A Brief History of Disease and Vaccines in the U.S.
By Kendra Findley, Health Program Administrator for Springfield-Greene County Health
When SARS-CoV-2- which later became known as COVID-19 — spread worldwide in 2020, concepts such as isolation, masking and quarantine were foreign to many people even though these methods of managing disease outbreaks have been around for longer than we may realize.
What we are familiar with is vaccination, and that may be the reason why these concepts seemed so foreign in the beginning. The modern advancements of science, technology and public health have contributed greatly to vaccine access and distribution making other precautions like isolation and masking mostly unnecessary — until a novel virus begins to spread with no vaccine available.
Vaccinology has largely been traced back to Edward Jenner, a British physician and scientist who pioneered the concepts of vaccines back in the late 1700s. Before Edward Jenner and vaccination, there was variolation. Variolation is a method of infecting someone with pustule material from a milder case of smallpox in hopes of reducing the severity when contracted. This term is used in reference to smallpox due to the scientific name of the virus, variola virus, and can be traced back to 15th century China and India.
Accounts from the 15th Century tell us that the variolation method used was to grind up smallpox scabs and blow the debris into the nostril to expose a person to the virus. Other methods were to scratch smallpox pustule material into the arm. It’s a method we would never use in modern medicine, but it shows just how far back methods of protection go.
So, it begs the question of how did we go from scratching scabs to the historical achievement of COVID-19 vaccines?
Well, let’s circle back to Jenner and his hypothesis in 1796.
Edward Jenner and Smallpox:
Try to imagine a time when George Washington delivers his Farewell Address, Tennessee is admitted as the 16th U.S. state and Missouri is simply a Colony of Louisiana. It’s difficult, right? This was the world in 1796 when Edward Jenner tested a hypothesis that would ultimately push science to where it is now. However, the way in which he tested his hypothesis is a violation of modern medical standards today.
His hypothesis was that exposure to cowpox, a skin disease which caused localized lesions, could protect a person from smallpox. Jenner had taken notice of some milkmaids who had contracted cowpox (a milder disease than smallpox) and seemed to then be protected from smallpox. Having the knowledge of variolation in mind, Jenner tested his hypothesis by taking material from a cowpox sore and inoculated it into the arm of a boy, then later exposed him to smallpox. The boy never developed smallpox.
Jenner’s published findings would eventually lead to vaccination replacing methods of variolation, giving way to efforts of creating and distributing vaccines for smallpox which ultimately eradicated the virus by 1980.
Studies of vaccines also helped future efforts in eradicating or diminishing disease. For example, poliovirus.
The U.S. Polio Epidemic:
There are still people alive today who experienced a Polio epidemic in the U.S. and can attest to the physical and emotional toll an epidemic can have on a community. Similar to what we’ve been experiencing in the last two years with COVID-19, families in the 1940s also had their daily lives shift when the poliovirus swept the nation.
Although the first ever U.S. Polio Epidemic occurred in Rutland County, Vermont in 1894, there was widespread panic in the late 1940s when outbreaks across the U.S. were occurring very frequently, which is why we consider it an epidemic in our history. While the cases didn’t reach a global scale, the severity and rate of infection was high. These cases happened so frequently in fact, that in the early 1950s these outbreaks were the cause of more than 15,000 cases of paralysis in the U.S.
Children were unable to go outside due to risk of spread and fear from their parents, and public health officials enforced quarantines to help curb the spread of disease.
Once the polio vaccine (IPV) was made available in 1955 and the oral vaccine in 1963, cases of Polio paralysis in the U.S. in the 1960s dropped to less than 100, and then dipped below 10 in the 1970s.
Thanks to vaccines, there has been no cases of poliovirus to originate in the U.S. since 1979.
Now that we’ve discussed epidemic, let’s talk about when disease impacts the world, also known as a pandemic.
The 2009 H1N1 Pandemic and Influenza Vaccines:
One of the earliest pandemics was the 1918 Pandemic (H1N1) virus (which is still technically around today due to mutation) and before COVID-19 the latest was the 2009 H1N1 Pandemic also known as Swine Flu.
To better understand how human influenza viruses become epidemics, endemics or pandemics, first we need to understand that there are four types of influenza. These include Influenza A and Influenza B which cause most human illnesses and seasonal epidemics (think flu season). An example of Influenza A would be Swine Flu (H1N1) which is a subtype and has different strains.
The difference between seasonal flu epidemics and a pandemic flu like what happened in 1918 and 2009 is that pandemics impact people on a global scale, they rarely happen, and most people have little to no immunity to the disease because they have not been exposed to the virus or similar viruses, according to the Centers for Disease Control and Prevention (CDC).
When the Swine Flu was officially categorized as a pandemic by the World Health Organization in June 2009, it was determined that this virus was antigenically distinct from seasonal influenza A (H1N1) viruses targeted by seasonal influenza vaccines, according to the CDC. Studies at the time also showed that seasonal influenza vaccines were “unlikely to provide substantial cross-protection against infection with the pandemic H1N1 virus,” the CDC reported in a 2009 weekly report. The Swine Flu continued to spread and peaked in May and June, with 980 schools being dismissed and impacting 607,778 students.
The CDC estimates that up to 575,000 people died from the 2009 H1N1 influenza during the first year of the virus.
In July of 2009 clinical trials to test the 2009 H1N1 flu vaccine began. Four vaccines were approved by the Food and Drug Administration to help fight against the pandemic, and by October 5, 2009, first doses were being distributed in the U.S.
On August 11, 2010, WHO officially declared the end of the 2009 H1N1 influenza pandemic.
And once again, we had vaccines to thank.
COVID-19 and mRNA vaccines
Although the history of Vaccinology is much longer and complex than what I have written here, this brief glimpse paints a picture that we’re all looking at right now: the COVID-19 pandemic. And, more specifically the question many have begun to ask: Are the vaccines working?
The answer is yes. Vaccines have a proven track record in our history that they can and do work. Efforts to create a vaccine to combat COVID-19 began in 2020, the year the virus reached a pandemic level and has saved countless lives from severe illness and side effects.
Both the Moderna and the Pfizer/BioNTech vaccine are mRNA vaccines, and this type of vaccine technology has been around for decades. In fact, mRNA vaccines are used every year to treat influenza.
The timeline of the SARS-CoV-2 virus had many people in 2021 wondering if it was too soon to have a COVID-19 vaccine. But thanks to pioneers of Vaccinology like Edward Jenner, past epidemics and pandemics, and years of research, we can create safe vaccines for people and save lives.
Over 220 years after Edward Jenner tested his hypothesis, we are seeing the COVID-19 vaccine help protect communities and families around the world from the devastating effects of COVID-19. As we continue to build onto the history of vaccines, we should remember the countless lives vaccines have saved in our history and choose vaccination because Every One Counts.
USC KECK SCHOOL OF MEDICINE