Today, I am thankful for the prowess of preventative health.
In the past, I’ve shared my thoughts on longevity and the power of certain medical innovations to improve human life expectancy. Between 1899 and 1999, the mean life expectancy increased a mind-boggling 29 years – from 49 to 78 years. Although it is impossible to pinpoint this unprecedented increase to a single medical advance, it is probably fair to say that that 3 factors were integral: technological advances in medical care, antibiotics, and vaccines. Of all the public health measures the world has in its toolbox to improve the wellbeing of humanity, vaccination ranks at or near the top. In fact, one of my old Emory University Medical School professors, the renowned William Foege, has been quoted as saying: “Vaccines are the tugboats that move preventative health.”
This week we are embarking on a celebration of the last of these 3 contributions – vaccination. For the last 9 years, the last week in April has been referred to as World Immunization Week (WIW), a week-long, global public health campaign endorsed by the World Health Organization (WHO) to raise awareness regarding the value and importance of global vaccination. The hope is that this initiative will spur individuals and parents to increase rates of immunization against vaccine-preventable diseases around the world. Such an effort is critical because our mission to vaccinate the world’s pediatric population is still not complete.
For this entire week, starting today (Apr 27), I’d like to pay tribute to major advances in vaccination. It’s only fitting we start the week with my sharing of the serendipitous story as to how vaccination came to be.
Dr. Edward Jenner was a late 18th Century country doctor practicing in the southwest portion of Great Britain. He often cared for the farm workers who worked in the surrounding parishes. In his daily dealings, Dr. Jenner would often came across ‘farm hands’, such as mild maids, who would present with sores on their hands. These sores were caused by cowpox, an infection acquired while milking cows. Luckily, cowpox is often a self-limiting, non-virulent disease associated with superficial skin infections. Interestingly, Dr. Jenner (along with other physicians at that time) realized that these milk maids were some of the few parishioners in the region would never develop smallpox. This phenomenon was an interesting realization because smallpox was normally a highly virulent disease prevalent in the majority of those living in late 18th Century England. Worse yet, smallpox was a devastating infection in the late 1700s, routinely leading to the death of up to 10-20% of the English population. At the time, the only way to prevent smallpox was to expose an uninfected person to variolous material collected from a smallpox victim; however, this ‘transfer’ often resulted in a life-threatening infection.
Jenner postulated that the pus in the blisters that milkmaids received from cowpox could possibly protect others from smallpox. To test this hypothesis, Jenner attempted something revolutionary in May 1796. He inoculated an 8-year-old boy named James Phipps, who was the son of Jenner's gardener, with cowpox in an effort to prevent the child from developing smallpox. Jenner scraped pus from cowpox blisters on the hands of a milkmaid, Sarah Nelmes, who was suffering from cowpox at that time; then, Jenner immediately inoculated little James in both arms. James developed a fever and became slightly queasy, but he did not develop a full-blown infection. Later, he injected Phipps with smallpox variolous material, but no disease followed. The boy was later re-challenged with a higher dose of smallpox variolous material and again showed no sign of infection. All in all, Jenner has successfully performed the first vaccine clinical trial (so named because “vacca” is the Latin word for cow). Vaccinology was discovered that day, thanks to the observations of a few mild maids and an astute Gloucestershire physician.
Eventually, a worldwide immunization effort led to the eradication of small pox in 1977. Sometimes a good shot in the arm is all it takes to change the world. Even Jenner was prescient enough to predict it:
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