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Northwest Public Health Leadership Institute
Case #3 Learning Objective
Rebecca Pawlak
Why is there mistrust around immunizations? How does the history of immunization play in? Rebecca
History of Vaccines and Immunization
Health Affairs has a great article on the history of vaccines and immunization, found here:
http://content.healthaffairs.org/content/24/3/611.full
Below are the highlights of the history of vaccines and immunization, with select quotes from the Health
Affairs article as well as other key sources:
The gasping breath and distinctive sounds of whooping cough; the iron lungs and braces designed for
children paralyzed by polio; and the devastating birth defects caused by rubella: To most Americans,
these infectious scourges simultaneously inspire dread and represent obscure maladies of years past. Yet
a little more than a century ago, the U.S. infant mortality rate was a staggering 20 percent, and the
childhood mortality rate before age five was another disconcerting 20 percent.1 Not surprisingly, in an
epoch before the existence of preventive methods and effective therapies, infectious diseases such as
measles, diphtheria, smallpox, and pertussis topped the list of childhood killers. Fortunately, many of
these devastating diseases have been contained, especially in industrialized nations, because of the
development and widespread distribution of safe, effective, and affordable vaccines.
Indeed, if you asked a public health professional to draw up a top-ten list of the achievements of the past
century, he or she would be hard pressed not to rank immunization first.2 Millions of lives have been
saved and microbes stopped in their tracks before they could have a chance to wreak havoc. In short, the
vaccine represents the single greatest promise of biomedicine: disease prevention.3
History: Edward Jenner and Louis Pasteur
- Edward Jenner observed that milkmaids were generally immune to smallpox, he postulated that
the contact with cowpox (a disease similar, but less virulent) protected them from smallpox.
- Jenner, the Father of Immunology, performed first vaccination in 1796 to test his hypothesis.
- Pasteur produced a rabies antitoxin that functioned as a post-infection antidote – expanding the
meaning of vaccine to include prevention and treatment
Terminology challenges
- As science evolves and changes, terminology changes and becomes more precise.
- Public reactions to vaccines are varied - from praise of public health science to skepticism and
outright hostility.
- Terminology related to vaccines has been shaped increasingly by regulations governing humansubjects research and the enforcement of sterilization and safety standards. Especially after
World War II, the ethical design and execution of vaccine research has become a core concern
for many stakeholders.
Government investment
- Governments have invested in vaccines - initially considered a matter of national pride, in the
19th century smallpox vaccination was required under laws. In the 20th century vaccination was
managed by governmental entities and required for public school attendance.
- In the 1970’s the World Health Organization and UNICEF took vaccine programs global,
dramatically increasing the rates of vaccinated children in developing countries.
Ironically, as vaccines have become more commonplace, they have lost support of public
funding agencies. The success of the polio vaccine in 1955 fostered the idea that it was possible
to obtain sufficient funding without the support of government, and relay on philanthropic
groups and out-of-pocket costs to individuals.
Transition to private sector
- In the 19th century, vaccine production shifted from government to commercial/private entities.
- Pharmaceutical companies cite they avoid the vaccine business because it is economically
prohibitive and hampered by regulatory barriers – the majority of the ten basic childhood
vaccines are manufactured by one company.
- In 2003, vaccine stockpiles became a priority to avoid issues if a business or production failure
occurs with the manufactures.
Vaccine safety
- Unlike most drugs, vaccines are biologic agents and can be disrupted at various points along the
journey from lab to vial. Quality control, sterilization and monitoring are essential practices.
Even with strict standards, the possibility of contamination remains.
- In 1955, 200 children contracted disease from a vaccine containing wild-type polio virus, the
disease was fatal for five children.
- Within the scientific community there is debate over how vaccines should be produced –
whether killed virus, whole cell, live-attenuated, etc.
Protesting Vaccines
- In the 1830s, after an initial generation of vaccination, the incidence of smallpox declines but
the anti-vaccination movement emerged.
- Protesters argued intrusion of privacy and viewed mandates as government assault.
- In 1905, the US Supreme Court ruled that the need to protect the public’s health through
mandates outweighed the individual’s right to privacy (Jacobson v. Massachusetts).
- Until quite recently, historical studies depict anti-vaccinationists as irrational and antiscientific.
In the past decade, parents and watchdog groups have raised questions about the noticeable
rise in autism, even though a series of scientific studies have demonstrated there is no causal
connection to vaccines.
- In 1999, the FDA ceased to license thimersol-containing vaccines (a preservative many think is
the link to autism), leading the public to believe the casual connection.
- In 1997, President Clinton formally apologized for participants of the Tuskegee Syphilis Study,
this as led to the mistrust of communities (particularly African Americans) toward public health
efforts.
The divestment of public agencies in vaccine research and production and shift to commercial
manufactures, examples of vaccine contamination, decline in infectious diseases, public health failtures
such as the Tuskegee Syphilis Study, and the FDA ceasing to license certain vaccines have all led to the
mistrust of the public.