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Aww, Give It A Shot!

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Vaccination has been named one of the Ten Great Public Health Achievements of the 20th Century. What a nice opener that is!

Enterprising people, probably women — and I mean women, since women are the caregivers of the world and also have been in the forefront of vaccine development over the centuries — enterprising people in 15th Century China recognized that those who survived smallpox didn’t contract the disease again. So they took smallpox scabs from people with mild cases, dried and ground them to a powder, and blew the powder up the nostrils of healthy people. Many years later, Voltaire would observe that the Chinese had administered this practice, called “variolation,” for hundreds of years.

In 1717, Lady Mary Wortley Montague, a 28-year-old English poet, writer, and feminist living in Constantinople, wrote to her friend Sarah Chiswell about how Turkish women immunized their communities against smallpox, which was the scourge of the world. Contagious and deadly, it killed as many as 60 percent of infected adults and over 80 percent of infected children. Lady Montague wrote, “There is a set of old women who make it their business to perform the operation. Every autumn, in the month of September, when the great heat is abated, people send to one another to know if any of their family has a mind to have the smallpox. They make parties for this purpose, and when they are met, an old woman comes with a nutshell full of the matter of the best sort of smallpox, and asks what vein you please to have opened. She opens what you offered to her with a needle (which gives you no more pain than a common scratch) and puts into the vein as much venom as can lie upon the head of her needle, and after binds up the little wound with a hollow bit of shell, and in this manner opens four or five veins.”

Despite considerable resistance from the medical profession, Lady Montague succeeded in popularizing this practice, called “engrafting,” among the aristocracy. Eventually the practice became accepted throughout Europe, largely thanks to her insistence that what had been dismissed as old women’s Turkish folk medicine could possibly succeed where European doctors failed. Usually, the vaccination timeline over the past centuries ignores Lady Montague and skips directly from China to 1796 and Dr. Edward Jenner of Gloucestershire, England, who collected bits of cow pox from the arm of Sarah Nelmes and scratched it into the arm of an eight-year-old boy. Even Jenner faced mockery from many of his fellow physicians, though he was defended by such women as Jane Marset, who in her book Conversations on Chemistry wrote in support of the vaccine, and one Mrs. Bailey of Hope Hall, who vaccinated over 2500 people in Manchester. It was observed at the time that “ladies of rank have alone vaccinated 30,000 children.” They also influenced many of the new Americans, including Abigail and John Adams, and George Washington, who insisted that his troops at Valley Forge be vaccinated.

In 1881, French biologist Louis Pasteur developed a successful vaccine against anthrax and in 1885 did the same for a vaccine against rabies. Dr. Pearl Kendrick and Dr. Grace Elderring, both former schoolteachers and both white women, developed a vaccine for pertussis (whooping cough), which killed thousands of children each year; they relied heavily on the work of Loney Clinton Gordon, an African-American chemist and researcher; her expertise developed the final vaccine, in 1914. In 1926 the diphtheria vaccine was developed after Dr. Ana Wessels Williams eventually succeeded in isolating a strain of diphtheria, which was then used to create the vaccine. Bacteriologist Margaret Pittman’s work led to the development of the first vaccine against the influenza that causes meningitis; she was also the first woman to head a National Institutes of Health laboratory in America.

Jonas Salk developed a breakthrough polio vaccine based on a dead polio virus in 1955; this work was aided by Dr. Isabel Morgan, who enormously advanced medical understanding of polio. Measles vaccine was developed successfully in 1963 — but thanks to anti-vaxxers, measles has now lost its elimination status in the United States, as cases continue rising, with 17 outbreaks in 2018 and 465 outbreaks by April 2019.

In 1967 the mumps vaccine was developed, and then in ‘69 the rubella vaccine. In 1977 the smallpox vaccine was no longer recommended: because of the vaccine’s success, the disease was considered eradicated. In 1981, hepatitis B vaccine was developed; in 2000, hepatitis A vaccine; and in 2001 pneumococcal vaccine.

Vaccination and immunization have a similar meaning in everyday language, as distinct from inoculation, which uses unweakened live pathogens, and also distinct from variolation as used in 15th Century China. The World Health Organization (WHO) estimates that vaccination averts two to three million deaths per year in all age groups; up to 1.5 million children die each year due to diseases that could have been prevented by vaccination. WHO faces a tragically decreased availability of resources: some countries in sub-Saharan Africa simply cannot afford to provide the full range of childhood vaccinations.

