by David Isaacs
A patch was stuck onto the back of each volunteer’s hand, or study participants could apply it themselves; it could then be peeled away after a few days and discarded. Within minutes of being inserted into the skin, the patch dissolved, releasing the vaccine. The main adverse effect was itch and localised redness for two to three days, but 48 of the 50 volunteers said the patch was painless, and 70% said they greatly preferred the patch to an intramuscular injection.
The patches are stable for at least one year at 40°C, which is useful for maintaining the cold chain. Another advantage is that the patch avoids the need to dispose of sharp needles. This new approach could improve influenza immunisation coverage by appealing to people who dislike needles, and should reduce the cost of giving immunisations.
The immunisation saga started centuries ago, when material from smallpox sores was scratched crudely into people’s arms in China and Turkey, in a technique that came to be called variolation. We have now come almost full circle: patches also induce an immune response by delivering foreign material directly into the skin, albeit with greater sophistication. What charming irony – but how indicative too of the technological leaps we have achieved within a relatively short period of human history.
Conclusion
In 1720 there were no vaccines. By 1820, smallpox vaccine was available for routine use, and rabies vaccine could be given to people bitten by a rabid animal. By 1920, countries like the United States, the United Kingdom and Australia were starting to give diphtheria vaccine. In 2020, young children in many countries will routinely receive vaccines against diphtheria, tetanus, pertussis, polio, Hib, hepatitis B, rotavirus, measles, mumps, rubella, varicella, meningococcus and pneumococcus. Schoolchildren will be immunised against human papillomavirus infection and cervical cancer will be on the way out. Infants in developing countries will be routinely immunised against tuberculosis. Vaccines against other diseases like yellow fever and hepatitis A will be used widely in areas where they are most needed. New vaccines will be developed against other infectious scourges.
What remarkable progress we have made.
The history of immunisation is full of enchantment and excitement and extraordinary drama, and the future looks equally entrancing. The story of vaccines and their delivery has featured many famous scientists and unsung heroes who risked and sometimes lost their lives, as well as its fair share of villains.
Wonderful tales such as the delivery of meningococcal A vaccine in Africa and the elimination of polio from the world are still emerging in the present day. We should be optimistic that, in the future, immunisation will continue to yield exciting and uplifting examples of human endeavour and achievement.
We may not yet have prevented all known diseases, but immunisation has made and will continue to make a massive difference to people’s lives. The past, present and future of immunisation constitute surely one of the greatest of all human stories.
Endnotes
CHAPTER 1: Our deadliest foes
Willie Lincoln: The death of Willie Lincoln. Abraham Lincoln Online, www.abrahamlincolnonline.org/lincoln/education/williedeath.htm.
Plague of Athens: Finley MI. The Greek Historians: The Essence of Herodotus, Thucydides, Xenophon, Polybius. Harmondsworth: Penguin Books, 1977; The plague. Livius, www.livius.org/sources/content/thucydides/the-plague/.
Genetic make-up of humans and viruses: Willyard C. New human gene tally reignites debate. Nature 2018; 558: 354–5, www.nature.com/articles/d41586–018–05462-w; Bouvier NM, Palese P. The biology of influenza viruses. Vaccine 2008; 26 (Suppl 4): D49–53, www.ncbi.nlm.nih.gov/pmc/articles/PMC3074182/.
European colonisation of the Americas: Diamond J. Guns, Germs and Steel: The Fate of Human Societies. New York: WW Norton & Co, 1997 (winner of the Pulitzer Prize).
1918 influenza pandemic: Spinney L. Pale Rider: The Spanish Flu of 1918 and How It Changed the World. London: Vintage, 2017; Porter KA. Pale Horse, Pale Rider. London: Penguin Classics, 2011; Persico JE. The great swine flu epidemic of 1918. American Heritage 1976; 27: 4, www.americanheritage.com/content/greats-wine-flu-epidemic-1918.
