Vax Facts

The History of  Vaccines Suggests the Issue Is Simply Complicated

In the wake of this year's particularly large measles outbreak, New York State eliminated religious exemptions for vaccines for children attending public school.¹ In 2015, after a measles outbreak in California, that state required all public school children to be vaccinated whether their parents objected or not. Several other states have also tightened their policies. The goal is to vaccinate enough people to prevent an outbreak when others are exposed to the virus, a concept called herd immunity.

Some people have called on social media outlets to block sites that post so-called "anti-vaxxer" materials. Amazon has removed from its marketplace materials that it claims promote misinformation about vaccines. Public libraries have also wrestled with whether or not to carry anti-vaccination materials.²

In June, the Today Show was met with a Twitter-mob backlash for tweeting, "Are vaccines safe?", despite the fact that the headline was meant to grab attention for a pro-vaccination article. The Twitter-mob, however, was incensed that the show would imply that there is any question of vaccine safety.

Reality Check

Though not as deadly or debilitating as polio or tetanus, measles is highly contagious and difficult to control. Even in the early 2000s, when almost 95 percent of the U.S. population was vaccinated against measles, small outbreaks still occurred, largely due to international travel to or from the U.S. Globally, 110,000 people died of measles in 2017, a large number, but a marked decrease from 2000, when 549,000 people died of it.³

British journalist Stuart Blume, author of Immunization: How Vaccines Became Controversial, points out that while many think that online propaganda from extremist groups is the biggest factor in parents' decision whether or not to vaccinate their children, studies show that peer group pressure is actually more influential. In fact, anti-vaccination sentiments were likely most prevalent in the pre-internet 1970s, when feminists were bucking paternalistic medicine and environmentalists were eschewing "unnatural" treatments.

Some people blame anti-vaccination attitudes on a 1998 study by Andrew Wakefield, which promoted an unproven connection between vaccines and autism. But fears about autism were already in the air in the 1990s. Not just ingredients in vaccines, but also processed foods, pesticides, and even a mother's emotional state while pregnant were suggested as causes of autism. Wakefield's paper merely ratified those fears.⁴ (Now most scientists believe genetics plays a large role in autism, and that autoimmunity may be related to some forms of it.) Before social media was widely used, the mainstream media played a role in keeping the autism-vaccine controversy in the public eye by airing debates between famous mothers and scientists. This continued into the early 2000s, largely motivated by increased viewership and public interest.⁵

To understand the passionate rhetoric about vaccines, we need to look at history. Vaccine skepticism is nothing new; identifying scapegoats and blaming parents for outbreaks have been going on since the 1960s. But the history of smallpox and polio can reveal the reasons why some people find it incomprehensible that parents wouldn't vaccinate their children. History also shows that vaccine programs and policies are about more than medical necessity.

A Brief History of Vaccines

Smallpox causes boil-like lesions on the skin and can lead to disability and death. Pictures of people with the disease can be difficult to stomach, and when one understands just how devastating the disease was and for how long it had plagued human populations, it is easy to see why the smallpox vaccine was considered such a breakthrough. Based on historical descriptions of the lesions, the earliest cases of smallpox can be traced to 3,000-year-old mummified remains in Egypt. The disease was apparently common in ancient India and China, and later spread to the Mediterranean and Europe. Eventually smallpox spread to North America and Australia, making it a truly global disease resulting in millions of deaths.⁶

In the eighteenth century, a farmer in Britain noticed that servants who had contracted cowpox, a milder version of the disease, did not get smallpox when others around them did. Later, in 1796, physician Edward Jenner showed that taking the fluid from a lesion on a person with cowpox and injecting it into another person inoculated the latter from smallpox. By the early 1800s more than 100,000 people had received this smallpox vaccine, so named from the Latin word vacca, for cow. The last smallpox case in the United States was in the 1970s, and in 1980 the World Health Organization declared the disease eradicated.

The eradication of smallpox came within the context of other huge advances in medicine. The twentieth century saw the discovery of penicillin, antibiotics, and several vaccines for both bacterial and viral diseases, many of which had long plagued humanity. When poliomyelitis reached its height in the U.S. in 1952, many were hopeful that Jonas Salk's new vaccine would cause polio to go the way of smallpox.

