Compared to Polio and Smallpox, America’s COVID-19 Vaccination Campaign Is Going Great
The slow and painfully slow increase in the U.S. COVID vaccine rate has made observers gloomy. Why is it that people refuse to receive the vaccines? People point out smallpox, polio and other diseases as proof of an earlier time in history when they trusted the authorities more and were more confident in science.As historians in medicine, however, we believe that vaccine hesitancy can be a cause for concern.
The U.S. COVID-19 vaccine campaign was an incredible success by historical standards. Fearsome diseases such as those linked to vaccine resistance have often been eradicated, even though they were more common than the public was expecting. Infectious diseases are rarely prevented or eradicated by vaccines. Additional measures such as quicker and easier testing and assistance for those infected who have to quarantine are essential.
This country’s anti-inoculation activism is more old than vaccination. The first inoculation campaigns in America date to the early 18th century, when members of the political and social elite began to promote variolation—the term “vaccination” didn’t exist yet—against smallpox. Although smallpox was a widespread and frightening disease, many resisted variolation, which meant inserting material from a smallpox sufferer’s pustules into a healthy person’s skin. The procedure was very risky. It was risky. The mortality rate for the procedure was between one and five per 100. This is better than the 25-30% death rate in smallpox natural cases, but it still drew opposition.
Dr. Zabdiel Boylston, an inoculation proponent, was threatened with hanging, and minister-physician Cotton Mather’s house was unsuccessfully firebombed by an irate critic. Smallpox might be spread to others by inoculated people who were not adequately quarantined. Many colonies have passed laws banning the practice. Benjamin Franklin later observed that “the practice of Inoculation always divided the people into parties, some contending warmly for it, and the others against it,” eerily reminiscent of today’s opposition, often propelled by political and cultural divides.
Learn more History of Vaccines. From Smallpox, to COVID-19
Inoculation was first introduced to America by Edward Jenner in the United Kingdom. One would have expected that resistance to it would recede at the turn of the 19th Century. After all, Jenner’s method—called “vaccination,” because the inoculating material was from cowpox (vacca being the Latin word for cow) instead of smallpox—was much safer than variolation, and offered even more effective protection. However, it was not without risks. Immunity-enhancing lymph was frequently transported far away unrefrigerated. In the pre-germ theories era, it wasn’t uncommon for the skin-piercing devices to deliver the lymph unsterilized. It was not uncommon for there to be contamination. Unease was also a common result of the idea of injecting a drug from a sick cow into a human being. When states began to make vaccination compulsory, punishing with fines and sometimes jailing parents, anti-compulsory-vaccination movements sprang up in earnest. This resistance proved so powerful that several states later repealed mandatory vaccination laws.
Yet, smallpox was slowly disappearing. The disease was eliminated from America by 1949 and the rest of the world by the 1970s. While the vaccine played a significant role in this success, everyone did not have to be vaccinated. A historian estimates that the U.S. achieved smallpox control with a mere 40% of its population. Since smallpox had distinctive and highly visible symptoms, it was possible to bring down rates dramatically by “ring-fencing,” which meant vaccinating intensively in the area surrounding an outbreak, even without reaching high rates of inoculation in the population as a whole. This strategy is not possible with COVID-19.
How about polio In the 1950s, we’ve all heard, Americans embraced Jonas Salk’s polio vaccine. After the vaccine was approved, Salk’s name became a national hero. Parents lined up all around the block for shots. Everybody got the vaccine and the horrible scourge that was polio was finally defeated.
There’s truth in this story: many Americans did, indeed, greet the polio vaccine with enthusiasm, and polio cases in the U.S plummeted after its introduction, halving in the first year it was publicly available, and halving again the next year.
This simple tale overlooks important complications. Prominent voices, including that of Salk’s rival Albert Sabin, publicly questioned the safety of the vaccine. The popular radio host Walter Winchell claimed that the government was preparing thousands of “little white coffins” for the children they anticipated would be killed by it. This fear was reinforced by the Cutter tragedy, which saw tens and thousands contract polio due to faulty vaccines produced at Cutter Laboratories. In the few weeks after the vaccine became available, approximately 200 people were left paralysed and 10 died.
What’s more, other data belies the impression we get from photos of families lining up for polio shots. One year after vaccine approval, 1956 was the date that many states started sending back their allotted shots to the federal government due to low demand. This, despite knowing that more than half of those under 40 were still unvaccinated. Dallas Morning News happily reported, on the anniversary of the vaccine’s approval, that the polio campaign was proving successful—but the numbers it reported indicated that a mere 2% of the city’s residents under age 20 had received the three shots required to be considered fully vaccinated.
However, the poliovirus disappeared just like smallpox.
These are just a few examples that show how sometimes, drastically reducing the number of cases of a disease can only be achieved by ensuring adequate and not total compliance to a public health regimen. A vaccination campaign that is too insistent in its pursuit can also cause doubt in the minds and hearts of those who are unsure about its goals. This is especially so where authorities seem otherwise unconcerned about the public’s well-being: where basic medical care is inaccessible and living or working conditions foster ill health.
Learn more Vaccines Can’t End Pandemics Alone—And We’ve Known That Since We Eradicated Smallpox
If we look at the COVID-19 pandemic from this historical perspective, there is reason for optimism. First of all, humility. COVID-19 is clearly a significant challenge for mankind. It does not appear that vaccination confers lifetime immunity. New variants are more common than smallpox and polio. Repeated vaccinations may be necessary to maintain protection from COVID-19, just as flu shots.
Let’s not lose sight, however, of the optimistic outlook. COVID vaccines arrived earlier and are safer than previous vaccines. The vaccines also received less violence and were more widely accepted. More than 60% of Americans have been immunized alreadyThis will be driven higher by the Omicron threat, which has a high transmission rate.. Only the flu vaccine (which is not mandatory) has been able to penetrate this much. According to the CDC, it reached 53.8% penetration in 2019-2020.
Our progress against COVID-19 is impeded by vaccine hesitancy. However, are we really living in an ignorant and hostile world? Hardly. Although we have no reason for complacency or to lose heart, our past does provide us with some hope.