Routine vaccines have taken once common diseases and essentially turned them into ghost stories from our grandparents’ generation.
Despite this, or maybe even as a result, the public seems to be less and less dedicated to childhood vaccines.
A recent Gallup poll found that over two decades ago, 94% of Americans viewed childhood vaccinations as either “extremely” or “very important.” Today, that sentiment is only held by 69% of the population.
Vaccine skepticism, or outright denialism, is not a recent concept. For as long as there have been vaccines, there have been vaccine skeptics.
Take, for example, the history of smallpox.
It’s estimated that smallpox has existed for at least 3,000 Smallpox-like rashes can even be seen on Egyptian mummies.
One of the first prevention methods was something called “variolation” (from “variole,” the name of the virus that causes smallpox). It involved taking material from an infected but recovering person (maybe a scab from the pustules or a bit of the puss itself) and scratching it into the skin of a healthy person.
Variolation was the standard up until the first smallpox vaccine (actually the first vaccine period) was developed by Edward Jenner in 1796.
Jenner noticed that milkmaids who had gotten infected with cowpox, a milder yet clinically similar disease, seemed not to be susceptible to smallpox.
He tested this theory by taking cowpox matter from a sore on the hand of a local milkmaid and using it to inoculate an 8-year-old boy named James Phipps.
Basically, he took some cowpox pus, made a cut in the kid’s arm and rubbed it in there. Sometimes science is disgusting!
The boy felt a little ill for a few days and then fully recovered. Two months later, Jenner exposed Phipps directly to actual smallpox to see if it worked.
Young Phipps was completely fine and thus became the first documented case of a person vaccinated for smallpox.
And in case you were wondering why we call it “vaccination” Jenner picked the term as a tribute to the cowpox-riddled milkmaids (vacca is Latin for cow and vaccinia is the name of the cowpox virus).
Of course, any scientific or medical breakthrough that effectively ended a disease that was known for toppling empires wouldn’t be complete without a faction of people who absolutely hate it. Enter the first recorded wave of vaccine pushback.
Some skeptics doubted Jenner’s invention because they didn’t think the disease came from whatever was in that cowpox pus. Instead, they thought disease was a result of decaying organic matter getting into the air.
The story of the smallpox vaccine isn’t just the first story about vaccines. It’s arguably the story of the greatest vaccine success so far.
Thanks to global cooperation on a smallpox vaccination campaign, the disease was declared eradicated in 1980.
Today, when we talk about diseases, we often use the term “eliminated” and that’s different from “eradicated.”
“Eliminated” means there are zero cases of a disease in a certain geographical region. For example, malaria still exists around the world, but we have functionally eliminated it in the United States.
“Eradicated” means there are zero cases of the disease anywhere in the world. Smallpox is the only human disease we’ve been able to eradicate so far, and we did it with an aggressive vaccination campaign.
I remember so distinctly when I was in grad school many years ago, one of my professors, Paul Fine—who was part of the smallpox eradication program in India in the ‘70s—said, “You could never eradicate smallpox today.”
Meaning, you’d get neither the level of voluntary participation they had, nor the institutional support to force the unwilling to be vaccinated. And rightly so, honestly.
Because we can’t make anyone get vaccinated, let’s try and get people on board by reminding them what other vaccines have been able to accomplish.
We now have 26 vaccine-preventable diseases. That’s 26 diseases we have figured out how to limit or nearly completely
The virus is spread through the fecal-oral route, meaning someone ingests the virus that an infected person has shed, and then they get sick. This kind of spread often happens through contaminated water.
Access to clean water and sanitation was improving in the United States from the start of the 20th century. And yet, polio epidemics still occurred regularly.
The largest polio epidemic of the 20th century peaked in 1952 with over 50 thousand cases and 3 thousand In 1955, the first polio vaccine was licensed. Within a decade, we went from over 28 thousand cases a year to fewer than 100.
The U.S. hasn’t had a case of locally-acquired wild polio since 1979.
Chickenpox is another great example of the impact of vaccination.
Since the vaccine was introduced in 1995, chickenpox cases have declined more than 97%.
We’ve known for a while that varicella zoster, the virus that causes chickenpox, can quietly hang out in the body after infection and be reactivated in adulthood as shingles, which is an extremely painful rash.
At least three recent studies have found a connection between adults getting vaccinated for shingles and a lowered risk of dementia
More research is needed to determine the exact reason this is happening, but it’s suspected that reactivation of the virus can contribute to some types of dementia.
If that turns out to be the case, lowering people’s risk of getting chickenpox (with the vaccine) can lower their risk of getting shingles, which could in turn lower their risk of dementia later in life!
What about combo shots like DTaP?
The “D” in DTaP stands for diphtheria, which had its own vaccine as early as 1914, but was combined with the vaccines for tetanus and pertussis (whooping cough) in 1948.
Diphtheria infections can result in a toxin that affects the throat and can result in asphyxiation, earning the disease the nickname “The Strangling Angel of Children”
In 1921, we saw diphtheria cases peak at over 200,000 that year, resulting in over 15,000 deaths. But now, thanks to routine childhood immunizations, it’s The last case of confirmed respiratory diphtheria in the U.S. was in 1997.
The “T” in DTaP stands for tetanus, also known as “lockjaw” due to the way the toxoid from the bacteria affects the muscles and nerves, causing stiffness, seizures, and difficulty breathing or swallowing.
Since the introduction of tetanus vaccines, cases of tetanus have declined more than 95%.