Olivia Dahl: Death of Olivia. Roald Dahl, www.roalddahl.com/roald-dahl/timeline/1960s/november-1962.
Herd immunity: Reichert TA et al. The Japanese experience with vaccinating schoolchildren against influenza. N Engl J Med 2001; 344: 889–96, www.nejm.org/doi/full/10.1056/NEJM200103223441204; Hardin G. The tragedy of the commons. Science 1968; 162: 1243–8, www.geo.mtu.edu/~asmayer/rural_sustain/governance/Hardin%201968.pdf; Browne K. Measles, vaccination, and the tragedy of the commons. The Hastings Center, 25 February 2015, www.thehastingscenter.org/measles-vaccination-and-the-tragedy-of-the-commons/.
Whooping cough vaccine and encephalopathy: Baker JP. The pertussis vaccine controversy in Great Britain, 1974–1986. Vaccine 2003; 21: 4003–10.
MMR vaccine and autism: Wakefield AJ, Murch SH, Anthony A et al. Ileal lymphoid nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children (retracted). Lancet 1998; 351: 637–41; Deer B. How the case against the MMR vaccine was fixed. BMJ 2011; 342: c5347, www.bmj.com/content/342/bmj.c5347; Deer B. How the vaccine crisis was meant to make money. BMJ 2011; 342: c5258, www.bmj.com/content/342/bmj.c5258.full; Godlee F et al. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ 2011; 342: c7452, www.bmj.com/content/342/bmj.c7452.
ABC documentary: Chapman S. Tilting at the immunisation windmill. BMJ 1997; 314: 1641; https://www.bmj.com/content/314/7095/1641.15.full
CHAPTER 2: Smallpox, the speckled monster
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Plague of Galen: Littmann RJ, Littmann ML. Galen and the Antonine plague. Am J Philology 1973; 94: 243–55.
Elizabeth I: Whitelock A. Elizabeth’s Bedfellows: An Intimate History of the Queen’s Court. London: Bloomsbury Press, 2013; Hume MAS (ed). Calendar of Letters and State Papers Relating to English Affairs: Volume 1. Cambridge: Cambridge Library Collection, 1983.
Mortality rates in 18th and early 19th centuries: Davenport R, Schwarz L, Boulton, J. The decline of adult smallpox in eighteenth-century London. Econ Hist Rev 20011; 64 (4): 1289–1314; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373148/.
Turlough O’Carolan: O’Sullivan D. Carolan: The Life Times and Music of an Irish Harper. Cork: Ossian Publications, 2001.
French and Indian War: d’Errico P. Jeffery Amherst and smallpox blankets. U Mass Amherst, people.umass.edu/derrico/amherst/lord_jeff.html.
Sydney outbreak: The origin of the smallpox outbreak in Sydney in 1789. Treaty Republic, 2008, treatyrepublic.net/node/651; Warren C. Was Sydney’s smallpox outbreak of 1789 an act of biological warfare against Aboriginal tribes? Ockham’s Razor, 17 April 2014, www.abc.net.au/radionational/programs/ockhamsrazor/was-sydneys-smallpox-outbreak-an-act-of-biological-warfare/5395050; Tench W. A Complete Account of the Settlement at Port Jackson. Adelaide: University of Adelaide Library, ebooks.adelaide.edu.au/t/tench/watkin/settlement/chapter4.html; Moorehad A. The Fatal Impact: An Account of the Invasion of the South Pacific, 1767–1840. Ringwood, Victoria, Australia: Penguin Books Ltd, 1966.
Lord Macaulay: Potter P. The fragrance of the heifer’s breath. Emerging Infectious Diseases 2011; 17: 763–4.
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Lady Mary Wortley Montagu: Grundy I. Montagu, Lady Mary Wortley. Oxford Dictionary of National Biography. Oxford: Oxford University Press, 2004, dx.doi.org/10.1093/ref:odnb/19029.
Benjamin Franklin: Franklin B. The Autobiography of Benjamin Franklin.
