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COVID-19 COVID-19
VACCINES VACCINES

Vaccine

Acceptance – each year. Through wide-spread vaccination, polio was eliminated References:

from the United States in 1979 and measles in 2000. Ironically, it is 1. Kreps S, Prasad S, Brownstein JS, et al. (2020). Factors Associated
An Historical Perspective this success that has allowed vaccine hesitancy to flourish. As time With US Adults’ Likelihood of Accepting COVID-19 Vaccina-
passes, disease prevalence declines and the public forgets the disease,
tion.
e2025594.
JAMA
Network
3(10),
Open,
the proven risks of illness become unrealistically compared to the per- https://doi.org/10.1001/jamanetworkopen.2020.25594
ceived risks of vaccination. Measles illustrates this phenomenon well:
By Kelly G. Elterman, MD 2. Malik AA, McFadden SM, Elharake J, Omer SB. (2020). Deter-
after elimination in 2000, cases peaked in 2019, with the majority oc- minants of COVID-19 vaccine acceptance in the US. EClini-
curring in unvaccinated communities where many fear vaccine-related calMedicine, 26, 100495. https://doi:
With the much-awaited arrival of the COVID-19 vaccine in De- By the middle autism more than measles despite scientific evidence that the concern 10.1016/j.eclinm.2020.100495.
cember 2020, vaccination has become a frequent topic of conversation of the 19th cen- is unfounded. 3. Lazarus, J.V., Ratzan, S.C., Palayew, A. et al. (2020). A global sur-
– discussed in hospitals, pharmacies, on social media, and around the tury, vaccination While some vaccination fears are born from misinformation, others vey of potential acceptance of a COVID-19 vaccine. Nat Med,
dinner table. Everyone has questions, concerns, and opinions. Despite of schoolchildren are based on actual, albeit minute, risk. Historically, smallpox variola- 1-4. https://doi.org/10.1038/s41591-020-1124-9
the ongoing pandemic and known risks of COVID-19 infection to against smallpox be- tion carried a risk of death. In 1955, a manufacturing error resulted in 4. MacDonald, N. E. (2015). Vaccine hesitancy: definition, scope
both individuals and society, vaccine acceptance appears neither uni- came mandatory in the 11 deaths and hundreds of cases of paralysis among children vacci- and determinants. Vaccine 33(34), 4161-4164.
versal nor outright, even among healthcare workers. United Kingdom and in nated with the injected, killed poliovirus. More prominent in the pub- https://doi.org/10.1016/j.vaccine.2015.04.036.
In a recent JAMA study, scientists found that only 51%-61% of Massachusetts, the first US state lic’s eye, however, are the cases of influenza that occur each year despite 5. World Health Organization. (2019). Ten threats to global health
Americans would accept a COVID-19 vaccine if offered, depending to pass a vaccination law. Less than vaccination. With such events scattered throughout history, it is not in 2019. The World Health Organization.
on vaccine efficacy; 51% would accept a vaccine with 50% efficacy and thirty years later, in 1882, a group difficult to understand why vaccine hesitancy exists. https://www.who.int/news-room/spotlight/ten-threats-to-
61% would accept one with 90% efficacy. The Lancet published a sim- known as the Anti-Vaccination League In sharp contrast to those who refuse vaccines are the scientists and global-health-in-2019
ilar study, demonstrating a 67% acceptance rate. Internationally, vac- held its first meeting in New York at which volunteers who accept risk for the sake of societal benefit. These too, 6. The Lancet Child & Adolescent Health. (2019). Vaccine hesi-
cine acceptance varied depending on the country’s trust of its speakers propagated the notion that smallpox are found throughout history. Centuries ago, it was those subjecting tancy: A generation at risk. The Lancet Child & Adolescent
government, but was still less than the 70% needed to achieve herd was spread by filth, rather than contagion. Much themselves and their children to variolation. More recently, it was Dr. Health, 3(5):281. https://doi.org/10.1016/S2352-
immunity. like in modern-day, this idea spread successfully de- Mikhail Chumakov and his wife, Dr. Marina Voroshilova, a pair of 4642(19)30092-6.
The reluctance or refusal to accept vaccination when it is available spite evidence to the contrary. Russian scientists who tested Dr. Albert Sabin’s live-attenuated polio 7. The College of Physicians of Philadelphia. (2020). The History
has been termed “vaccine hesitancy,” by the World Health Organiza- Another historical parallel to modern-day vaccine hesi- vaccine on themselves and their children to prove its safety and efficacy of Vaccines – An Educational Resource. https://www.historyof-
tion and has been identified in 90% of countries worldwide. In 2019, tancy is the 1905 case of Jacobson v. Massachusetts, in which the de- when neither the United States nor the Soviet Union would conduct vaccines.org/multilanguage/timeline