Pertussis, the final letter in DTaP, is also known as “whooping cough,” for the sound those infected make when trying to breathe and cough at the same time. It is a highly contagious respiratory disease, which can leave a cough that lasts for weeks or months.
Infants under 1 are at greatest risk for serious disease and death. Before we had the vaccine, there were about 9,000 deaths a year.
Cases of pertussis today are 90% lower than they were in the pre vaccine era.
The MMR vaccine is another combo shot.
Rubella, the “R” in MMR (the other two letters stand for measles and mumps) is a great example of a disease not many people think about today, but in the mid-1960s you would have thought about it a lot.
That’s because, before there was a vaccine in 1969, there was a massive outbreak in the U.S. It’s estimated that 12.5 million people got rubella between 1964 and 1965.
It’s a disease that’s particularly dangerous to pregnant people and their infants. This outbreak resulted in 11,000 lost pregnancies, 2,100 newborn deaths, and 20,000 infants born with congenital rubella syndrome or CRS.
CRS can cause complications for infants like cataracts, heart problems, and hearing loss. There were so many babies born with the syndrome that entire wards of hospitals had to be dedicated to their care.
While we’re on the subject of MMR, now is probably a good time to quickly go over the whole “vaccines and autism” situation, which actually isn’t a situation at all.
There has been extensive research into the topic by the American Academy of Pediatrics, the National Academy of Medicine, and the CDC, among many other groups, that has found no scientific evidence of a link between the MMR vaccine and a
The issue can be traced back to an English doctor named Andrew Wakefield, who published a paper in a well-regarded medical journal, purporting to show a link between receiving the MMR vaccine and developing autism.
The paper was highly flawed, including the fact that Wakefield had been paid by the lawyer of parents whose children had autism and were looking to establish a link to the MMR vaccine.
The paper was found to have so many ethical and methodological issues that it was eventually retracted by its own co-authors and The Lancet, and Wakefield lost his medical license.
Despite all this, the autism myth continues to persist and damages our ability to have meaningful conversations about actual vaccine-related adverse events.
Because vaccine injuries do happen. Just like any other medical intervention, nothing is completely without risk. Trying to understand the true incidents of severe injury is also difficult because they are very rare.
Clinical trials with tens of thousands of participants aren’t enough to detect side effects that will only happen once in hundreds of thousands or millions of doses.
And after a clinical trial ends, establishing a link between vaccination and a particular outcome becomes even more difficult. In life, people are exposed to so many factors, and have a variety of underlying genetic conditions, all of which could impact their health, that timing of an adverse event could simply be a coincidence.
That’s why it’s important to have dedicated funding to be able to actively study outcomes after a clinical trial ends, rather than relying on the passive surveillance systems we currently have in place.
And I think that also really plays into why people have increasing vaccine hesitancy: back at a time when there were 2 million cases of whooping cough and 7,000 deaths a year, people were less concerned with the possibility of a few severe reactions to the vaccine.
Now that these diseases, and the harm they cause, are less prominent in our minds, people question the risk to benefit trade-off.
Your risk of a severe outcome from the infection is much higher than your risk of severe outcomes from
And if more people choose not to vaccinate, then vaccine-preventable disease can make a comeback, increasing your risk of severe disease even more.
When a pathogen cannot easily spread in a population because enough people in that population are already immune, we call that “herd immunity.”
It means that people who are unable to build immunity because they are too young for vaccines or too immunocompromised to mount an immune response will still be protected by the immunized people around them, who prevent the disease from spreading.
Measles is so contagious that a community needs to have at least 95% of the population protected (usually through vaccination) to prevent an outbreak.
The disease was declared eliminated in the U.S. in 2000, meaning cases were only happening when someone got measles outside the U.S. and brought it in.
It’s a massive achievement when you consider just about 40 years ago, before the MMR vaccine was first licensed, there were between 3 to 4 million infections per year.
In the United States, for the 2022-2023 school year, vaccine coverage among kindergartners was only 93.1%
We’re just halfway through 2024 and we’ve already had 13 measles outbreaks.
The U.K. is currently experiencing a whooping cough outbreak with over 10 thousand cases so far this year, over 300 of which have been in infants too young to be vaccinated.
Getting vaccinated in pregnancy is the best way to bridge protection for newborns until they are old enough to get vaccinated, but the rates of pertussis vaccination in the U.K. have dropped to 60% this year.
Unfortunately, this outbreak has claimed the lives of 10 infants since it began in November of
A common argument from people who don’t consider vaccines important is that, if they get sick, they’ll just get treated.
Now, setting aside the fact that it’s better to prevent an issue than to deal with it later, treatment might not always be an option.
Several of these vaccine-preventable diseases are caused by bacteria, and you treat bacterial infections with antibiotics.
In an age of bacteria increasingly gaining resistance to antibiotics, I’d personally prefer to prevent illness in any way I could, rather than hoping the antibiotic treatment would still work, should I need
Vaccines are good and childhood vaccines are very good.
The CDC estimates that in the 30 years since the start of the Vaccines for Children Program, which provided vaccines to kids without insurance, vaccines have been able to prevent half a billion cases of illness, 32 million hospitalizations, and over 1 million deaths in the U.S. alone.
According to an analysis by the World Health Organization (WHO), 40% of the decline of infant mortality around the world is due to childhood vaccinations.
In the 50 years since the WHO started its expanded immunization access program, it’s estimated to have averted 146 million deaths in children under 5 years old.
The bottom line is that vaccines save lives, and childhood vaccines cause adults.
