Questions that arose in vaccine rollouts decades ago are still debated today. How should local and federal authorities coordinate? Who should get vaccinated first? What should officials do about resistance in communities? Should the hardest-hit places be prioritized? Who should pay?
Some answers can be found in the successes and failures of vaccine drives over the past two centuries.
In 1796, once scientist Edward Jenner discovered that people infected with cowpox became immune to smallpox, doctors went from town to town in England, deliberately spreading cowpox by scratching infected material into people’s arms.
The rollout worked on a local level, but how could it be distributed to people in faraway places, like in the Americas, where smallpox had devastated populations? In 1803, the Spanish government put 22 orphans on a ship to its territories in South America. The lead doctor, Francisco Xavier de Balmis, and his team injected cowpox into two of the boys, and then, once cowpox sores developed, took material from the sores and scratched it into the arms of two more boys.
By the time the team arrived in the Americas, only one boy was still infected, but that was enough. Vaccine distribution in the Spanish territories was unsystematic, but eventually members of the Spanish expedition worked with local authorities to establish vaccination clinics. More than 100,000 people in Mexico received free vaccinations by 1805, according to a journal article, “The World’s First Immunization Campaign,” in the Bulletin of the History of Medicine.
By the 20th century, when scientists had determined how to store and mass produce the smallpox vaccine, outbreaks had generally been contained.
But an outbreak in 1947 in New York City, just before an Easter Sunday parade on a warm weekend, posed a major problem. The city’s health commissioner at the time, Israel Weinstein, called for everyone to get vaccinated, even if they had received the vaccination as children. Posters across the city warned: “Be Sure. Be Safe. Get Vaccinated!”
The rollout was swift and well-orchestrated. Volunteers and professional health care providers went to schools, delivering vaccines to students. At the time, the public had strong faith in the medical community, and the modern anti-vaccination movement barely existed. In less than a month, more than 6 million New Yorkers were vaccinated, and the city ended up recording only 12 infections and two deaths.
On April 12, 1955, the U.S. government licensed the first vaccine against polio, created by Dr. Jonas Salk, after scientists announced it was found to be 80% to 90% effective. The next day, The New York Times reported in a headline: “Supply to be low for time, but output will be rushed.”
State and local health officials were in charge of the rollout to children, who were most at risk.
Shortly after the rollout began, the program was suspended after reports that children had contracted polio in the arms where they received the vaccination, rather than the legs, which was more typical of the disease.
More than 250 cases of polio were attributed to faulty vaccines, caused by a manufacturing error by one of the drugmakers involved in the effort, Cutter Laboratories, based in California, according to the Centers for Disease Control and Prevention.
The so-called Cutter Incident led to stronger regulatory requirements, and the vaccine rollout continued in the fall of 1955. The vaccine prevented thousands of cases of crippling illness, saved lives and ultimately ended the yearly threat of epidemics in the United States.
“The possibility was raised today that the virus that caused the greatest world epidemic of influenza in modern history – the pandemic of 1918-19 – may have returned,” The Times reported Feb. 20, 1976.
An Army private in Fort Dix, New Jersey, had died from a type of swine flu that was genetically similar to the virus that caused the deadly influenza outbreak starting in 1918. President Gerald Ford acted quickly, and Congress purchased 200 million doses of vaccines to be distributed at no cost.
But the campaign got off to a difficult start, after several people died soon after receiving shots at the same clinic in Pittsburgh. Two months later, reports emerged that some vaccine recipients developed Guillain-Barré syndrome, a rare neurological condition in which the body’s immune system attacks the nerves. Vaccinations were halted.
In the end, the virus was not detected outside Fort Dix, and the Army private turned out to be the only known death from the virus.
The H1N1 influenza virus, which originated in Mexico, struck in spring 2009, not in typical flu season.
By late summer it was clear that the virus caused fewer deaths than many seasonal flu strains and that some of the early reports from Mexico had been exaggerated. That was one of the big reasons that a lot of Americans avoided the flu vaccine when it was ready in the fall. It wasn’t just the anti-vaccination movement, though that was a factor.
The H1N1 virus was tough on children and young adults and appeared to have a disproportionately high fatality rate among pregnant women. Because of these factors, the first groups to be vaccinated, after health care workers, were people with the highest risk of complications, pregnant women and children.
The last group to be eligible for the vaccine were healthy people over 65, who were the least likely to contract it because they seemed to have had some resistance to it.