Vaccination – a discovery and practice that changed the world, and the context of the anti-vaccination diatribes.

It was a bright Spring day in March 1918 when a twenty-seven-year-old cook Albert Mitchell at Camp Funston near Kentucky, showed up at the site clinic after a tiring day of work, complaining of muscle pain, fever, and labored breathing. Camp Funston came into existence during the 1853 California gold rush, as a resting place for people moving from the East to the West in search of their fortune and dreams. The camp had since then been converted into a military outfit to train cavalry units. When the first world war broke out, the camp grew larger and was transformed into a mini-city that could host around fifty thousand people. Literally, hundreds of civilians and soldiers poured into the camp each day to be trained for America’s entry into the first world war. The number of mouths to feed increased each day, and so did Albert’s work. When Albert visited the clinic that day, he thought he was just plain overworked and tired and would request the doctors to give him some medicine to numb the bodily pain. He didn’t expect the visit to last more than a few minutes. He had to return to the mess. The doctors who examined him, however, were smart and thorough. They looked at his symptoms, ran the routine tests, quickly diagnosed Albert with influenza, and immediately ordered him to the isolation ward to prevent the further spread of the disease. Little did the doctors know that it was slightly too late for this isolation tactic to work, for the strain of H1NI that Albert had contracted was a new variant never seen before. It had been incubating in Albert’s lungs for a few days and ferociously replicating itself. In fact, each breath Albert exhaled was ejecting truckloads of the virus into the air, possibly infecting hundreds and thousands in the camp. It was wartime, and camp Funston was a busy place with troops constantly moving in and out to Britain, France, Italy, and many other parts to augment the war effort there. God knows, how far the virus had traveled by the time Albert was diagnosed? By the end of March, literally, the whole of Europe was infected with this new H1N1 influenza strain. This was the first wave of the epidemic. The tragedy had just begun.

The first wave of influenza that spread in March of 1918 was definitely contagious, but not fatal (like the current covid variant Omicron). In scientific terms, the virus had a high morbidity rate ( rate of spread), but low mortality ( rate of death). The virus spread rapidly through the air, and thousands were infected with this viral strain. The infection manifested itself as fever, tiredness, and sometimes breathing difficulties in the patient. But over course of a few days, the body was able to successfully fight the viral intruder. The first Influenza variant allowed the bodies to survive its rupturing onslaught. It weakened the body but was benign enough to spare it. The second wave was a different game altogether, the virus showed no mercy. When the new mutation erupted in the fall of 1918 ( September), six months from the first wave, the H1N1 virus had assumed an ominous form. In the months between March and September, the virus found enough healthy bodies to mutate into a more virulent version of itself, and this time around, the host human bodies weren’t spared. This variant killed without remorse. The second wave swept away nearly 5% of the world’s population. It is estimated that nearly a hundred million people died of the influenza epidemic of 1918, and what is important to note, and not very widely known, is that a vast majority of those deaths happened in the twelve weeks during the fall of 1918. Scientists reason that the first strain of H1N1 that spread in March wasn’t dangerous because the virus had just made the transition from an animal to a human host, and therefore it was relatively new and weak, with not enough genetic ammunition to fight the human immune system. However, in the next six months, with the human mobilization caused by the war, the virus had enough time, opportunity, geographical spread, and the necessary number of human bodies to replicate itself into a genetic form that proved fatal. This is the essential problem with an epidemic. As long as the virus continues to have access to virgin bodies – in this case, virgin means bodies without the necessary antibodies to fight it – the virus will continue to replicate into newer forms. And, there are infinite numbers of variants a virus can mutate into, it is virtually impossible to predict what form and shape the next mutation is likely to take. We are today running the same risk with the Covid virus.

All of us know, when scientists talk of epidemic waves, they are not talking about the same virus strain in each wave. Each variant that manifests in a new wave of infection is structurally different than the previous ones, often more impervious than before, and generally resistant to the existing antibodies in the bloodstream. These new strains learn fast, reproduce fast, and gather the genetic flexibility to circumvent the vaccinated defenses erected in the body against a previous variant. This vicious cycle can and will continue until we arrest the mutations of the virus. This can only be done by not giving the virus a chance to replicate, which in turn means we have to restrict the number of vulnerable human bodies it can infect. Therefore vaccination is a must. That is the only way to create that ring of protection against the spread of the virus. There is no other way. The alternative is to wait for the virus to lose its virulence with each successive mutation and somehow miraculously vanish from the face of the earth. I don’t think we can afford this.

