Human beings have benefited from vaccines for more than two centuries. Yet the pathway to effective vaccines has been neither neat nor direct. This paper explores the history of vaccines and immunization, beginning with Edward Jenner’s creation of the world’s first vaccine for smallpox in the 1790s. We then demonstrate that many of the issues salient in Jenner’s era—such as the need for secure funding mechanisms, streamlined manufacturing and safety concerns, and deep-seated public fears of inoculating agents—have frequently reappeared and have often dominated vaccine policies. We suggest that historical awareness can help inform viable long-term solutions to contemporary problems with vaccine research, production, and supply.
The gasping breath and distinctive sounds of whooping cough; the iron lungs and braces designed for children paralyzed by polio; and the devastating birth defects caused by rubella: To most Americans, these infectious scourges simultaneously inspire dread and represent obscure maladies of years past. Yet a little more than a century ago, the U.S. infant mortality rate was a staggering 20 percent, and the childhood mortality rate before age five was another disconcerting 20 percent.1 Not surprisingly, in an epoch before the existence of preventive methods and effective therapies, infectious diseases such as measles, diphtheria, smallpox, and pertussis topped the list of childhood killers. Fortunately, many of these devastating diseases have been contained, especially in industrialized nations, because of the development and widespread distribution of safe, effective, and affordable vaccines.
Indeed, if you asked a public health professional to draw up a top-ten list of the achievements of the past century, he or she would be hard pressed not to rank immunization first.2 Millions of lives have been saved and microbes stopped in their tracks before they could have a chance to wreak havoc. In short, the vaccine represents the single greatest promise of biomedicine: disease prevention.3
Nevertheless, the story is more complicated than it might appear at first glance. Even as existing vaccines continue to exert their immunological power and new vaccines offer similar hopes, reemerging and newly emerging infectious diseases threaten the dramatic progress made. Furthermore, obstacles have long stood in the way of the production of safe and effective vaccines. The historical record shows that the development of vaccines has consistently involved sizable doses of ingenuity, political skill, and irreproachable scientific methods. When one or more of these has been lacking or perceived to be lacking, vaccination has engendered responses ranging from a revised experimental approach in the laboratory to a supply shortage and even insurrection in the streets. In short, vaccines are powerful medical interventions that induce powerful biological, social, and cultural reactions.
Edward Jenner, Cowpox, And Smallpox Vaccination
We begin our history of vaccines and immunization with the story of Edward Jenner, a country doctor living in Berkeley (Gloucestershire), England, who in 1796 performed the world’s first vaccination.4 Taking pus from a cowpox lesion on a milkmaid’s hand, Jenner inoculated an eight-year-old boy, James Phipps. Six weeks later Jenner variolated two sites on Phipps’s arm with smallpox, yet the boy was unaffected by this as well as subsequent exposures.5 Based on twelve such experiments and sixteen additional case histories he had collected since the 1770s, Jenner published at his own expense a volume that swiftly became a classic text in the annals of medicine: Inquiry into the Causes and Effects of the Variolae Vaccine. His assertion "that the cow-pox protects the human constitution from the infection of smallpox" laid the foundation for modern...