Let’s now briefly consider vaccinations at birth to improve humans. Exposure to a tiny amount of a disease causes the immune system to build a response and to remember that exposure. Such vaccination permanently changes a person’s cells. No wonder people initially feared it; it is irrevocable.
Vaccinations do not cure a disease in a specific patient; rather, they prevent a disease in possible patients. As such, vaccinations prove that we can intervene in humans, even children and babies, not just to cure disease but to prevent its start.
Vaccinations enhance, in the negative sense, by preventing something bad and hence, indirectly elevating normal health.
The justification of mass vaccination against infectious diseases depends on utilitarianism, the belief that morally correct actions produce the greatest good for the greatest number of people. The justification also depends on knowledge of medical history.
The best way to appreciate mundane vaccines is to focus on what happened in 1918 when no flu vaccine existed. In one month, influenza killed 400,000 Americans, most under the age of thirty.[1] By the time it had swept the planet, it had killed 50 to 200 million people—between 3 and 6 percent of the world’s population. About 500 million more suffered from it and thought they might die.[2] In India alone, 20 million children died.
In the last century, two of the great, little-known heroes were agricultural scientist Norman Borlaug and vaccine-developer Maurice Hilleman. Norman Borlaug developed a form of dwarf wheat in the 1960s that could grow plentifully in bad conditions, sparking the Green Revolution and preventing a then-predicted global starvation that might have killed a billion people.[3] Thanks to biotechnology, food-importing countries such as India, China, and the Philippines became self-sufficient.
As virologist Paul Offit details in Vaccinated, Maurice Hilleman is the other unsung hero of the last half of the twentieth century.[4] Before he began his work in the late 1950s, millions of children and adults worldwide were struck down by measles, mumps, rubella (German measles), chickenpox, hepatitis A and B, pneumococcus, meningococus, and type b influenza. These diseases killed, paralyzed, deafened, or injured for life. Because of Hilleman’s work, we know how to quickly create a safe vaccine against the deadly flu that killed so many in 1918. As the movie Contagion showed in 2011, whether a flu epidemic like it occurs again will depend on whether we have the will to combat it early.
Consider the world at the time of the American Revolution, before Edward Jenner created the first vaccine against smallpox. At that time, deadly infectious diseases, such as smallpox, yellow fever, diptheria, tetanus, whooping cough, and polio killed millions worldwide. Because they had no prior immunity, the Native American population dropped from 10 million to 400,000 between 1600 and 1900. What killed them? Yellow fever, measles, smallpox, cholera, and other imported diseases,
Edward Jenner developed the first smallpox vaccine in the late 1700s. Received controversially, its success in saving lives gradually won it adherents, as seen in the HBO series, John Adams.[5] It is important to note that the smallpox vaccination is a biological enhancement that people now trust.
A century later, Louis Pasteur created the world’s second vaccine, this time against rabies. Between 1900 and 1957, scientists created bacterial vaccines against diptheria, tetanus, and some strains of whooping cough. At the end of World War II, they created the first vaccine against flu; in the 1950s, Jonas Salk and Albert Sabin created a vaccine against poliomyelitis.
The most recently developed vaccine was created to combat human papillomavirus (HPV), known to cause cervical cancer. This vaccine created controversy because of its cost (about $140) and because it had to be given to young girls before onset of sexual activity. Vaccines against malaria and the various strains of HIV remain to be created.
Around 1900, public officials recognized the need for mass vaccinations to prevent epidemics among those living in crowded, unsanitary places. Public health officers, sometimes backed by policemen, vaccinated the poor and their children involuntarily in slums, migrant camps, and schools. This created an anti-vaccination fire that has never burned out, in some cases combining assertions of individual bodily rights with religious freedom and fear of medicine, especially by minorities.[6]
Maurice Hilleman entered the world’s history again when the Asian flu broke out in southwestern China in February 1957. As it spread eastward to the Philippines and onto U. S. Navy ships, Hilleman knew that only a vaccine would check its spread and, on May 22, appealed to start one.[7] He convinced drug companies to make a vaccine, and by July, 40 million dosages were ready. That fall, 20 million Americans contracted the Asian flu, but thanks to Hilleman’s work, only 70,000 died.
