Vaccination League claimed they had 103 branch leagues and over 10,000 members. They published the National Anti-Compulsory Vaccination Reporter.

The anti-vaccination movement gained steam with the publication of various tracts, articles, books, and journals and began to spread into Europe. For example, by 1872 strong resistance to vaccination caused the percentage of vaccinated people in Stockholm to fall to ~40% compared to 90% throughout the rest of Sweden.

Then, in 1874 a major epidemic created a panic leading to widespread vaccination and an end to future epidemics.

But that didn’t stop the movement from gaining ground in England and across the waters in America. In 1885 in Leicester, a huge anti-vaccination demonstration drew ~ 100,000 people! It resulted in the formation of a commission which after 7 years of hearing all sides to the issue concluded in 1896 that vaccination did protect against contracting smallpox. But as a compromise to the anti-vaccination movement, it recommended the removal of cumulative penalties and introduced a conscience clause.

Interesting note: In 1898 the vaccination law was amended to allow exemption for parents, based on conscience, and thereby introduced the concept of “conscientious objector” into English law.

By 1896 the movement had grown and was consolidated into a new organization, The National Anti-Vaccination League. In 1898 The League took on Lily Loat as an assistant to their Secretary. At the time of Loat’s hire, she was not anti-vaccination but as she continued to work for the league she became a strong supporter. In 1909 the Secretary retired and she took on that position until she died almost a half-century later.

Loat became a tireless campaigner for the anti-vaccination movement and produced 2 books, both of which are still used by today’s anti-vaxxers.

The first was titled “The Pasteurization of Milk: The Case Against Compulsion” published in 1939. The second book, “The Truth About Vaccination and Immunization”, essentially itemized the arguments against vaccination and appeared in 1951. It is still being reissued and quoted today, with recent citations appearing in 2020. She passed away in 1958.

What was happening in America and Canada?

In 1878, a publication that called itself the National Anti-Compulsory Vaccination Reporter stated “the dangerous illnesses following the vaccine process are… on the whole… a greater evil to humanity than small-pox itself!” And in 1879 the Anti-Vaccination Society of America was founded. Their position was that mandating vaccines' “efficacy of vaccination as a disease preventative is a matter of individual opinion.”

Over the next 6 years, two more anti-vaxxing organizations were founded, the New England Anti-Compulsory Vaccination League and the Anti-Vaccination League of New York City. As a result of their efforts, mandates were repealed in California, Illinois, Indiana, Minnesota, Utah, West Virginia and Wisconsin.

When the Massachusetts state law was challenged in the US Supreme Court in Jacobson v. Massachusetts, the court upheld the state’s right to mandate child vaccinations as a condition to attend public school. It was challenged again in 1922 and the court declined to hear the case, Zucht v. King, stating that it was “within the police power of a state to provide for compulsory vaccination.”

So what we are seeing in modern times in response to COVID-19 and other vaccines is nothing new and has a long history of objectors.

Risks and Side Effects of Smallpox Vaccination.

One of the main concerns of anyone getting vaccinated is the possible side effects. Let’s look at the side effects of receiving a smallpox vaccination.

About 1 in 1000 people who received their first smallpox vaccination experienced side effects.

These range from typical, mild reactions to serious side effects.

The typical mild effects happen to 1 of every 3 vaccinated people and include

• a sore spot at the site of injection and it may turn red.
• The glands and lymph nodes in your armpits may swell up and become sore.
• You may get a fever for a day or two
• You may feel sick enough to miss work or school for a day or so
• you may lack energy for recreational activity
• you may have trouble sleeping

More serious reactions happen to about 1 in 1000 people who receive their first smallpox vaccination. These are not life-threatening and include:

• spread of the vaccinia virus to other parts of the body including the eyes where it can damage sight after touching the injection site
• spread of the virus to other individuals, again from touching the injection site and then touching other people. Both of these are prevented by washing with soap and warm water after touching the site.
• a toxic and allergic rash that can take various forms.

Life-threatening reactions include:

• a serious rash known as eczema vaccinatum. It generally happens to people who already have a pre-existing skin condition
• a large inflammation at the injection site that can look like a bullseye and grow into a large, non-healing sore. This usually happens to immunocompromised individuals.
• Inflammation of the brain and is known as postvaccinal encephalitis.

It is estimated that 1 to 2 people out of every 1 million people vaccinated could die as a result of life-threatening reactions to the vaccine.

Smallpox and COVID-19

When I looked into the reasons given as to why people are anti-vaccination for COVID-19, I came across an article, “Anti-Vaccinationists Past and Present”, that compared the reasons put forth by the modern anti-vaxxers to those of the anti-vaccination movement for Smallpox in the late 18th century.

I find it fascinating because so many of today’s reasons for COVID-19 anti-vaxxers are the same as those in previous generations.

I condensed and reworded their original text and constructed the table below so you can easily see the similarities.

I find it fascinating because as you can see, even after 125 years there’s not a whole lot of difference in the reasons why people don’t want to get vaccinated! And note that this article was written taking data from more than 20 years ago, way before the current COVID-19 pandemic.

And as I promised at the start of this article, I’m not going to support or try to undermine these contentions. That, dear reader, is your job!

