FEATURE Vaccines: A Hot Topic Once Again Larry Lynam, DSc1 and Melory Johnson, VN2/ 1Principal, The Lynam Group, LLC, Coral Springs, FL; 2Principal, MJ Medcom, LLC, Boca Raton, FL ABSTRACT movement has become more effective than ever. Even with our Since Edward Jenner’s day, there has been a steady improve- miraculous strides toward eliminating diseases that once dev- ment in vaccine science, including numerous advances in pro- astated entire populations, we find ourselves, yet again, face- duction, quality, efficacy, and safety. Vaccines have long been to-face with misinformed “anti-vaxxer” propaganda. regarded as one of the most significant contributions to public Presently, Ebola is spreading in the Democratic Republic health since clean water. Yet, for as long as there have been of the Congo (DRC), where, for the first time since its discov- vaccines, there has been an anti-vaccination movement. The ery in 1976, a vaccine is available. Despite this momentous 18th century “anti-vaxxers” posed arguments eerily similar to breakthrough, we find vaccine implementation hindered and those raised today. Twenty-first century anti-vaxxers repeat the distribution delayed by geographic challenges, financial short- same antiquated and discredited sentiments as did those in comings, political obstacles, and—worse still—by warring fac- Jenner’s day, only with updated scare-tactics and more embel- tions, disinformation campaigns, and anti-vaxxers. Failure to lished “truths.” Although their claims are scientifically illogi- contain this currently isolated crisis could have adverse global cal, sadly, their propaganda has had a profound influence. The impacts. After more than 2,000 Ebola deaths in the DRC, the success of the anti-vaccine movements has not only led to a outbreak has now spread into neighboring Uganda.2 Moreover, resurgence in measles, which was declared eliminated in the as the DRC fights Ebola—and cholera—they are also now fight- United States in 2000, but also threatens to reverse the prog- ing measles! Since January 2019, more than 100,000 measles ress made against other deadly infectious diseases. Although cases, entirely preventable by vaccine, have claimed the lives of vaccines have steadily evolved, making great strides in control- an additional 3,000 Congolese.3,4 ling or eliminating many infectious diseases and improving To find the origins of the anti-vaccination movement, we our quality of life, their legitimacy is under ill-informed assault. need only to look at the first vaccine and the public health pro- However, as medical communicators, we can help restore col- gram that was initiated to rid the world of what was then its laboration between healthcare providers, vaccine manufac- most deadly and destructive infectious disease: smallpox. turers, and the general public by encouraging more effective, scientifically validated communication. Constructive commu- A HISTORY OF VACCINES nication strategies might help restore trust in medical authori- Smallpox, a virus believed to have jumped species from ani- ties and combat the inaccurate narratives from paid celebrities mals to humans, has ravaged mankind since the time of the and dubious social media platforms—the modern vehicles for ancient Egyptians, killing 20% to 30% of an affected population ancient anti-vaccine messages. with each outbreak. The disease would devastate a community, leaving its survivors permanently scarred with pox marks from erupted skin pustules anywhere on their bodies. Permanent oday, vaccines are dominating our health news, as once blindness was also a common complication—but at least the again, we face infectious diseases we thought were survivors were immune and spared from repeating the horror T eradicated from our everyday lives. The World Health when it returned. And it did return—repeatedly.5 Organization declared that, next to clean water, vaccines are the single most important public health advancement in Before Vaccination, There Was Variolation modern history.1 Despite this proclamation and our advances For centuries, people realized that if they survived, they would in medicine and science, however, the anti-vaccination be immune. So much so that early Eastern and Middle Eastern 100 AMWA Journal / V34 N3 / 2019 / amwa.org Table 1. Smallpox and the Anti-Vaccine Movement The term smallpox was coined in the 15th century to differentiate this ancient disease from another physicians inoculated their disease that was plaguing man at that same time—The Great Pox (known today as syphilis). The cause patients with pustule fluid from of neither disease was known, but both often proved fatal. The pustules that erupted and later left the smallpox lesions. They observed victims with small permanent scars, called pocks, inspired