Over the next thirty years, Hilleman created two dozen vaccines for infectious diseases, beginning with mumps. Since 1967, when Hilleman’s vaccine for mumps began to be used, “more than one hundred fifty million dosages have been distributed in the United States. By 2000, his mumps vaccine had prevented a million children from getting mumps every year, thus every year preventing meningitis and deafness in thousands.”[8]
But the history of vaccinations is not one that Enthusiasts can champion without qualification. Hilleman tested his vaccine in the same way that hepatitis vaccines would later be tested: on children in institutions for the cognitively challenged. Indeed, between 1930 and 1970, scientists often tested their vaccines on mentally impaired children.
Today, we would consider such children paradigms of vulnerable populations because they are captive, unable to consent, and dependent on the state or charity for custodial care. On grounds of justice, critics think it wrong that such children be used as guinea pigs for vaccines that, if successful, would benefit the majority of children.
On the other hand, because of their confinement, any infectious disease quickly spreads among such children. Because of difficulties in maintaining hygiene, it is impossible to protect uninfected children from contact with infected children. Because of cognitive impairment, normal attempts to control the spread of infection often are useless.
For these reasons, Hilleman felt justified in using these children. Moreover, his intention was therapeutic. In addition, because he was successful, the children benefitted. Saul Krugman argued the same about his hepatitis B vaccination of similar children at the Willowbrook facility on Staten Island, New York, one of the classic cases in bioethics.[9]
Use of captive populations to test vaccines always has its risks, and in the 1940s, the first vaccine against yellow fever suffered contamination with hepatitis B. American servicemen during World War II had no choice but to get this vaccination, and as a result, 300,000 got hepatitis B, of whom at least 60 died as a direct result.[10] The contamination occurred because human serum had been used to stabilize the vaccine against yellow fever. Afterward and because of these deaths, human serum was never used again.
Perhaps the most infamous accidental infection occurred with Jonas Salk’s polio vaccine. His vaccine was essentially a very weakened version of the polio virus, which conferred later immunity. But in making the vaccine, one manufacturer, Cutter, failed to properly kill the live virus and inadvertently created a batch of vaccine with a live polio virus that infected 100,000 children, who in turn spread the infectious disease to other children, resulting in another 100,000 infected. In the end, the Cutter-vaccine-with-live-virus killed 10 children, permanently paralyzed 200, and sickened 70,000. Pictures of children forced to live in iron lungs—the first artificial ventilators—scared people and stiffened resistance to mandatory vaccination.
As said, utilitarianism justifies mass vaccinations. Consider measles, which in 1965 killed 8 million children worldwide. Even if a vaccine killed 1 percent of children vaccinated, it would be justified on utilitarian grounds. If it only killed 0.1 percent, the justification deepens. If, when problems were being found, it only killed 0.1 percent in the initial phase, its justification looks very solid. Finally, if a pure vaccine could be created which rarely killed any child, vaccination of all children worldwide would be mandatory.
That is essentially what has happened, and today measles vaccine prevents 7 to 8 million deaths in childhood every year. But there were bumps along this road. Measles vaccine had to be grown in eggs of chickens, and such eggs could be easily contaminated. In one case, the first vaccine became contaminated by a chicken leukemia virus, similar to the one in cats. The key to success was a drug company’s purchase of a large, contamination-free chicken farm and use of its eggs to produce the vaccine. Today the Moraten strain still comes from chickens whose ancestors lived at Kimberly Farms.
Hilleman went on to create vaccines against rubella, which between 1963 and 1964 infected 12 million Americans. In this case and as in rabies, chickenpox, and hepatitis A, researchers developing new vaccines used tissue from aborted human fetuses. Such usage angered the Catholic Church and some U.S. evangelicals.
German measles at the time would have been expected to harm 80 percent of the fetuses of the hundreds of thousands of pregnant women it infected, causing miscarriage, retardation, blindness, epilepsy, and autism. A fetus infected with German measles would have been a primary candidate for a genetic abortion.
Fortunately, the rubella vaccine worked well and prevented many deaths, in part because no animal viruses contaminated it. Stanley Plotkin, the virologist who created it by using aborted human fetuses, unapologetically defended its creation against critics: “Frankly, I think that our rubella vaccine has prevented more abortions than all the anti-abortionists put together.”[11]
We now assume eradication of formerly lethal, infectious diseases. That diptheria or measles could suddenly kill a million American children is inconceivable. Mass vaccinations have proven remarkably safe and saved millions of lives. They prevented untold suffering.
