How immunity work: a brief overview

VOICES FROM THE PAST

The Covid-19 pandemic wasn’t the first time in history that global health faced challenges from the ‘no-vaxx’ movement. 

Its origins date back many years, revealing a longstanding divide in public health. In this article, we’ll delve into history to explore the highlights of one of the most contentious debates in public health: no-vaxx versus vaccines.

Anti-vaccine movements feed on misinformation. In order to put together this article, I had to gather a lot of INFORMATION. It was not easy to decide where to start, so I decided to start from the 17th century.

The very first vaccine wasn’t a real vaccine. It involved taking some infected material oozing out from a variola (smallpox) pustule and inoculating it into a healthy person, with the idea that triggering a mild infection might prevent a deadly one. Smallpox deserves a little reflection. This is what it looked like 👇 

Only 1-2% of the individuals who received the “variolation” died from the intentional infection, whereas 30% of the naturally infected individuals died from the disease contracted spontaneously. Fortunately, despite the anti-vaccine movement’s resistance towards the smallpox vaccine, humanity eradicated this awful and deadly disease in 1980 (with the last naturally occurring case reported in 1977).

The “anti-variolation” movement as a prototype

The “anti-variolation” movement belongs to a far past. In fact, we are talking about the 17th century, so neither yesterday nor when Covid-19 was out disseminating terror.

The “variolation” technique started in India, Africa, and in the Middle East. Fortunately, despite the anti-vaccine movement’s resistance to the smallpox vaccine, humanity eradicated this awful and deadly disease in 1980, with the last naturally occurring case reported in 1977.

The real issue is that vaccine hesitancy and anti-vaccine activism exist within a broader context that involves cultural tradition, religious belief, approaches to health and disease, and political affiliation. Yes, it is a terrible disease in itself, deeply ingrained in human nature, making its complete eradication unlikely (unfortunately).

The role of religion

Religion has a special spot in this story. In Australia, anti-vaccinationists founded the Church of Conscious Living, a “fake church”, which led to the removal of religious exemptions in that country. Additionally, one US pastor was reported to offer vaccine exemptions in exchange for online membership to his church. 

For example, in a 1722 sermon entitled “The Dangerous and Sinful Practice of Inoculation,” the English theologian Reverend Edmund Massey argued that diseases are sent by God to punish sin and characterized any attempt to prevent smallpox via inoculation as a “diabolical operation.”. Is it just me or it seems like, three hundred years after this statement, we are still on square one?

Edward Jenner and the great discovery

Edward Jenner, the English physician who introduced the very first vaccine against smallpox, formally invented vaccination. The scientific community was so impressed by this discovery that the vaccine was quickly endorsed by many centers. But even when the evidence was so obvious, still a group of disbelievers tried to impede the technological advancement, in regards to which the notorious physician John Coxe wrote:

“Such are the falsehoods which impede the progress of the brightest discovery which has ever been made! But the contest is in vain! Time has drawn aside the veil which obstructed our knowledge of this invaluable blessing; and in the examples of the Emperor of Constantinople, of the Dowager Empress of Russia, and the King of Spain, we may date the downfall of further opposition”.

Nevertheless, as vaccines began to be widely deployed, England implemented compulsory vaccinations for children from birth, starting at three months of age, becoming the first country to do so. This initiative, a series of legislative acts passed by the British parliament in the 19th century, encountered strong opposition from what could be considered the first prototype of anti-vaxxers..

The spreading of a lethal disease: ignorance

The movement spread so fast that soon reached all levels of the British society (from middle class to aristocracy), with the usual little help of religion and various obscurantisms. Back then, a lot of people campaigned against the smallpox compulsory vaccination, with young mothers stating that a lot of children died from the inoculation, but “nobody talked about it” (sounds familiar, eh?). The scariest part tho has yet to come. There were also doctors who did not believe in Jenner’s discovery.

The anti-compulsory vaccination league was up and running, keeping humanity one step behind the truth.

THE PRESENT LIKE THE PAST?

During the COVID-19 pandemic, the dark age seemed to be back. Groups of anti-vaccine activists employed several measures to discredit the efficacy of the new vaccine. And a new weapon was ready to be deployed: social media.

The increasing number of people who refuse to vaccinate their children, often referred to as vaccine hesitancy, has become a major problem globally. Reasons for this are complex.

Many parents today have never encountered the diseases targeted by immunization schedules, leading to a diminished perception of their severity. This lack of firsthand experience can reduce their sense of urgency and concern about vaccinating their children. Coupled with this is the pervasive concern about vaccine safety. Fears about potential side effects or the belief that vaccines might cause other diseases persist, despite scientific evidence to the contrary. For instance, the false claim linking the MMR vaccine to autism caused significant adverse publicity and a notable decline in vaccine uptake in several countries.