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Edward Jenner: Baxby D. Jenner, Edward. Oxford Dictionary of National Biography. Oxford: Oxford University Press, www.oxforddnb.com/view/10.1093/ref:odnb/9780198614128.001.0001/odnb-9780198614128-e-14749; Jenner E. Observations on the natural history of the cuckoo. By Mr Edward Jenner. In a letter to John Hunter, Esq FRS. Philosophical Transactions of the Royal Society of London (1776–1886) 1 January 1788; 78: 219–37, archive.org/details/philtrans06624558. Edward Jenner. Brought to life, Science Museum; http://broughttolife.sciencemuseum.org.uk/broughttolife/people/edwardjenner
Benjamin Jesty: Pead PJ. Benjamin Jesty: new light in the dawn of immunisation. Lancet 2003; 362: 2104–9.
Catherine the Great: Ben-Menahem A. Historical Encyclopedia of Natural and Mathematical Sciences. New York: Springer, 2009.
John Savage: Weston KM, Gallagher WC, Branley JM. Smallpox vaccination, colonial Sydney and serendipity. Med J Aust 2014; 200: 295–7, www.mja.com.au/system/files/issues/200_05_170314/wes11021_fm.pdf.
Dr Alex Cook: Cook A. The preservation of the vaccine lymph. Sydney Morning Herald, 6 March 1843.
1841 vaccine sample: Forwarding vaccine virus. NSW Government State Archives & Records: Colonial Secretary; NRS 905, Main series of letters received, 1841 Medical (4/2531.4). Letter No. 41/5095 Deputy Inspector General of Hospitals (Dr Thompson), registered 21 May 1841; Vaccine sample from 1841 found in the archives. NSW Government State Archives & Records, www.records.nsw.gov.au/archives/collections-and-research/guides-and-indexes/stories/vaccine-sample-1841-found-the-archives; Weston KM, Gallagher WC, Branley JM. Smallpox vaccination, colonial Sydney and serendipity. Med J Aust 2014; 200: 295–7, www.mja.com.au/system/files/issues/200_05_170314/wes11021_fm.pdf.
Anti-vaccination protests: History of anti-vaccination movements. The History of Vaccines, www.historyofvaccines.org/content/articles/history-anti-vaccination-movements; Crutch D (ed). Lewis Carroll: Three Letters on Anti-vaccination (1877). London: Lewis Carroll Society, 1976; Rolleston JD. The smallpox pandemic of 1870–1874. Proc Roy Soc Med 1933; 27: 177–92, journals.sagepub.com/doi/pdf/10.1177/003591573302700245; Mariner WK et al. Jacobson v Massachusetts: it’s not your great-great-grandfather’s public health law. Am J Public Health 2005; 95: 4: 581–90, www.ncbi.nlm.nih.gov/pmc/articles/PMC1449224/.
Smallpox eradication: Foege WH. House on Fire: The Fight to Eradicate Smallpox. Berkeley: University of California Press, 2011; Fenner F, Henderson DA, Arita I, Jezek Z, Ladnyi D. Smallpox and Its Eradication (History of International Public Health, No 6). Geneva: World Health Organization, 1988.
DA Henderson: Dennis, B. DA Henderson helped eradicate smallpox. He also used to keep it in his fridge. Washington Post, 21 August 2016.
Rhondda Valley outbreak: 1962 South Wales smallpox outbreak memories recorded. BBC News, 12 June 2012, www.bbc.com/news/uk-wales-18365385; Mansworth S. Deadly disease; analysis: survivors of the 1962 South Wales smallpox outbreak have helped to paint a terrifying portrait of how the UK would cope with a bio-terrorist attack. Free Library 2002, www.thefreelibrary.com/DEADLY+DISEASE%3B+Analys is%3A+Survivors+of+the+1962+South+Wales+smallpox . . . -a082591810.