It is one of the greatest achievements of mankind to have discovered and understood the process of vaccination. Often, when we think of great human achievements, we tend to recount the invention of the steam engine, electricity, or the landing on the moon, computers, and so on. While these are wonderful achievements, no doubt, think of the blessing of prolonged life that vaccination ushered in. How many viruses have been stalled, curtailed, and eradicated by this simple process of inoculation? Take, for instance, Smallpox, one of the devasting scourges of mankind for thousands of years, responsible for millions and millions of deaths – far more than the casualties of all wars man has ever fought – today stands eradicated. All that exists of the lethal Variola major and minor – the two potent viruses that caused smallpox – are a few samples kept in high-security laboratories in America and Russia as specimens, and nothing more. We have neutralized its effect by learning how to prevent its devastating effects. How did we do it? Vaccination! Vaccination is the practice of introducing small doses of the genetically modified virus into the bloodstream to prepare the immune system for a defense against the same virus. It is similar to pulling out a thorn with a thorn. One of my favorite pics is the one below. This is a landmark photograph in the scientific history of mankind, just as Armstrong’s pic of landing on the moon. Here, the three-year-old Rahima Bhanu from the island of Bhola in Bangladesh is seen in her mother’s arms with the innocence of that age written large across her face. This little girl was the last person on the globe to be affected by the Major smallpox virus. In October 1975, the young girl had developed the telltale signs of smallpox on her skin. The WHO was immediately notified, and they rushed a team to Bangladesh to vaccinate Rahima all those who could have come in contact with the child. It was one of those rare instances of global co-operation, a wonderfully orchestrated medical intervention by the WHO and the team on the ground. Not only did the timely vaccination save Rahima, but it effectively stopped the spread of the virus on the Island and signaled the end of the dreaded disease. Four years later, on December 9th, 1979, the WHO, in one of the most triumphant proclamations of the twentieth century, declared that smallpox was eradicated across the globe. It was a soul-stirring moment, a moment that had its chance beginnings in Edward Jenner’s lab, a pure scientific accident( as most great discoveries tend to be ) that opened the doors to a medical treatment that would change the face of human life and condition.

The story of the discovery of vaccination is highly romanticized in science; just as Newton’s apple story, or Frankin’s kite. I am not a great believer in such romances because a deeper reading of history will prove that such discoveries have a deeper past to them and are not due to sudden revelations as they are often made out to be. In Edward Jenner’s case too, as a young child, he was inoculated in 1757 – nearly forty years before the romantic date of May 14th, 1796, the date recorded in history as the discovery of vaccination. The tradition of vaccination had a long history in India and China, and even in Victorian England, the idea of “variolization” was evangelized by the members of the royal family who had spent time in the middle east. So, on May 14th, 1796, when Jenner decided to vaccinate an eight-year-old boy with the pus scraped from the blisters of a milkmaid with cow-pox ( a milder variant of smallpox), he was inheriting the principles long in use. The boy developed a slight fever, but quickly recovered and gained permanent immunity from smallpox. The stroke of Jenner’s genius lay in figuring out the connection between the cowpox virus and smallpox. The timing of his discovery and the networks he possessed to evangelize the technique was just right for the process to gain traction among the wider public. Anyway, Through Jenner’s pioneering work, the process of vaccination spread across Europe and Asia as an antidote to viral epidemics. A big step for mankind.

The fact that vaccinations were successful against epidemical viruses was clear since the eighteenth century. The improvements in tools and techniques of epidemiology made it easier to spot epidemics and treat them with vaccinations. In America, President Thomas Jefferson, a moonlighting doctor during his spare time, tested the efficacy of the smallpox vaccine doses he was receiving from a Harvard medical professor, on a small group of patients. It worked. Jefferson’s day job was running the country, and during the nights he exercised his passions for medicine. Do we have such leaders these days? It was due to his insistence that in 1813, Congress passed the Vaccine act with the aim to ” furnish…. genuine vaccine matter to any citizen of the US”. In a few decades, England and Germany followed suit. Writers of the caliber of Charles Dickens, Cotton Mather, the redoubtable Lady Mary Montagu, and many others actively evangelized the process of vaccination. Science could be done as a solitary exercise, but its adoption needs a community of well-wishers.

It is ironic that along with Vaccination laws, the anti-vaccination movements also came into being. The anti-vax societies were skeptical of the process, and rightfully so, at that time because not enough data was available. Writers like Charles Dickens wrote extensively about the benefits of vaccination to allay the fears whipped up by the anti-vax groups. Even formidable intellects such as philosopher Herbert Spencer, and the co-father of evolution, Alfred Russell Wallace, distrusted the efficaciousness of vaccination. Of course, they questioned the data-collection methods and the percentage of cure, etc, but the point is, when voices as strong as Spenser and Wallace raised questions, it was easy for the anti-vax groups to pick up on that rhetoric for their own selfish benefits. Listen to F W Newman, a prominent member of the anti-vax movement in England on why Vaccination shouldn’t be enforced: ” Against the body of a healthy man, Parliament has no right of assault, whatever under the pretense of public health. to forbid public health is tyrannical wickedness, just as much to forbid chastity or sobriety. The law is an unendurable usurpation, and creates the right of resistance”. Sentiments like these have been part of the vaccination history for two hundred years. Unlike other medical advances, voices of dissent have always punctuated the history of vaccination.