Furthermore, our society has grown increasingly less tolerant of risk. The heightened scrutiny and demand for absolute safety in all aspects of life extend to vaccines, exacerbating apprehensions. Some individuals also believe that receiving multiple vaccines can overwhelm the body, leading to hesitancy or outright refusal to follow immunization schedules.

People did not trust the health system

Distrust in health services compounds these issues, as some people question the motives and credibility of healthcare providers and public health authorities. This skepticism is further fueled by the formation of groups opposed to specific vaccines or vaccination in general. These groups, driven by personal convictions, religious beliefs, cultural values, or socio-economic factors, often use social media platforms to amplify their messages and generate fear among the public.

The confluence of these factors—reduced concern about disease severity, fear of vaccine side effects, decreased tolerance for risk, belief in vaccine overload, distrust of health services, and the influence of anti-vaccine groups—creates a complex and challenging environment for public health officials working to maintain high vaccination rates and protect communities from preventable diseases.

Ah, the tumultuous tale of the 20th century and its dance with anti-vaccine activism. Like a stubborn weed in a well-tended garden, it ebbed and flowed, refusing to be completely eradicated. Even as the need for smallpox vaccines waned, groups like the National Anti-Vaccination League in the UK persisted, stubbornly publishing their journals until the early ’70s. Meanwhile, new vaccines emerged to combat diseases like diphtheria and whooping cough, introduced voluntarily without much fuss. But then, as the clock struck midnight on the 21st century, the anti-vaccine movement found new life. It’s almost like they were waiting in the shadows, ready to pounce on any ounce of doubt. And pounce they did, fueled by a fraudulent study that falsely linked the MMR vaccine to autism.

The devastating effects of the movement

But let’s pause for a moment and ponder: how did such a preposterous idea gain any traction at all? Was it the allure of controversy, the intoxicating scent of rebellion against established science? Or perhaps it was simply a case of misinformation spreading like wildfire in the age of the internet. Regardless, the damage occurred. Vaccination rates plummeted, causing diseases once thought to be under control to resurface.

The “MMR tale”

Let’s not forget our protagonist in this sordid tale: Andrew Wakefield, the mastermind behind the MMR autism hoax. His paper, now infamous, was retracted, and his reputation was rightfully shattered as a result. Yet, like a stubborn stain on the fabric of society, his ideas lingered, haunting the minds of those susceptible to doubt. And so, here we are, locked in a perpetual battle between reason and skepticism, with lives hanging in the balance.

But fear not, dear reader, for science shall prevail. The truth, though battered and bruised, will emerge victorious in the end. As for the anti-vaccine activists? Well, they may shout and scream, but in the grand scheme of things, they are but a mere blip on the radar of progress. So let them tremble in the shadows, for their time in the sun is fleeting, and soon they shall fade into obscurity, nothing more than a cautionary tale for future generations.

The Covid-19 pandemic

Ah, the COVID-19 pandemic, a turbulent chapter in the annals of human history, where the resilience of healthcare workers clashed with the relentless onslaught of an invisible foe. As a Nurse who served in the trenches of the ICU at Lister Hospital in the UK during the darkest days of the pandemic, I witnessed firsthand the harrowing toll it exacted on our patients, our colleagues, and our society at large. Yet, amidst the chaos and despair, another insidious threat lurked in the shadows: anti-vaccine activism.

But what form did this resistance take? Oh, the tales are as varied as they are disheartening. Some chose the path of obstruction, physically blockading vaccination sites with their bodies, heedless of the lives at stake. Others, more cunning in their machinations, sought to disrupt the very fabric of society, flooding booking systems with false reservations, like digital saboteurs intent on sowing chaos.

And then there were the state-sponsored internet trolls, weaving their web of deceit in a sinister game of social manipulation. Like malevolent puppet masters pulling invisible strings, these shadowy figures sought to sow discord and confusion, turning citizen against citizen in a bid to undermine the very foundations of trust and cooperation.

But amidst the darkness, there were brave souls who dared to stand against the tide, refusing to be cowed by the forces of ignorance and fear. Prominent scientists and healthcare workers, like myself and esteemed colleagues, became beacons of truth in a sea of misinformation, our voices ringing out like clarions in the night, calling for reason and rationality in the face of overwhelming adversity.

LOOKING AT THE FUTURE

So, what lies ahead for the anti-vax movement? Will they continue their relentless assault on science and reason, or will they fade into obscurity like so many failed revolutions before them? Only time will tell. But one thing is certain: the battle for truth and enlightenment rages on, and we, as healthcare professionals and champions of public health, must remain steadfast in our commitment to combatting ignorance and misinformation, ensuring that the light of knowledge shines bright in even the darkest of times.

Michele Ritucci, MD