CHAPTER 3: The flawed genius of Louis Pasteur
Life of Louis Pasteur: Debré P. Forster E (transl). Louis Pasteur. Baltimore: JHU Press, 2000; Ligon BL. Biography: Louis Pasteur: a controversial figure. Seminars in Pediatric Infectious Disease 2002; 13: 134–41, www.sciencedirect.com/science/article/pii/S1045187002500595; Vallery-Redot R, Devonshire R (transl). The Life of Pasteur. Vol 2. New York: Doubleday, 1923, archive.org/stream/lifeofpasteur02vall/lifeofpasteur02vall_djvu.txt.
Rabies: Finnegan CJ et al. Rabies in North America and Europe. J Roy Soc Med 2002; 95: 9–13, www.ncbi.nlm.nih.gov/pmc/articles/PMC1279140/.
Emile Roux: Delaunay A. Roux, Pierre Paul Emile. Complete Dictionary of Scientific Biography. New York: Charles Scribner’s Sons, 2008.
Louis Pasteur’s notebooks: Geison GL. The Private Science of Louis Pasteur. Princeton: Princeton University Press, 1995; Fee E. Book review: The Private Science of Louis Pasteur. NEJM 1995; 333: 8: 84–5, www.nejm.org/doi/pdf/10.1056/NEJM199509283331321.
CHAPTER 4: The end of polio
FDR: Black C. Franklin Delano Roosevelt: Champion of Freedom. Cambridge, Massachusetts: Public Affairs, 2003; Coker JW. Franklin D Roosevelt: A Biography. Westport, Connecticut: Greenwood Press, 2005; Beckman M. Did FDR have Guillain-Barré? Science, 31 October 2003, www.sciencemag.org/news/2003/10/did-fdr-have-guillain-barr.
Polio victims: Marshall A. I Can Jump Puddles. Melbourne: FW Cheshire, 1955; Offit P. The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis. New Haven: Yale University Press, 2005; Roth P. Nemesis. Boston: Houghton Mifflin Harcourt, 2010.
Sister Kenny: National Library of Australia. Kenny, Elizabeth (1880–1952), trove.nla.gov.au/people/493848?c=people; Pearn J. The Sylvia stretcher: a perspective of Sister Elizabeth Kenny’s contribution to the first-aid management of injured patients. Med J Aust 1988; 149: 636–8; Kenny E. Infantile Paralysis and Cerebral Diplegia: Method of Restoration of Function. Sydney: Angus & Robertson, 1937.
Dr Morris Fishbein: Cohn V. Sister Kenny: The Woman Who Challenged the Doctors. Minneapolis, University of Minnesota Press, 1976.
Albert Sabin and Jonas Salk: Norkin LC. Jonas Salk and Albert Sabin: One of the great rivalries of medical science. Virology: Molecular Biology and Pathogenesis, 27 March 2014, norkinvirology.wordpress.com/2014/03/27/jonas-salk-and-albert-sabin-one-of-the-great-rivalries-of-medical-science/; Oshinsky DM. Polio: An American Story. Oxford: Oxford University Press, 2006.
Polio in India: John JT, Vasitha VM. Eradicating poliomyelitis: India’s journey from hyperendemic to polio-free status. Indian J Med Res 2013; 137: 881–94.
Ciro de Quadros: Seaton D. Remembering Ciro de Quadros, vaccines champion. BIOtechNOW, 6 April 2014, www.biotech-now.org/health/2014/06/remembering-ciro-de-quadros-vaccines-champion.
