Dr.Edward Jenner Vaccinating Young Boy
On May 14, 1796, Dr. Edward Jenner (1749-1823), administered his first vaccine to James Phipps (8 years old) E. Board, London Welcome Museum. Credit - Bettmann Archive/Getty Images
In 1806, President Thomas Jefferson wrote an open letter to Edward Jenner, an English physician. Jenner had infected a boy infected with cowpox ten years before to protect him from the more deadly smallpox. It worked. Jenner collected more evidence and published his Inquiry into Variolae vaccinee, also known as the Cow Pox. News traveled across the Atlantic and Jefferson was one of the first Americans to realize the incredible potential of vaccination. He spoke highly of Jenner, saying that medicine had never produced a single improvement in such utility. Jefferson also predicted the end of a disease that was the most dangerous and fearsome in the world at the time. History will be the only way future nations know that small-pox is no longer a problem.
Jefferson was too visionary, but also optimistic. The smallpox mortality rate dropped precipitously with the spread of vaccination, but there was slow progress and sometimes reversed in late 19th century. At the start of the 20th Century, smallpox was still a problem in America. The disease was not completely eradicated until the 1920s. Progress was slower worldwide. In the 1960s and 1970s, a massive global health crusade realized Jefferson's vision of making the disease extinct. In 1977171 years, the last case of smallpox was reported naturally. This occurred after Jefferson's letter to Jenner.
Smallpox elimination is just one example that shows us how social and technical adaptations are necessary to control infectious diseases. Jenner's discovery of vaccination is one of the most important scientific achievements of all times. However, technical solutions are not enough. The spread of vaccination in the United States required a successful communication campaign, cultural acceptance of vaccines, and changes in the power and nature of the state. To bring down the disease domestically, it was necessary to create public health boards and allow them to mandate vaccination.
Continue the story
The COVID-19 epidemic has served as a stark reminder of the need for both science and social adaptation when confronting infectious disease challenges. It is remarkable that multiple vaccines for COVID-19 were developed in less than a year. The combination of vaccine hesitancy in the home and vaccine inequity overseas has allowed the pandemic to surge and persist, with no end in sight. The U.S. was high in pandemic preparedness before COVID-19. Our response was an embarrassment, a tragedy, and a detailed map showing our weaknesses. This is something our enemies will be following closely. Our society was not ready for our science.
Continue reading: The History of Vaccines: From Smallpox to COVID-19
This is not surprising to me as a historian of infectious diseases. I never thought we would be facing a pandemic. It is alarming that we aren't learning the lessons. The Biden Administration published a preview last month of its future pandemic preparedness strategy. This vision is impressively bold. It calls for a $65 billion investment over 10 year that will be managed with seriousness, commitment and accountability like an Apollo Program. This is because it is certain that another pandemic will occur. The plan states that there will be more natural and possibly human-made biological threats over the years ahead. It also warns that the next one could be even worse. COVID-19, a deadly and severe disease, is not likely to be eradicated. However there are many opportunities for a new pathogen which is more contagious but less virulent.
The President Joe Biden's strategy has much to love. It promises major investments in areas that we don't do enough. These include surveillance and early-warning systems, as well as real-time tracking viral evolution. It proposes a pathway to faster vaccine development and deployment as well as fundamental improvements to the treatment of viral diseases. It calls for basic improvements to the public health infrastructure both domestically and internationally.
Problem is, almost all the agenda focuses only on technical solutions. Only a few hints are made about a greater effort to understand how societies react to pandemics, and how we can make ourselves more resilient. Although the plan calls for evidence-based communications in public health, which is admirable, there are no other scientific aspirations that match its ambitious call to prepare society for the next threat with greater cohesion, strength, and unity. Two cheers for Apollo-like vision. Pandemic preparedness, however, is a completely different project from getting to the Moon. Success depends on the behavior and contributions of over 300 million Americans as well as 8 billion worldwide.
It is sad to see that our society has become less prepared for future challenges due to COVID-19. Our response to mitigation measures, such as vaccines, masking and vaccinations, has been tribalized, which is a major obstacle to our preparedness. Public health is always politically charged. It isn't always bitterly partisan in a polarized society. We have actually taken a step back. For example, compulsory vaccination allowed us to defeat smallpox, other deadly diseases, and became part of our constitution and social fabric. The Supreme Court ruled 7-2 in favor of mandatory vaccination. This was after a Massachusetts man protested against the mandate for vaccines. According to the majority opinion, there are many restrictions to which everyone is subject for the common benefit. In a time of high levels of distrust and divisiveness, we are trying to rehabilitate our senses about the common good.
Sign up for the TIME History weekly newsletter to get your history fix all in one place
The better we are prepared for this reality the sooner we face it. Although evidence-based public communication in health is a good start, it is far from sufficient. The plan should include a R&D agenda that draws on the social sciences as well as the humanities. It should also provide the resources, incentives and framework to help us understand the determinants of public health initiatives. A lot of research is ongoing to understand the reasons why states and countries have responded differently to COVID-19. This complex question is not only a result of seemingly fixable factors like good leadership but also deep, historical-rooted cultural factors. To build resilience, a plan must address the tensions between individualistic and social values, the decline in public trust in institutions and the poison of Polarization. It also needs to address the role of social media and how it influences attitudes towards health and medicine. We need a coherent, bold agenda to understand the human side of this equation.
Although the Biden strategy is technically acceptable, its weaknesses will mean that it will not be able to achieve its social-behavioral goals. This combination has proven to be effective in the past and today.
