Having recently observed World Immunization Week, let’s review the history of vaccination. One thousand years ago, when a wave of smallpox hit India, something extraordinary happened: People lined up to buy the disease.

Healers used a cloth to rub a healthy person’s upper arm. Then, they’d scratch it — just enough to draw blood. The healers would then apply dried smallpox scabs to the area. But here’s the thing: They would only apply scabs from smallpox patients who had survived the disease.

Though people “vaccinated” this way would often get sick, most would survive infection and go on to build immunity. (Today, most vaccines in use, including the Pfizer, Moderna and Johnson & Johnson Covid-19 vaccines, are not live vaccines and cannot infect you with the virus they inoculate against.)

India wasn’t the only country where healers observed one of the basic principles of immunity, paving the way for modern-day vaccination. At about the same time, people in China were using “variolation,” a form of inoculation where a powder made of dried smallpox scabs was blown up the nose, to protect against severe infection. Scabs from mild cases were always sought out, dried and carried for a couple weeks, resulting in a semi-killed virus akin to that in our modern-day nasal flu vaccine, which contains weakened viruses not strong enough to result in influenza infection.

In the early 18th century, when smallpox was killing about 400,000 people a year in Europe, Lady Mary Wortley Montagu brought the practice of variolation from Constantinople to her home country of England. Having just survived smallpox, she desperately wanted to protect her children. While in Constantinople, she wrote of seeing a practice unheard of in English medicine. She carefully brought home some scabs from smallpox and inoculated her own son, providing him with something remarkable — immunity.

In 1798, Edward Jenner, a doctor in Gloucestershire, established the procedure of vaccination by introducing material from a cowpox vesicle on Sarah Nelmes, a milkmaid, into the arm of a boy named James Phipps. Two months later, he inoculated the boy with smallpox and the disease did not develop. He then published “An Inquiry into the Causes and Effects of the Variolae Vacciniae,” which created widespread interest.

He distinguished “true” and “spurious” cowpox (which did not give the desired effect) and developed an “arm-to-arm” method of propagating the vaccine from the vaccinated individual’s pustule. By 1801, his report was translated into six languages and over 100,000 people were vaccinated. The term “vaccination” was coined in 1800 by the surgeon Richard Dunning in his text “Some observations on vaccination.”

To eliminate the risk of outbreaks of some diseases, at various times governments and other institutions have employed policies requiring vaccination for all people. For example, an 1853 law required universal vaccination against smallpox in England and Wales, with fines levied on people who did not comply. Common contemporary U.S. vaccination policies require that children receive recommended vaccinations before entering public school.

Beginning with early vaccination in the 19th century, these policies were resisted by a variety of groups, collectively called antivaccinationists, who object on scientific, ethical, political, medical safety, religious and other grounds. Common objections are that vaccinations do not work, that compulsory vaccination constitutes excessive government intervention in personal matters or that the proposed vaccinations are not sufficiently safe. Many modern vaccination policies allow exemptions for people who have compromised immune systems, allergies to the components used in vaccinations or strongly held objections.

In countries with limited financial resources, limited vaccination coverage results in greater morbidity and mortality due to infectious disease. More affluent countries are able to subsidize vaccinations for at-risk groups, resulting in more comprehensive and effective coverage. In Australia, for example, the government subsidizes vaccinations for seniors and indigenous Australians.

Public Health Law Research, an independent U.S.-based organization, reported in 2009 there is insufficient evidence to assess the effectiveness of requiring vaccinations as a condition for specific jobs as a means of reducing incidence of specific diseases among particularly vulnerable populations.

Jerry Lincecum is a retired Austin College professor who now teaches classes for older adults who want to write their life stories.  He welcomes your reminiscences on any subject: jlincecum@me.com.

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