Polio was first identified in the U.S. in 1894. It tended to strike children and young adults in the summer, causing paralysis, severe debilitation, and death. Polio cases increased each year until 1952, when 3,000 people died from it and many others were left debilitated. But by 1954, in the largest trial of its kind, over 600,000 people received Salk's inactivated-virus vaccine, which proved to be 80–90 percent effective.⁷ After Congress passed the Polio Vaccination Assistance Act in 1955, which promoted the mass vaccination of children, instances of polio in the U.S. dropped from 30,000 cases in 1955 to less than 900 in 1961.⁸

Modern Vaccination Programs

Elena Condis, author of Vaccine Nation: America's Changing Relationship with Immunization, makes the case that our modern understanding of vaccination began in 1962, when the Vaccine Assistance Act was passed on the coattails of the Polio Vaccination Assistance Act. President Kennedy sought the eradication of polio through a federal vaccination campaign, and then extended the terms of the act to cover "milder" diseases such as measles, mumps, and rubella. But convincing people of the necessity for vaccination against measles and mumps proved much more difficult than it was for polio.

Measles is fatal in about 0.1 to 0.01 percent of cases, typically due to secondary infections, and is particularly dangerous in children living in places without a good medical infrastructure. Prior to mandatory vaccination, for most people, measles came and went without any adverse effects. But because it is highly contagious, some 4,000,000 children per year contracted it, meaning there were still a significant number of severe and fatal cases.

Mumps and rubella were added to the required vaccination list for children, even though these diseases are more serious in adults, because it is easier to mass vaccinate babies and schoolchildren. Such is the reasoning today for vaccinating babies against diseases like hepatitis B. To help promote compliance, vaccination campaigns would re-brand mild diseases as serious ones. Mumps was re-branded from a mild disease to a potential cause of neurological disorders and infertility in men.⁹ This same type of re-branding occurs today, most recently to promote the varicella (chicken pox) vaccine by emphasizing the risk of contracting shingles when one is an older adult.

Vaccination Hesitancy

In her book On Immunity Eula Biss takes the reader through her journey researching vaccines after her son was born. Biss is in the demographic that has the largest number of people who voluntarily choose not to vaccinate their children: white, older, married mothers with a college education and a household income of more than $75,000 per year.¹⁰ Nevertheless, most unvaccinated children in the U.S. reside in poor and uninsured households.¹¹ Religious groups account for only a small minority of unvaccinated children.

Biss's description of the prevailing views among her demographic echoes many of the sentiments of the 1970s' feminists and environmentalists. She writes insightfully that the modern obsession with toxins, or contaminants, is likely a by-product of fears over the effects of industrialization. She also touches on the fear that greedy doctors and pharmaceutical companies seek to make money at the cost of children's safety.¹²

Even many parents whose children receive all the recommended vaccines consider themselves "vaccine hesitant" for at least some of them. For example, many parents are fine with the older vaccines, such as DPT, polio, or the combination measles, mumps, and rubella vaccine (MMR), but question the safety or necessity of newer ones, such as varicella, rotavirus, or hepatitis B.¹³

This is partly due to high-profile blunders on the part of governmental vaccination campaigns. In the 1950s, one pharmaceutical company took shortcuts with Salk's method to inactivate the virus used in his polio vaccine. As a result, several children contracted polio after being vaccinated. The pertussis vaccine got a bad reputation when it became known that some children developed seizures or coughing fits after receiving it. The whooping cough vaccine was blamed for the rise in autism and other neurological disorders.¹⁴ In 1999, the CDC recanted a recommendation that all babies receive the rotavirus vaccine after some children ended up with a bowel obstruction.¹⁵

Aborted Fetal Tissue

Some Christians and others object to using vaccines whose viruses are grown in cells that came from aborted fetuses. Viral-based vaccines commonly used in the United States that are grown in such cells include chickenpox, hepatitis (A and B), MMR, polio, rabies, and shingles. Each of these vaccines uses one of three human cell lines that were originally derived from fetuses aborted in the 1960s. Because they are maintained through cell replication, they are the only source of human cells used for vaccine development; no additional fetal tissue is needed. The original cell lines are tightly regulated.¹⁶

Notably, one of the three strains of the polio virus derived in 1939 came from a fetus obtained after a caesarian section. (The original paper did not specify the circumstances of the C-section.¹⁷) Subsequent production of the polio vaccine uses one of the three cell lines derived from aborted fetuses, as mentioned above.

Dr. Ferdinand Yeates, a pediatrician and fellow with The Center for Bioethics & Human Dignity, believes that it is ethical to use these vaccines because they do not require new aborted tissue, even though the original line was made from an unethical source.¹⁸ Others disagree.

Theresa Deisher of Sound Choice Pharmaceutical Institute points out that animal-based vaccines are safer than human-derived ones, and she has called on the U.S. government to adopt those animal-based vaccines that have been successfully used in other countries.¹⁹ Except for the chickenpox vaccine, there are now alternative vaccines, which use viruses grown in animal or yeast cells, that can be substituted for the human-derived ones.