the name smallpox. Perhaps because of its loud that variolation (inoculation with and often abrasive intrusion into our consciousness today, we often think of the anti-vaccine movement infectious material) could lessen as new, but these ill-informed and misguided individuals have been hindering disease eradication since 5 the severity and complications of before the first vaccine. We can trace their origins back to the very first smallpox intervention: variolation. In the late 18th century, there were 3 choices for dealing with smallpox: the illness, which was preferable to becoming infected naturally.6 Natural Infection8 Variolation8 Vaccination8 The practice can be traced Path of The smallpox virus The virus is intentionally A naive person has the back to 1,000 BC in India and to Infection enters the respiratory introduced into the body cowpox virus injected 16th century China. Historians tract through inhala- by taking fluid from a into their skin (the tion smallpox victim’s pustule smallpox virus is credit Lady Mary Wortley Montagu, and scraping it into a naive completely avoided) a severely scarred smallpox sur- person’s skin vivor and wife of an 18th century Smallpox British diplomat posted in Turkey, Mortality Rate 20%-30% Approximately 2% 0% with introducing variolation to Typical Disease • 1/3 of all survivors • Usually a somewhat • Smallpox was Great Britain. Wanting her chil- Manifestations were left blind milder infection, but completely avoided, dren to be spared infection, Lady • Most survivors were no guarantee and the cowpox Montagu had them variolated in left permanently and • Survivors were often left infection only produced 6-9 Constantinople. severely scarred with significant scarring a few small temporary pustules of the hands Variolation had much room • Illness was very • An active, even mild for improvement (Table 1).5,8 The contagious to others variolation infection was • The cowpox infection that made a person im- practice was neither standardized who were exposed to contagious to others, an active infection and the transmitted mune to smallpox was nor regulated, and worse still, left infection could be severe not contagious to others a significant number of people with syphilis. Although under normal circumstances syphilis was sexually Table 2. Pro- and Anti-Variolation Sentiments transmitted, this incurable disease, The Variolation Conundrum which was considered to be the Although variolation was not without risks to the person variolated (as well as others exposed to them while it ran its course) and did leave a patient with permanent scarring, it seemed a preferable alterna- second biggest scourge of the day, tive to the disease manifestation via natural infection. Yet there was a significant opposition to the was transferred to healthy indi- practice, and those arguments sound very similar to the so-called modern anti-vaccine movement. viduals through smallpox variola- tion.5 However, when you consider The Pro-Variolation Crowd The Anti-Variolation Movement the consequences of a smallpox Not unlike today’s celebrity endorsements of a When variolation was introduced in the United outbreak, you can understand why position, the variolation proponents had endorse- States, there was a significant, and on occasion so many people, even knowing the ments from Benjamin Franklin, who lost a child violent, opposition to it. In 1721, during the to smallpox, as well as Thomas Jefferson, who had height of the Boston smallpox epidemic, Mas- consequences, willingly agreed to his entire family variolated and then vaccinated sachusetts Rev. John Williams wrote that these variolation. It did not guarantee when that process became available. The impor- inoculations were the work of the devil.48 That an ideal outcome, but at least it tance of infectious diseases and its societal effects same year, a bomb was hurled through the win- offered hope (Table 2).8,48,49 were not lost on Gen. George Washington. In dow of a different Boston minister. Attached to 1775, when he was commander of the Continen- the explosive was the message: “Cotton Mather, Beyond Variolation Was tal Army, he recognized the devastating effects you dog, dam you! I’ll inoculate you with this; disease could have on an army’s readiness, and he with a pox to you.’’ Fortunately, the explosive Vaccination ordered all of the Revolutionary War troops that didn’t detonate.49 The attack on the reverend Edward Jenner was hardly the had not previously been diagnosed with smallpox was not a religiously motivated act of terror- first to note that dairymaids rarely to undergo variolation. The technique they used ism. It was a violent response to Mather’s active contracted smallpox, hence their is described as removing the fresh pus from a promotion