Unfortunately, vaccination is under attack today. First, for reasons outlined above, some people fear that any vaccine will be contaminated and the vaccine will be worse than the disease.
Second, because of a remarkable case of medical fraud, one in five U.S. and U.K. parents believe that contaminants in vaccines cause autism.[12] In 1998, a paper by English physician Andrew Wakefield argued that a vaccine against measles-mumps-rubella caused autism and other disorders. In the judgment of the editors who published his original article, Wakefield not only committed “bad science,” but also “deliberate fraud.” His views were undoubtedly influenced by money given to him by a lawyer involved in suing the manufacturer of the vaccine. In 2010, Wakefield was barred from practicing medicine in the United Kingdom.
Today, the weight of medical evidence stands strongly against Wakefield. He is no misunderstood Ignaz Semmelweis or Stanley Prusiner; rather, he is a fraud. He resembles the South African physician who made up data showing that bone marrow transplants could cure recalcitrant breast cancer, thereby causing thousands of women with breast cancer to needlessly undergo such transplants.[13] Because it scares parents about all childhood vaccinations, Wakefield’s fraudulent claim will harm children who later get sick because of lack of vaccination.
People who don’t vaccinate their children actually depend on most children getting vaccinated to shield their child from exposure; their children benefit from herd immunity. Because each and every child does not need to be vaccinated to protect a population from infection, sometimes only 95 or 99 percent is enough (although to eliminate a disease such as polio permanently from the world, all children must be vaccinated, or a reservoir of infection will continue).
But if enough parents don’t vaccinate, herd immunity decreases, mutations rise, and soon measles, whooping cough, or diphtheria will kill again. In 2010, the CDC reported that 40 percent of U.S. parents of young children had refused or delayed one or more vaccines for their child.[14] This is one area of enhancement where the United States is moving backward. It is also one area, as Contagion illustrated, where the Internet does more harm than good, because anyone can claim anything and others will believe him.
Interestingly, parents who resist vaccinations because they believe that something in vaccines causes autism spectrum disorders may also resist taking folic acid during pregnancy. However, a new, look-back study in late 2011 showed that, in mothers and children with genetic variants that affect how folic acid is metabolized, not taking prenatal folic acid before conception increased the risk of a child with autism by seven times.[15]
Historically, mass vaccinations against infectious diseases saved millions of lives of children and prevented millions more from being sick and disabled. Although ethical lapses occurred in development of past vaccines, we are now able to quickly produce safe vaccines that have few downsides.
We now have two vaccines against cancer, one of which is controversial (the one preventing HPV and later, cervical cancer). If we develop a dozen more, will we have the guts to protect future citizens with them?
K.D. Patterson and G. F. Pyle "The Geography and Mortality of the 1918 Influenza Pandemic" Bull Hist Med. (Spring 1991) 65 (1): 4–21.
Jeffery K. Taubenberger and David M. Morens, Centers for Disease Control and Prevention, 1918 Influenza: The Mother of All Pandemics, January 2006. Retrieved on May 9, 2009. Archived 2009-10-01.
Gregory Pence and Joyce Hsu, “A Hero for Our Time,” Birmingham News, July 23, 2000.
Paul Offit, Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases, (New York: Smithsonian/Collins Books, 2997).
David McCullough, John Adams (New York: Simon & Schuster, 2001).
Maurice Willrich, Pox: An American History, Penguin, 2011, New York.
Paul Offit, Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases, 2007, Smithsonian/Collins Books, New York, 14–15.
Paul Offit, Vaccinated, 30.
Saul Krugman, “The Willowbrook hepatitis studies revisited: Ethical aspects,” Reviews of Infectious Diseases (Jan-Feb, 1986), 8, no. 1:157–62.
Paul Offit, Vaccinated, 40.
Paul Offit, Vaccinated, 91.
Michael Willrich, “Why Parents Fear the Needle,” New York Times, January 21, 2011, A23.
Richard Rettig et al., False Hope: Bone Marrow Transplantation for Breast Cancer (New York: Oxford University Press, 2007.
Daniel J. DeNoon,, “More Parents Refuse, Delay Childhood Vaccinations,” May 55, 2010, WebMD Health News.
Rebecca J. Schmidt et. al., “Prenatal Vitamins, One-carbon Metabolism Gene Variants, and Risk for Autism,” Epidemiology, July 2011, 22, no. 4, 476–85.