the WHO listed vaccine hesitancy as a top ten global health threat. fendant argued that the Massachusetts law requiring smallpox trials of a live vaccine on children. Their confidence and bravery ulti- 8. Edwards KM & Hackell JM. (2016). Countering Vaccine Hesi-
While this phenomenon may seem a product of the modern age fueled vaccination violated his individual rights to decide what was best for mately led to the development of trials and the approval of the oral tancy. PEDIATRICS, 138(3):e20162146.
by the spread of misinformation on the internet, it has actually af- his own body. The Supreme Court determined, however, that individ- polio vaccine, which subsequently benefited countless children world- https://doi.org/10.1542/peds.2016-2146.
flicted society for centuries. ual rights must fit within a framework of what is best for society as a wide. Today, it is the COVID-19 vaccine trial volunteers and the 9. Centers for Disease Control and Prevention. (2020). Measles.
Vaccination has a long and complicated history. The first precursor whole, particularly during an epidemic. Interestingly, this case was set- frontline workers willing to take the vaccine immediately despite the Centers for Disease Control and Prevention.
to modern day vaccination appears to have occurred as early as 1000 tled in favor of public health over 100 years ago, yet the same argument concerns of their families, friends, and colleagues. https://cdc.gov/measles
AD in China, where smallpox sores were ground and inhaled. In the persists a century later amidst a global pandemic. Vaccination, its acceptance and refusal have an interesting history 10. Centers for Disease Control and Prevention. (2020). Global im-
1700s, small pox variolation – the practice of deliberate infection using Since smallpox, other diseases plaguing humankind have been suc- that appears, as all unstudied history, to repeat itself. Over time, the munization. Centers for Disease Control and Prevention.
dried smallpox scabs from an afflicted individual – was practiced in cessfully controlled if not eliminated through vaccination. In 1917, diseases change but the arguments remain the same. Despite many https://cdc.gov/polio
Asia, India, and the Ottoman Empire. The practice was promoted in little more than a decade after Jacobson v. Massachusetts, the influenza forms over the centuries, it is still the spread of misinformation, little 11. Kramer, A. (2020 June 24). Decades-Old Soviet Studies Hint at
England by Lady Mary Wortley Montagu, who variolated her son in pandemic began in the United States. Then, as now, public health of which is fact-based, that is responsible for fear and mistrust leading Coronavirus Strategy. The New York Times. https://www.ny-
Turkey, and in the colonies by Boston clergyman Cotton Mather, both measures such as masking were instituted with mixed acceptance, and to vaccine hesitancy and the resultant public health consequences. times.com/2020/06/24/world/europe/vaccine-repurposing-
of whom were heavily criticized despite evidence than only 2-4% of scientists raced to develop a vaccine as the virus claimed the lives of Nonetheless, the facts and numbers remain: throughout history and polio-coronavirus.html
those variolated died, compared to 20-30% of those who became ill more than half a million Americans. Unlike current times, however, in modern day, vaccination results in the decline of disease and illness-
naturally. it was 20 years before scientists could successfully isolate the virus and related death.
Smallpox continued to kill many in Europe and the colonies develop a vaccine, then another decade before the vaccine could be We are fortunate to live in a time where our scientific advances allow
throughout the 1700s. In 1796, Edward Jenner successfully publicly available. Fortunately, vaccine development science has ad- us to forget the scars of childhood diseases and to develop tools to
demonstrated prevention of smallpox using vaccination with cow- vanced such that we need not wait decades to find the tools to suc- fight new viral foes within a matter of months. If only we could fight
pox material. Four years later, Benjamin Waterhouse, a Harvard cessfully prevent similar tragedies. vaccine hesitancy as quickly.
physician, introduced the practice to the United States when he Various childhood diseases that previously resulted in death or dis-
performed the first vaccinations on his own children. Within a ability are another example. Prior to vaccination, polio resulted in Kelly G. Elterman, MD is a board-certified anesthesiologist
matter of years, the term “vaccination” emerged and the first U.S. 15,000 cases of paralysis annually in the United States. Measles caused and independent contractor in San Antonio and is a member
Vaccine Agency established. 3 to 4 million cases of illness, 48,000 hospitalizations and 500 deaths of the Bexar County Medical Society.

14 SAN ANTONIO MEDICINE • February 2021 Visit us at www.bcms.org 15