Indeed, right here at home in the wealthy United States, race and ethnicity are strong determinants of vaccination, as well as of other preventative or therapeutic health services and health outcomes. Rates of infant mortality and most of the leading causes of overall mortality are higher in African Americans than in European Americans. Recent analyses of mortality from influenza and pneumonia show that African Americans die of these causes at higher rates than European Americans, and contributing to these racial disparities are lower rates of immunization against influenza and pneumococcal pneumonia. Suspicion of vaccines in communities of color dates way back, and has been fueled by appalling historical evidence, including forced experimentation on poor or incarcerated populations. Certainly, the most infamous example was the Tuskegee Institute in Alabama which, under the official name “The Study of Untreated Syphilis in the Negro Male” worked fist in glove with the U.S. Public Health Service to recruit hundreds of rural black men in 1932. The project advertised free meals and check-ups, but never explained that participants would be human subjects in a study designed to withhold medical attention.

With the advent of the coronavirus, women researchers have been leading the field in developing precious vaccines: the mRNA vaccine, which forms the basis of the Moderna and Pfizer/Biontech vaccines, is due to Hungarian Professor Katalin Karico; the Novavax shot was developed by Dr. Nita Patel and her all female team, and Professor Sarah Gilbert heads the team responsible for developing the Oxford/Astro Zeneca protocol.

It is certainly interesting that, down through time, it would appear that female scientists are even more interested in preventing diseases in the first place than in curing them after the fact. Not that there haven’t been notable female physicians and clinicians, and also not to ignore the reality that women were not even permitted to practice medicine for many centuries (after their midwifery and herbalism had virtually invented it).

But now comes the funny part. After all, stupidly embraced with passion is always funny.

The anti-vaxxers are, these days, more vociferous than ever, stealing feminist language to project its opposite meaning: e.g., “My body, my choice.” They use every excuse, claiming vaccines are ineffective, unsafe, or untested — and let’s pause here for a second’s silent tribute to all those people who fought so exhaustively for so long to establish stringently rigorous Phase I, II, III and even Phase IV trials for these vaccines: imagine the battles over those regulations! The anti-vaxxers have also discovered new uses for religious exemptions, which only a few of the most traditional and authoritarian religions require. Some parents falsely assume that their kids don’t need vaccines because vaccines have already driven the disease out, which is not only circular non-logic but also overlooks the likely return of diseases in unvaccinated people as well as it ignores the process of mutation in creating even deadlier strains (like the Delta variant). Then of course there are the parents who claim autism is caused by vaccination — despite all scientific evidence to the contrary, and despite the scandal that in 2011, Andrew Wakefield, leading proponent of the lie that vaccines cause autism, was found to have had financial motives in falsifying data and was stripped of his medical license.

Those are the merely ignorant anti-vaxxers. That’s not counting the vituperative MAGA Morons — although I must confess that my lower self got activated to cheer them on, given their Trumpist refusal to get vaccinated or even wear masks.

As David Leonhardt pointed out in The New York Times, there is a strongly partisan pattern to all this: The red states that went strongly for Trump have by far the highest rates of contagion, hospitalization, and death, while the blue states are doing just fine with low rates thank you very much. (Hmmm, the elections next year just became even more interesting.) The MAGAs include folks who take horse de-wormer medication rather than perfectly safe vaccines (I do not make these things up). These are the people who assault mask wearers at the grocery store (it’s termed AVA: “Anti-Vaxx Aggression), who scream that President Biden is a dictator for urging people to be vaccinated (his position strongly supported by a large majority of the population), but then who, when dying from Covid, like three evangelical pastors in one week recently, express regrets and urge others to get vaccinated.

Look. This isn’t a country wracked by poverty, like Afghanistan. Nor is the population of this country especially ignorant (note the adjective). So this isn’t a case of uneducated Taliban fanatics targeting health workers for fear that the vaccines they offer will make Muslims sterile or barren. No, this is a decision of privilege and of choice — choice to get sick, choice to infect others, choice even to opt for suicide.

Back in 1956, Elvis Presley was on the verge of global stardom when he appeared on the then very popular “Ed Sullivan Show.” Standing with Sullivan and the press, in public, a beaming Presley was voluntarily inoculated with the polio vaccine. As many as 60,000 children were infected annually with this disease, and I remember, as a child, how we lived in terror of it. Before Presley was vaccinated, immunization rates among teenagers were at an abysmal 0.6 percent. In the six months following, rates of immunization skyrocketed to 80 percent.

I confess I don’t know any more what would work. Some cities and states are opting for money payments as incentives. I wonder if language could come to our aid and we might employ the word “host” as in a science-fiction horror film: “Are you vaccinated or is the virus circling you for a host?” Spooky pod-people invaders? Maybe that would work?

Me, I’m not alarmed by public-health-inspired mandates that save lives. They don’t frighten me and they don’t oppress my individuality. If voluntary measures fail, then I say bring ‘em on!

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