All 29 diseases for which vaccines are administered

FYI, here’s a list of all the other diseases for which vaccines are currently administered:

The WHO lists 29 diseases for which vaccines are available:

1. Cholera
2. COVID-19
3. Dengue fever
4. Diphtheria
5. Ebola
6. Haemophilus influenzae type b
7. Hepatitis A
8. Hepatitis B
9. Hepatitis E
10. Human papillomavirus infection
11. Influenza
12. Japanese encephalitis
13. Malaria
14. Measles
15. Meningococcal disease
16. Mumps
17. Pneumococcal disease
18. Pertussis
19. Poliomyelitis
20. Rabies
21. Rotavirus gastroenteritis
22. Rubella
23. Tetanus
24. Tick-borne encephalitis
25. Tuberculosis
26. Typhoid fever
27. Varicella
28. Yellow fever
29. Shingles (Herpes Zoster)

You’ll notice that smallpox is not on this list. And that’s because for all intents and purposes, in 1979 it was considered eradicated and officially declared so in 1980.

It only took about 200 years!

Vaccination Failures and Disasters

Although many vaccines have been “accused” of causing serious infections and diseases after carefully studying them investigators could only verify 3 instances: Polio, Swine Flu and Rotavirus.

Polio and the Cutter virus incident of 1955

In 1955 in the USA, some batches of polio vaccine produced by Cutter Laboratories which were supposed to consist of inactivated-virus inadvertently contained live polio virus. This resulted in more than 220,000 cases of children with abortive or short-lived polio. 164 of these children suffered permanent paralysis and 10 children died. As a result, in late April the Cutter polio vaccinations were recalled and polio vaccination was immediately suspended.

While this was certainly a tragedy, one positive outcome is that it directly resulted in much tighter governmental oversight and regulation of vaccines. Once these regulations were put in place, polio vaccination was resumed in the Fall of that year.

As a result of the polio vaccination program, polio was essentially eliminated from the US in 1979 and from the Western Hemisphere by 1991.

Also, back then there was no program in place to compensate the victims of this oversight. However, today there is the Vaccine Injury Compensation Program which was put into law in 1986.

Guillain-Barré Syndrome and Vaccines

Guillain-Barré Syndrome (GBS) is a rare disease where your immune system attacks and causes damage to nerve tissue. This can result in weakness or paralysis and although most people recover, in some cases the damage is permanent.

People over the age of 50 are more at risk for GBS, and it usually follows infection with a bacteria or virus. But the actual cause is still not known. And in very rare occasions it may be associated with being vaccinated.

In 1976, there was a potential flu pandemic due to infections with swine flu, a strain normally found in pigs. More than 45 million people were vaccinated and when the cases of GBS were analyzed, the CDC found that 10 additional cases above normal arose for every million people vaccinated.

The CDC has continued to monitor this association and it seems to be constant for all subsequent yearly flu vaccinations. The actual cause of the GBS-vaccinations association has yet to be determined. There seems to be some indication that people are more likely to get GBS after getting the flu than from the actual vaccination.

Rotavirus and Intussusception

Rotavirus is most often found in infants and young children. It is less likely to infect adults. It is a gastrointestinal infection and usually results in vomiting and watery diarrhea which can last anywhere from 3–8 days.

“Intussusception is a serious condition in which part of the intestine slides into an adjacent part of the intestine. This telescoping action often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that’s affected. This can lead to a tear in the bowel (perforation), infection and death of bowel tissue.

Intussusception is the most common cause of intestinal obstruction in children younger than 3 years old. The cause of most cases of intussusception in children is unknown. Though intussusception is rare in adults, most cases of adult intussusception are the result of an underlying medical condition, such as a tumour.

In children, the intestines can usually be pushed back into position with a minor procedure. In adults, surgery is often required to correct the problem.” (taken from the Mayo Clinic’s website)

It is usually prevented with an oral vaccine given to infants.

In August 1998, the RotaShield was the first vaccine licensed by the FDA to prevent rotavirus infection. Shortly after it began to be administered, cases of intussusception began to appear and when the CDC investigated they determined that it was likely being caused by the RotaShield vaccine. The manufacturer, Wyeth, withdrew the vaccine in July 1999.

And that’s all the vaccine-disease associations that have evidence-based confirmation. Just 3!

There are many more that people have claimed over the years but in all those cases, extensive research has disproved any association between the vaccine and the disease allegedly resulting from it.

If you’re ever in doubt, just remember one of the golden rules of scientific research: Correlation does not equal Causation and see if that’s what you’re dealing with.

Nonetheless, that doesn’t seem to stop people from believing what they want to believe.

In Summary

Taking a stance against being vaccinated is nothing new. It’s been going on for more than a couple of hundred years now. Ever since vaccines were developed. And the arguments for and against it have also stayed pretty much the same, too.

What that tells me is that when it comes right down to it, we are dealing with some fundamental ground-of-being facets of human nature.

For the anti-vaxxers, I think that is the simple autonomous right to choose and say no to whatever is being asked of the individual at that moment.

For the pro-vaxxers, I think it falls into the ethical category of utilitarianism; the greatest good for the greatest number.

One really powerful human right that emerged from the original anti-vaccination movement and became part of the ethics enshrined in modern law is the concept of conscientious objection. Not something I knew!

So I think that pretty much wraps up what I wanted to say about vaccinations. I hope you learned a few new things, that I gave you food for some thoughts of your own and that you enjoyed reading about this topic.

Until next time,

Rich

Sources

1. History of Vaccines. A website with lots of great information.
2. Myths in medicine. Jenner did not discover vaccination. By Richard Horton, January, 1995
3. Anti-vaccinationists past and present, by Robert M Wolfe and Lisa K Sharp, August, 2002.
4. Vaccine Safety, Center for Disease Control and Prevention, September 2020