Polio in Pakistan: Riaz H, RehmanA. Polio vaccination workers gunned down in Pakistan. Lancet Infect Dis. 2013; 13: 120; Bhutta ZA. What must be done about the killings of Pakistani healthcare workers? BMJ 2013; 346: f280; Saleem S. Muslim scholars fight to dispel polio vaccination myths in Pakistan. Guardian, 5 November 2011, www.theguardian.com/commentisfree/belief/2011/nov/04/polio-vaccination-pakistan; www.theguardian.com/world/pakistan+society/polio; Rasmussen SE. Polio in Afghanistan: ‘Americans bomb our children daily, why would they care?’, Guardian, 10 April 2017, www.theguardian.com/global-development/2017/apr/10/polio-afghanistan-taliban-health-chief-americans-bomb-children; Janjua H. Afghan clerics in talks with Isis to break polio myths. Guardian, 27 March 2018. www.theguardian.com/global-development/2018/mar/27/afghan-clerics-in-talks-with-isis-to-break-polio-myths.
Polio in Nigeria: Ahmed S et al. Police officers gunned down while protecting vaccination workers in Pakistan. J Infect Public Health 2017; 10: 249– 50; McNeil Jr DG. Gunmen kill Nigerian polio vaccine workers in echo of Pakistan attacks. New York Times, 8 February 2013, nytimes.com/2013/02/09/world/africa/in-Nigeria-polio-vaccine-workers-are-killed-by-gunmen.html.
‘Polio endgame’: Aylward B, Yamada T. The polio endgame. N Engl J Med 2011; 364: 2273–5, www.nejm.org/doi/full/10.1056/NEJMp1104329#t=article; Garon J, Patel M. The polio endgame: rationale behind the change in immunisation. Arch Dis Child 2017; 102: 362–5, adc.bmj.com/content/archdischild/102/4/362.full.pdf.
CHAPTER 5: Tuberculosis, the great equaliser
TB in literature: Dickens C. The Life and Adventures of Nicholas Nickleby. London: Chapman & Hall, 1839; Sontag S. Illness as Metaphor. New York: Farrar, Straus & Giroux, 1978; Mukherjee S. The Emperor of All Maladies: A Biography of Cancer. New York: Simon & Schuster, 2010; Keats J. Lamia, Isabella, The Eve of St Agnes
, and Other Poems. London: Taylor and Hessey, 1820.
Origins of TB: Chisholm R et al. Controlled fire use in early humans might have triggered the evolutionary emergence of tuberculosis. PNAS 2016; 113: 9051–6, www.pnas.org/content/113/32/9051.full.pdf.
TB and fashion: www.smithsonianmag.com/science-nature/how-tuberculosis-shaped-victorian-fashion-180959029.
Effectiveness of BCG vaccine: Mangtani P et al. Protection by BCG vaccine against tuberculosis: a systematic review of randomized controlled trials. Clin Infect Dis 2014; 58: 470–80, academic.oup.com/cid/article-lookup/doi/10.1093/cid/cit790.
Outdated measures against TB: Le Get R. Isolation, collapsing lungs and spitting bans: three ways we used to treat TB, and still might. The Conversation, 15 September 2017, theconversation.com/isolation-collapsing-lungs-and-spitting-bans-three-ways-we-used-to-treat-tb-and-still-might-81685.
James Lind: White M. James Lind: the man who helped to cure scurvy with lemons. BBC News, 4 October 2016, www.bbc.com/news/uk-england-37320399.
TB statistics: Tuberculosis. World Health Organization, www.who.int/tb/en/;www.who.int/news-room/fact-sheets/detail/tuberculosis.
CHAPTER 6: Diptheria, the scourge of childhood
Langdon Clemens: White J. Diphtheria killed Langdon, Mark Twain’s baby son. Write to the Point! 27 September 2013, twainstudios.com/2013/09/27/diphtheria-killed-twains-baby-son-langdon/.
Joost van Lom: Andrewes F, Bulloch W, Douglas SR, Dreyer G, Gardner AD, Fildes P, Ledingham JCG, Wolf CGL. Diphtheria: Its Bacteriology, Pathology and Immunology. London: Medical Research Council, 1923.
Year of strangulations: Laval E. El garotillo (difteria) en España (siglos XVI y XVII). Revista Chilena de Infectología 2006; 23: 78–80; Guilfoyle PG. Diphtheria. New York: Chelsea House, 2009.