How Vaccines, a Collective Triumph of Modern Medicine, Conquered the World’s Diseases

Physicians used different techniques to transfer vaccine to their patients. In the early 19th century, Edward Jenner (1749-1823), who had first demonstrated the effectiveness of cowpox in providing immunity from smallpox, collected a vaccine made of the lymph material from the pustule of an individual infected with cowpox and then infected another patient with it. Jenner loaded ivory points such as these with vaccine and then used the point to scrape or scratch the skin, inserting the vaccine under the skin. Throughout the 19th century, doctors in places ranging from India to the United States followed Jenner’s lead and used ivory points on their patients.

For centuries smallpox ravaged Africa, Asia and Europe. After 1492, when Europeans made contact with the Americas, smallpox also became a killer here. Beginning in the early 19th century, the newly developed practice of vaccination, which entailed injecting cowpox in a patient’s arm to create immunity against smallpox, was often done “arm to arm.” To do so, infectious material from a patient who had been vaccinated was collected and then used to vaccinate a different patient. Ferdinand Edme Chatard (1805-1888), a physician in Baltimore, crafted this elegant carrier to transport the scab, or what was then called vaccinia.

In the 19th and 20th centuries, inventors and physicians constantly sought to improve on methods of vaccinating. This vaccinator uses a trigger mechanism to inject vaccine. Made by Codman and Shurtleff, a medical devices company in Massachusetts, the Whittmore vaccinator undoubtedly found a ready market in Massachusetts as the state in 1855 was the first to pass a law requiring all schoolchildren to be vaccinated against smallpox. Although Massachusetts led the way in calling for vaccination in the United States, other countries, such as Great Britain, had already required that all children be vaccinated within a few months of their birth.

Beginning in the late 19th century, a number of patents were filed for “vaccination shields.” These shields promised to protect the patient from reinfection and from scarring caused by smallpox vaccination. Described as looking like small birdcages or catchers’ masks, the shields were typically made of wire, gauze or celluloid. Shields were quite expensive, selling for about 10 to 25 cents each, roughly $6 in today’s dollars. But it wasn’t the expense that worried doctors; many physicians pointed out that shields were rarely sterile, they failed to stay in place, and most importantly, they did not prevent scarring and reinfection. By the 1920s, a growing consensus had led many to reject their use.

When the World Health Organization (WHO) set out to eradicate smallpox permanently, they needed an easy and effective method of vaccination one that almost anyone could learn. In 1961, Benjamin Arnold Rubin invented the bifurcated needle. The flat prongs of this needle allowed the vaccinator to puncture the skin several times and to deposit the vaccine within the Malphigian layer of the epidermis. Rubin’s employer, Wyeth Laboratories, viewed the WHO’s vaccination campaign as so important that it agreed to waive all royalties for needles manufactured under contract to the WHO. After modifying the bifurcated needle slightly and developing a plastic container, which allowed for the sterilization of 100 needles at a time, WHO deployed this tool in its worldwide smallpox eradication campaign. And in 1980, WHO proudly announced “Smallpox is Dead!”

Although known as the "scourge of childhood,” diphtheria killed both children and adults. By 1900, doctors had discovered that injecting horses with small doses of the toxin led the horse to create anti-toxins (antibodies). Serum made from the blood of these infected animals could, when injected in a patient with diphtheria, cure the disease. Within this small turned-wood case is a bulb-shaped bottle of anti-toxin. Parke-Davis boasted that its “well-known hermetically sealed bulb” had the "confidence of the medical profession” and was easy to use. Physicians could simply load the anti-toxin directly from the bottle onto a syringe and then inject it into a patient. Although this anti-toxin is technically not a vaccine, the use of the term vaccine had broadened during the 19th century and many used the word to refer to any type of injection.

In January 1925, when a diphtheria epidemic erupted in Nome, Alaska, the ice-bound city had no diphtheria anti-toxin on hand to contain and end the outbreak. The United States Public Health Service sent the serum to Alaska by steamer and a relay of dog teams then raced the 600-plus miles to bring the serum to Nome. Upon its arrival in Nome, the serum had frozen and it was only after it was thawed that the city’s one doctor could use it to stop the outbreak. Balto, the dog, who led the team on the last leg of the journey, became a national hero. After the race, New Yorkers called for the erection of a statue of Balto for Central Park, sparking a large protest by anti-vaccinators. The protest was, however, short-lived and the statue of Balto was erected within a year. 

In 1945, President Franklin D. Roosevelt asked if Congressional legislators would mind if he sat down while speaking. “It makes it a lot easier for me in not having to carry about ten pounds of steel on the bottom of my legs,” Roosevelt explained. Only a small percentage of people who contracted polio experienced permanent consequences after the virus attack. However, for many of those who did, metal braces were crucial in assisting them to use muscles that had become paralyzed. These braces were intended for a toddler; padded leather protected the leg within the brace. 

In 1952, a major epidemic of paralytic poliomyelitis rocked the United States. Nearly 58,000 cases of polio were reported and more than 3,000 people died, with many others becoming permanently paralyzed. As the nation struggled to come to grips with the epidemic, Jonas Salk, a medical researcher, quietly presented preliminary results of a polio vaccine test he had performed on 161 children to the National Foundation for Infantile Paralysis. Deeply impressed by Salk’s work, scientists associated with the organization called for a major field trial of his vaccine. Following the successful conclusion of the field trial, which had demonstrated the effectiveness of the vaccine by testing it on 650,000 children in 1954, the press noted that “Science has enriched mankind with one of its finest gifts.”

At the height of the Cold War, Albert Sabin warned Congress that the Soviet Union was winning both the war against polio and the Cold War itself. Like Salk, Sabin had developed an effective polio vaccine, in the late 1950s. Sabin’s oral polio vaccine, however, was easier to administer than Salk’s. Because it was a live vaccine, it had the added benefit of passively conferring “herd” immunity against polio in large populations. Best of all, it was extremely inexpensive. During the late 1950s, Sabin’s vaccine was widely used in the Soviet Union, where it ended that country’s devastating polio epidemics. By 1961, the Soviets had mass stockpiles of the oral vaccine, which Sabin argued, they could use to court developing countries with high levels of polio. Sabin urged Congress to pressure the FDA to approve his vaccine and to encourage American pharmaceutical companies to mass-produce and share his vaccine. In response, Sabin’s vaccine was approved and its use became widespread in the United States and elsewhere.

The development of vaccines owes much to our relationship with animals. Cows were the inadvertent source of the first vaccine with the discovery by Edward Jenner that milkmaids who contracted cowpox were immune to smallpox. The first laboratory-made vaccines were developed by French chemist Louis Pasteur to protect livestock. He developed a chicken cholera vaccine in 1879, and an anthrax vaccine for sheep and cattle in 1881. Both of these vaccines predate Pasteur’s 1885 rabies vaccine, which could treat both dogs and the humans infected by the rabid animal bite. Canine distemper is a fatal viral disease that affects dogs and their kin, but not humans.

By the late 19th century, dogs had become important as pets, for breeding and for fox-hunting. Interest in protecting their health grew accordingly. In 1901 French pathologist Henri Carré identified a virus as the cause of distemper, but it wasn’t until after World War I that a concerted effort began at the British National Institute for Medical Research to produce a vaccine. Following the announcement of successful field trials in 1928, the American Distemper Committee selected Lederle Laboratories and Mulford Laboratories to begin commercial production.