A vaccine is defined as a harmless derivative of a pathogen that triggers the body’s immune system response to act against the harmful pathogen. The history of the development of modern vaccines stems from the ground-breaking research undertaken by Edward Jenner, now more famously known as the father of immunology. His revolutionary and pivotal discovery of the smallpox vaccination laid the foundations for modern-day medicine practices. He pioneered the movement of inoculation as a preventive measure for rampant maladies saving countless lives in the process and paved the way to the eradication of two major worldwide viral infections: smallpox and rinderpest. The arsenal of available vaccinations continues to expand yearly in order to tackle the ever emergence of new potentially dangerous contagions such as the Ebola and Zika virus epidemics in 2014 and in 2016 respectively. The innovative future of immunization is heading into a new era of prevention and modulation of non-infectious disease such as addiction, hypertension, diabetes, and Alzheimer’s disease (Greenwood, 2014). Indisputably vaccinations have made and will continue to make the greatest contribution to global health. Its development and success as a public health tool will ever be attributed to Jenner and his experiments with cowpox.
The long and difficult pathway that led to the discovery of vaccines begins with the story of smallpox and the work of a brave research pioneer and clinician Edward Jenner. Smallpox was an infectious, disfiguring, and often fatal disease that plagued humanity for centuries. The earliest substantiation of skin lesions those of mirroring those of smallpox was discovered on the faces of mummies from the 18th and 20th Egyptian Dynasties (1570-1085 BC). However, Smallpox was first believed to have emerged around 10,000 BC concurrently with the first agricultural settlements in north-eastern Africa. The introduction of smallpox to Europe was alleged to have been sometime between the 5th and 6th centuries and was later brought to the New World by Spanish and Portuguese conquistadors, where it annihilated and devastated the native populations.
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Smallpox spread by exposure to the Variola virus and infection. Symptoms typically began in a similar fashion to the common cold. The victim would experience headaches lethargy, fever, and muscle pains. After a few days, an inflammation would appear on the face and skin, with abscesses forming inside the mouth, throat, and nose. Fluid-filled pustules would develop and enlarge, covering extensive areas of the skin. By the third week, if the victim endured the viral infection, scabs formed and separated from the skin. During the 18th century, smallpox was extensive and prevalent in Europe, claiming an estimated 400,000 lives each year, including five reigning monarchs. Researchers approximate that between 20% and 60% of all infected adults, and 80% of infected children, perished from the illness. Survivors often were left with a large degree of permanent scarring with several individuals losing their lips, nose, or ear tissue. Smallpox additionally was the cause of corneal scarring. It alone was responsible for one-third of all blindness.
Early scholars established that survivors of smallpox developed immunity to the disease after the initial pestilence. As early as 1000 CE, Chinese healers commenced the inoculation process of their patients by scratching matter from a smallpox sore and blowing the powdered material up the nose of a healthy individual.
Variolation was the term used to describe the earliest form of vaccination that provided protection against the Variola virus. This was initially introduced to Europe and North America during the 18th century. This process involved rubbing powdered smallpox scabs or fluid from pustules into superficial scratches made in a healthy individual’s skin resulting in the subsequent development of a milder form of smallpox within the patient identified by the presence of painful boils on their skin. Variolation was not without risks, however, as there was a significant risk of the recipient either suffering from the full extent of the smallpox disease itself, becoming infected by an alternative illness unintentionally transferred by the procedure for example syphilis or even death.
In 1757, Edward Jenner who was only eight years old at the time was one of the thousands of children treated by variolation. As a boy, Jenner demonstrates a keen interest in science and nature, leading him to the study of medicine, surgery, and even geology (Ford, 2003). Eventually, Jenner settled in rural England, outside of London, and commencing his medical practice and performing variolation on his patients
It was in this rural setting and whilst working with the agricultural community, Jenner heard tales of the country folklore that milkmaids never caught smallpox. They were renowned for their beauty and flawless complexions, which were unmarked by smallpox scarring. However, they inevitably caught cowpox due to the nature of their work. He also observed that he could not successfully inoculate such persons with smallpox. Jenner hypothesized that a bout of cowpox produced immunity against smallpox, even encountering locals who claimed to have deliberately infected themselves to provoke such a response and thus confirming his suspicions. As a forward-thinking doctor who enjoyed experimentation, Jenner wanted to prove his theory. In May 1796 Jenner encountered a young dairymaid, Sarah Nelms, who had fresh cowpox lesions (Riedel, 2005). Using material from her lesions, Jenner inoculated an eight-year-old boy James Phipps. Subsequently, the child developed a mild fever and discomfort in his axillae. Nine days after the procedure Phipps developed cold sweats and loss of appetite. However, after ten days the boy was fully recovered and in good spirits. In July of that same year, Jenner inoculated the boy again, this time with fresh a fresh smallpox lesion. No disease developed and Jenner inferred that protection was complete (Willis, 1997). Jenner continued to inoculate children with cowpox with similar results. He named this procedure variolae vaccinae meaning “smallpox of the cow” which in today’s society has been anglicized and shortened to “vaccination.” Jenner was unable to determine the reasoning behind the logic of his theory. Today, however, we now know that the initial infection by the cowpox virus enabled the individual’s immune system to gain the ability of the memory T cells to recognize the similar smallpox virus from its similarly shaped antigens and was able to defend against it more effectively and rapidly.
As a result of his experiment, Jenner unknowingly during his time had laid the groundwork for what would become live, attenuated vaccines. Today, several of the most common vaccines including measles, mumps, yellow fever, and others, use a comparable approach. Viruses can be attenuated by passing the virus through a foreign host, including other live animals or embryonated eggs. The offspring of each virus progressively evolve over time becoming less capable of creating a strong infection in humans. These weaker, less virulent viruses can be fought off in a more effortless and straight forward manner by our immune systems, leading to long-term protection.
Edward Jenner was not the first to endeavour to overcome the smallpox pandemic nor did the problem terminate with him, nevertheless, his work represented the first scientific attempt to control a contagious disease by the deliberate use of vaccination. In coming years, the practice of smallpox vaccination spread across the globe and ultimately saved millions of lives. In 1980, the World Health Assembly announced that “the world and all its people have won freedom from smallpox, which was the most devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness, and disfigurement in its wake” and to cease vaccination as the preceding recommendation into the prospective future (The Global Eradication of Smallpox, 1980). Jenner’s work captured the imagination of scientists all over the globe and set the stage for future exploration, bringing the world into the age of modern vaccine research.
References
- The Global Eradication of Smallpox. (1980). Final Report of the Global Commission for the Certification of Smallpox Eradication. Geneva: World Health Organisation.
- Willis, N. (1997). Edward Jenner and the Eradication of Smallpox. Scottish Medical Journal, 42(4), pp.118-121.
- Riedel, S. (2005). Edward Jenner and the History of Smallpox and Vaccination. Baylor University Medical Center Proceedings, 18(1), pp.21-25.
- Ford, J. (2003). Edward Jenner, MD FRS (1749–1823). Journal of Medical Biography, 11(4), pp.241-241.
- Greenwood, B. (2014). The contribution of vaccination to global health: past, present, and future. Philosophical Transactions of the Royal Society B: Biological Sciences, 369(1645), pp.20130433-20130433.
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