A functional vaccine is the ultimate solution against COVID-19. It can save lives, the healthcare system, and the world economy. However, vaccine development is not something to toy with, according to an expert who revealed the history of the smallpox vaccine.
The caution around vaccine breakthroughs was discussed by an anthropology expert at Stanford University, a private research university in the US. Despite the need for a vaccine today, its development could not be quickened conveniently. As reflected by human history, the creation of one vaccine could expose people to harmful substances or pathogens. The exposure could result in casualties, a contrast to the objective of vaccines. Still, vaccines remain essential in the global effort against infectious diseases.
The First Successful Vaccine Developed by Humanity
Smallpox, a highly contagious, life-threatening infection, is one of the two diseases eradicated by humans. The other illness is called rinderpest, which strikes cattle and causes famine in human communities. Both diseases have been eradicated through vaccines – the ultimate preventive measure against illness. But the development of the first vaccine is shrouded by secrets.
According to the World Health Organization (WHO) of the United Nations, the invasion of smallpox triggered numerous events across the globe. The disease also caused a pandemic back in the early 1950s because of millions of cases each year. Though, the presence of the disease could be traced back to as early as 1500 BCE. It indicated that millions of people died from the illness before the first vaccine was developed.
During the fight against smallpox, the initial defense was inoculation to protect people from the disease. While inoculation and vaccination could be interchanged, inoculation refers to any methods of artificially inducing immunity in a subject, in which vaccination is one example of inoculation. The inoculation for smallpox appeared to have started in China in the 1500s, but the modern smallpox vaccine was introduced in 1796 by Edward Jenner.
Unfortunately, Jenner's vaccine was not automatically applied to every region affected by smallpox. There were several factors that influenced the efficacy and efficiency of the vaccine, compared to early inoculation methods. That was the reason why it took 150 years before Jenner's method was made safe for everyone. Moreover, Jenner's vaccine idea did not come out of thin air. It was inspired by the folklore of certain individuals who seemingly inherently immune against smallpox. And when the prototype vaccine was ready, Jenner administered it to the child of his gardener – a potential ground for ethical violation in today's terms.
Based on the details from Our World in Data, an online source of research data, a total of 401,318 cases of smallpox were reported worldwide in 1920. By 1923, the annual case declined to 174,799 but bounced back to a staggering 632,858 cases in 1949. At that time, the US had its last natural outbreak of smallpox. The last known spike of cases was in 1974 with 218,367 confirmed smallpox cases. The final year with confirmed cases was 1978 that showed two cases – one of those was the medical photographer named Janet Parker, the last person who died from the disease.
Potential Violations in Jenner's Vaccine
"This history of vaccines is an incredibly interesting history of social relationships, colonial relationships, global relationships, and relationships between animals and humans," said S. Lochlann Jain, a medical anthropologist at Stanford.
The history of the success behind every vaccine could show more than science in a closer look. Social dynamics of each era could be unraveled, and per dynamic, one part of the scientific success would either slow or speed up vaccine research. Unlike today, the technology back then was crude while science was not at its peak due to external forces pushing it down. As such, scientists of the old days must juggle between science and social norms to produce a vaccine or an effective treatment.
Jain highlighted Jenner and his vaccine. Even though he is the father of vaccines, Jenner based his vaccine on the folklore of those immune from smallpox. The folklore pointed out milkmaids with inherent ability to resist smallpox, compared to other individuals. Since milkmaids lacked unique traits, such as royalty, nobility, or divinity, some people were curious about their innate immunity. There were claims that working with cattle might be connected to the resistance.
For Jenner, the connection might be between the smallpox pathogen and a similar pathogen in cattle. The pathogen in cattle could cause cowpox, a disease people could contract as well. But it shared similar properties with variola viruses of smallpox. The opportunity for Jenner was presented when a milkmaid contracted cowpox. Upon examination, Jenner discovered that the lesions were highly similar to that of smallpox, which inspired a theory. He took samples from the milkmaid's lesions and prepared a series of tests.
James Phipps, the son of Jenner's gardener, became the test subject of the experiments. He was only eight years old at that time and could have developed serious complications from the tests. The boy was inoculated by Jenner with the cowpox lesion sample. The child developed a mild fever and the expected local lesion, yet he recovered from the disease. Around two months later, Jenner inoculated the boy with the smallpox lesion sample. The boy developed no symptoms because of his newly acquired immunity.
The development of Jenner's smallpox vaccine could define certain aspects of today's methodology. The acquisition of the sample from the milkmaid and the preparation for the boy's inoculation would be included in preclinical trials, while the inoculation of the child demonstrated a human clinical trial. But the father of vaccines obviously failed in human safety due to ethical violations, an effect from loose ethical standards where the test was done.
Compared to the adult version, clinical trials involving children are far stricter because of mortality. Regulatory bodies like the FDA will require accurate results of safety tests conducted in candidate drugs. These safety tests are to ensure that as much as possible no child will die during clinical trials. Jenner's approach may have gone the other way if the cowpox virus exhibited dissimilarities to smallpox, which can affect the recognition of the immune system.
In the July 6, 2020, Situation Report of the WHO, the total global deaths due to COVID-19 peaked at 532,340. Out of that, 4,134 were new deaths reported within the last 24 hours. The Americas had the highest deaths at 265,024. It was followed by Europe at 200,238, the Eastern Mediterranean at 27,566, Southeast Asia at 25,036, the Western Pacific at 7,489, and Africa at 6,974. If a vaccine or a treatment was available in the early months of the pandemic, the death toll from the disease might not have reached that number.
The smallpox vaccine shows that modern vaccines for infectious diseases like COVID-19 are no longer being developed carelessly. If scientists do it, many people will die from clinical trials. If the failed trials involved COVID-19, they may become the source of new outbreaks. Even with urgency, scientists currently busy with the COVID-19 vaccine have to weigh risks to avoid releasing a less potent vaccine.