The Ethics of Risk

Vaccines are one of the few medications given to an otherwise healthy person.²⁰ This means their risks must be assessed in light of what could happen. There is no way to know for sure if a child will contract a severe or mild form of a disease, will serve as a carrier who might infect a vulnerable person, or will have an adverse reaction to a vaccine.

From a medical ethics standpoint, "Is it safe?" is a reasonable question that any person should ask about any medical intervention. Vaccines today are highly regulated and monitored by both the FDA and the CDC, with periodic review by the Institute of Medicine.²¹ When the risk of disease is weighed against the risk of side effects, it turns out that the wisest course to take for most healthy children is to vaccinate them. But not all vaccines are equally risky. The whooping cough vaccine, for example, still carries a small risk of seizure, while the hepatitis B vaccine has very few side effects. But whooping cough poses a greater threat to children than hepatitis B.²²

Risk itself is a hard thing for modern parents to measure. Brown University economist Emily Oster points out that parents have a hard time assessing actual risk versus possible risk, in part because the billion-dollar baby industry's message is that parents should be hyper-vigilant about every possible risk to their children—an attitude that is good for business but bad for curbing the spread of misinformation.²³ Add to this the vaccination campaigns that overstate the risk of disease in order to promote compliance, and you have a recipe for paranoia.

In any case, prioritizing certain vaccines over others does not make a person an "anti-vaxxer." Many parents question the necessity of giving a baby a vaccine for hepatitis B or a pre-teen girl a vaccine for HPV, particularly when the child can choose to get the vaccine when he or she is an adult. Smallpox and polio were debilitating and deadly. Measles is highly contagious. These vaccines, therefore, should take higher priority over those for behavior-based diseases. The latter do not spread as readily as airborne communicable diseases, so achieving herd immunity for them is not as crucial.²⁴ This doesn't mean that being vaccinated for diseases transmitted through sexual activity or by coming into contact with another person's bodily fluids is bad or unethical, but it is valid to question whether it is necessary to mandate such vaccines for babies and children.

In sum, when thinking about vaccines, there are several things to bear in mind: First, people objected to mass vaccination before the advent of the internet. Second, there have always been multiple ­motivations for vaccination campaigns, and they haven't all been purely medical. Third, vaccines work well, as evidenced by the history of smallpox and polio. Fourth, any medicine is going to have some side effects in some percentage of the population. Fifth, not all vaccines are of the same urgency because not all diseases carry the same risks. And finally, today's vaccines are highly regulated and constantly monitored for safety.

Notes
1. pewresearch.org/fact-tank/2019/06/28/nearly-all-states-allow-religious-exemptions-for-vaccinations.
2. https://undark.org/article/libraries-vaccine-misinformation-vaxxed.
3. cdc.gov/measles/symptoms/complications.html; who.int/news-room/fact-sheets/detail/measles.
4. Eula Biss, On Immunity: An Inoculation (Graywolf Press, 2014), 70.
5. Elena Condis, Vaccine Nation: America's Changing Relationship with Immunizations (Univ. of Chicago Press, 2015), 220.
6. https://biotech.law.lsu.edu/blaw/bt/smallpox/who/red-book/index.htm (ch. 5).
7. thenewatlantis.com/publications/jonas-salk-the-peoples-scientist.
8. Condis (note 5), 27.
9. Condis (note 5), 81.
10. Biss (note 4), 27.
11. npr.org/sections/health-shots/2019/05/20/724468630/the-other-reasons-kids-arent-getting-vaccinations-poverty-and-health-care-access.
12. Biss (note 4), 73.
13. Stuart Blume, Immunization: How Vaccines Became Controversial (Reaktion Books, 2017), 232.
14. Condis (note 5), 147–148.
15. Condis (note 5), 206.
16. https://abcnews.go.com/Health/aborted-fetuses-vaccines/story?id=29005539.
17. Ibid., note 7.
18. https://cbhd.org/content/should-children-be-routinely-immunized.
19. Soundchoice.org.
20. For a more comprehensive discussion, see https://cbhd.org/content/should-children-be-routinely-immunized.
21. Biss (note 4), 132.
22. cdc.gov/vaccines/vac-gen/side-effects.htm.
23. theatlantic.com/ideas/archive/2019/06/too-many-parenting-rules-not-enough-help/591487.
24. https://cbhd.org/content/hpv-vaccine-panacea-or-pandora%E2%80%99s-box-costs-and-deceptiveness-new-technology.