The question is why? Why would people object to vaccination, even today in the era of Covid, despite so much statistical evidence backing it? We can think of a few reasons. The first is the distrust of modern medicine in general. There are significant sections of the population who still believe in native cures. That a herb can cure cancer, or a timely concoction of homegrown ingredients can resuscitate a sick or dying man, or more importantly, a sense that modern medicine is invasive, unnatural, and kills more than it cures is widely prevalent. And in the case of vaccines, the case for not taking them is even stronger for such people because vaccination, after all, is an attempt to prevent disease, and therefore by definition has to be administered to a healthy body. There is an inherent contradiction there, isn’t it?. If I am not sick yet, why should you inject something into me? It takes a rational mind to prevent an effect when the cause hasn’t manifested itself. Vaccinations will generate a short-term disability in the form of fever and tiredness for a day or two before the immune system is prepared for a bigger battle. Some of us did feel weak and feverish when the vaccine shots were administered. It is a small sacrifice to pay to protect ourselves. The second reason why Vaccination is viewed with skepticism is there are many who believe that it is the job of the government to prevent the spread of the virus, improve the conditions of living, and not work on evangelizing vaccinations to cover up for their incompetencies. The very process of elaborately orchestrating a marketing need for vaccination among the people, then pumping money to produce the vaccine, then selling or hoarding it, smacks of capitalism and profiteering at the cost of the common mans’ well-being. The third reason is about protecting civil liberties. Democracy is the will of the people, and the state has no right to force something on my body, without my consent. Today it is a vaccine, tomorrow it could be something else? Fourthly, Vaccines are not 100% guaranteed against the disease. Vaccines do have a high rate of success, but there is a statistical chance they could fail. No medicine is a guaranteed cure for anything, there is always the lingering possibility that it may not work. So the basic question: Will the vaccine work for me looms large in the public imagination? Lastly, there are always rebels in a democracy – Ideological rebels, Political rebels, religious rebels, medical rebels and for them, the only reason for not getting vaccinated is to prove a point to an opposition. While all these reasons have an aura of validity to them, the sheer number of lives saved through vaccination between the nineteenth and twentieth centuries is enough to prove to the most ardent skeptic, that vaccination works, and works well.

A few days ago, Novak Djokovic, the Serbian champion was sent back from Australia because he was not vaccinated and adamantly refused to do so. He claimed he had immunity against Covid -sars virus due to an infection he contracted in December. But the Australian administration was unmoved. They knew what Djokovic had at stake during this Australian Open. He was chasing a dream, a dream that could have given him immortality in the annals of tennis; but No!, his entry and presence in the country was a health risk, and the Government took a clear stand that either he vaccinates himself, or go back. That is the way to do it. No exception whatsoever. The only way we are going to overcome the mutation and spread of Covid is to give our bodies the antibodies to fight it. Vaccinated bodies may still contract the virus, but it will pass away as the flu or fever with just a trace of tiredness and nothing more. But by not vaccinating, we give the virus a body to replicate, mutate and spread, which is far more dangerous and risky, Who knows how virulent or fatal the next wave/strain will be?

Stopping the spread of an epidemic is a collective effort, with each individual doing their bit. If history has taught us anything at all in our fight against epidemics, it is the need for restraint, caution, and protection until we manage to reduce the potency of the virus so much that it loses the power to mutate into deadlier variants. It is like weaving a silent spider’s web around a rogue gene slice, choking and smothering the very life out of it. Unfortunately, there is no other way. In order to do this, we have to believe in our institutions – both national and international. The vaccine doses have to be administered through these agencies. The WHO has come under a lot of flak in the last two years for turning a blind eye towards policies of certain nations; but again, it is worth remembering that it is the WHO who played such a seminal role in the eradication of the Smallpox virus. We also have to listen to the voice of scientists who study the evolution of epidemics and recommend precautions. The precautions are not magical, in the sense, their effects are not immediately tangible like how a pain killer cures a headache. These public measures are inconvenient, prolonged, and sometimes irritating too. But they have to be endured. Wearing masks in public space, cutting down on social gatherings, stopping unnecessary travel, are the only keys we have to fight the epidemic, and of course, getting those vaccine shots into the bloodstream. If we diligently follow these practices, we have a fighting chance to ward off this virus.

I am sure all of us hope to see the day, sooner than later, when we wake up to hear the global announcement that Covid is officially eradicated, and we are free from the scourge of this epidemic. For this day to come, all of us have to work together with understanding, compassion, and act on factual reasoning. The fact we were able to bring out a vaccine in less than a year from the time Covid was identified shows how far we have advanced in understanding these viruses and creating vaccines in quick time, but what hasn’t improved much is in the human psyche in dealing with it. We are still grappling with the objections that our eighteenth-century ancestors had with vaccination – its efficacy. But now, with nearly 150 years of statistical data with us, and the triumph over so many life-taking diseases, it is foolish to doubt the importance of vaccination. It is like questioning gravity. It is time we individually volunteer to vaccinate ourselves, if we have not done so already, and it is also time for all the nations to work as one force to ensure vaccines are available to everyone across the globe. It is in each nation’s own interests that others have enough vaccines for their people. We should stop the Covid virus from having enough unvaccinated bodies as hosts. That is when this epidemic will show signs of ending.

God bless…

yours in mortality,

Bala