Five Triumphs of Vaccination–and Five Tragedies Along the Way

1. Smallpox

Triumph: The Eradication of Smallpox. A global campaign led by D.A. Henderson of the CDC (then the Communicable Disease Center) tracks smallpox down to its last redoubts in south Asia and Africa. The last case of wild smallpox is reported in 1975, when Ali Mao Maalin, a Somali vaccine worker, becomes ill with a mild  form of the disease (he survives). (Chapter 6, “Fighting Measles, Remodeling Society”) The eradication of smallpox has a long history. In 1721, the Congregationalist minister Cotton Mather of Boston introduces variolation, in which a bit of fluid from a smallpox boil is scratched into a patient’s skin, infecting him or her with a generally milder form of the disease. (Chapter 1; “Experimenting on the Neighbors”). In 1798, a rural English doctor, Edward Jenner, introduces smallpox vaccination using vaccinia, a virus grown on the underside of the cow. (Chapter 2, “The Peculiar History of Vaccinia”).

Tragedy: In 1901, smallpox vaccine contaminated with tetanus kills an estimated 90 children, mostly in the Philadelphia area, after manufacturers rush “green,” contaminated vaccine to market to fight a smallpox epidemic. This is one of many disease outbreaks linked to contaminated smallpox vaccine. Even when the vaccine is free of contaminating bacteria, it can be dangerous. In 1971, after a campaign led by Dr.C. Henry Kempe, pediatricians end the routine vaccination of American children against smallpox -- to prevent the estimated 10 deaths a year from the vaccine itself. (Chapter 3, “Vaccine Wars”; Chapter 6, “Battling Measles, Remodeling Society”)

2. Diphtheria

Triumph: In the 1890s, New York City bacteriologists William H. Park and Hermann Biggs begin administering diphtheria antibodies, grown in horses. Later, a combination of antibodies and diphtheria toxins are administered, allowing children to build a more robust immune response. Finally, in 1928 the city begins using diphtheria toxoid, made from deactivated diphtheria proteins. The disease once known as "childhood's greatest scourge," is nearly eradicated in the United States by the end of World War II. Outbreaks still sometimes strike in far-flung or medically weakened places, including several former Soviet republics in the 1990s, after soldiers from Afghanistan bring home a virulent form of diphtheria. (Chapter 4, “War is Good for Children”)

Tragedy: The use of antisera grown in horses and other animals creates a laboratory for immune system disorders. Horse proteins frequently cause serious reactions in children given diphtheria serum. The terms anaphylaxis, allergy and serum sickness are coined in the early 20th century to descibee the immune responses to foreign proteins contained in vaccines and sera.

3. Polio    

Triumph: Franklin Delano Roosevelt contracts polio in 1921, and three years later he purchases Warm Springs, a spa in Georgia, so that polio patients like himself could get decent occupational therapy in an atmosphere of fellowship. Roosevelt convinces his law partner, Basil O’Connor, to administer Warm Springs. O’Connor’s philanthropy, eventually called the March of Dimes, becomes the major source of funding for vaccine development. In 1955, Jonas Salk’s inactivated polio vaccine is licensed amid much jubilation. Five years later, a live, oral polio vaccine created by Albert Sabin at the University of Cincinnati comes on the market, and soon becomes the dominant vaccine. By early 2007, Sabin’s vaccine has nearly eradicated polio worldwide. The Western Hemosphere's last case of wild polio is reported in 1991.

Tragedy: Experimental vaccines developed by John Kollmer and Maurice Brody in the late 1930s cause hundreds of cases of polio. Shortly after the Salk vaccine is licensed, improperly inactivated vaccine causes a polio epidemic of its own, paralyzing about 200 people and giving thousands transient cases of the disease. Then scientists discover, in 1961, that the Salk vaccine had been grown in monkey kidney tissues contaminated with SV40, a virus that causes cancer in lab animals. Epidemiological evidence later suggests that the virus has caused few, if any, cancers in the children who received it. Sabin’s live vaccine causes about one case of polio for every million doses administered, usually affecting people with compromised immune systems.

4. Measles, Rubella and other Viral Vaccines

Triumph: Viral vaccines produce two Nobel prizes in the postwar era. The first goes to Max Theiler of the Rockefeller Institute for Medical Research in New York, who shows that when yellow fever virus is grown in a series of tissues, the virus loses most of its virulence and becomes suitable to use as a live vaccine. The second goes to John Enders, Frederick Robbins and Thomas Weller at Harvard University, who show it is possible to grow and attenuate viruses in tissue cultures–pieces of tissue from humans and various animals, pasted to the side of laboratory glassware. The work of Enders, Robbins and Weller facilitates Salk’s vaccine. Sam Katz, another Enders protegee, helps create a live measles vaccine by growing measles in human amniotic and chick tissues in 1954. Pharmaceutical companies make a variety of measles vaccines starting with this recipe. The maker of the Merck vaccine, Maurice Hilleman, goes on to attenuate mumps virus in a similar medium in 1965, and grows rubella virus in duck embryos, eventually creating the first measles-mumps-rubella, or MMR vaccine. Before these vaccines, measles struck about 3 million American children each year, killing or crippling about 10,000 kids every year. Rubella, which strikes in waves, left an estimated 30,000 children with severe birth defects during an epidemic in the mid-1960s. In 2002 and 2005, respectively, the Panamerican Health Organization declares that measles and rubella transmission has ceased throughout the Americas.

Tragedy: Yellow fever vaccine is a lifesaver, but difficult to make. In the early 1940s, scientists at the Rockefeller Institute find they need human serum to stabilize the vaccine. In early 1942, vaccine contaminated with hepatitis B virus is injected into 300,000 American troops, prostrating thousands of them in the months following Pearl Harbor. Many of the early measles vaccines are poorly made; two of the killed-virus vaccines, made by Pfizer and Lilly, respectively, are faulty because the inactivation process has damaged some of the measles proteins, resulting in “atypical measles”–-with severe allergic reactions and pneumonia--when the patient encounters the "natural" measles virus.

5. Whooping Cough

Triumph: Whooping cough has been one of the most severe and deadly childhood illnesses. Often fatal to infants, it produces a prolonged cough and shortness of breath for around three months, and sometimes causes permanent lung damage. In the 1940s, Pearl Kendrick and Grace Elderling at the Michigan Department of Health develop the first reliable whooping cough vaccine. Working with Margaret Pittman of the National Institute of Health, Kendrick develops tests for the efficacy and safety of this vaccine, made from killed pertussis bacteria. In the United States, whooping cough vaccines reduce what had been a devastating childhood illness, with thousands of deaths each year, to a far less severe threat. But immunity to whooping cough wanes, and many older people contract whooping cough–and spread it–without realizing they are sick with the disease. There are currently as many as 1 million cases of whooping cough each year in the United States–and at least 20 deaths.

Tragedy: While whooping cough vaccine has prevented more death and suffering than perhaps any vaccine currently in use, it has been devilishly hard to make reliably and safely. The whole cell vaccine is causes seizures, high fevers and rarely, permanent brain damage. Parents who believe their children have been damaged by the vaccine file many lawsuits in the 1980s. These suits threatened to drive vaccine makers out of the business until Congress in 1986 passes a law to compensate vaccine-injured children, while giving a measure of liability protection to manufacturers.