By Patricia Harte-Maxwell
In 1722 Mr. Maitland’s Account of Inoculating the Small Pox was published in England. The goal of the account was to give “to the World a certain Method of Relieving Mankind, and rescuing them from Fears and fatal Effects of that very loathsome and malignant Disease” (2) known as smallpox. For Maitland, after recounting cases of effective inoculation of smallpox through exposure of an open wound to “Matter” generally gathered from pustules or scabs of the affected, “all impartial People will allow this Method to be not only safe, but useful; and highly worthy to be receiv’d with Esteem and Applause” (13). The crude “Method of Relieving Mankind” depicted in his account has been refined and relabeled, after Jenner’s work with cowpox, as vaccination in our time.
Inoculation and vaccination have not left the public eye since Maitland’s time; recently vaccination was a central character on the newest doctor drama, Transplant. In episode 3, “Your Secrets Can Kill You” aired Sept 15, a young boy named Max (Percy Hynes White), unconscious and with a high fever, is brought to the hospital by his older brother, Ethan (Dale Whibley). As it is shown in commercials for the episode across the network, I feel no qualms revealing here that the hospital staff learn the sick child is unvaccinated. The response of the doctors, particularly the main characters Dr. Bashir Hamed (Hamza Haq) and Dr. Jed Bishop (John Hannah), is to reassert, without breaking the fourth wall, that vaccines are “worthy.” Dr. Hamed, who was educated and practiced in Syria, admits to smuggling vaccines into that country: obviously vaccines are so valuable and desired that he risked his life under the Regime. Perhaps a better illustration of how humanity should feel towards vaccination is summed up by a single line from Dr. Bishop upon learning the unvaccinated child’s diagnosis, he has “a disease that should not exist.” Vaccines not only protect persons from disease, they erase those diseases from the map. But not all of Maitland’s time or the period of this writing in 2020 see vaccination as “worthy to be receiv’d with Esteem and Applause” (13). The father of Max and Ethan (Stéphane Séguin) elected to forgo vaccinating both of his sons after a serious though temporary allergic reaction left Ethan paralyzed as an infant. The worried father, a foil to the vaccine worshippers that are the medical professionals, constantly questions what the doctors do and administer his son: the drugs they pump into Max’s listless body are not helpful but harmful.
Here is the construction of vaccination in the human psyche. Vaccines occupy, for many, a corner of human consciousness reserved for the miraculous because that has been how the method is portrayed for 300 years. For Maitland vaccines were “a Motive of Thankfulness to the divine Providence, and a great one too,” (15) while for the fictional Dr. Hamed vaccines are a rare commodity, the scarcity and unattainability of which leads to death. Vaccination is, essentially, a miracle. But “miraculous” has a flip side, perhaps better understood in it’s synonym “marvelous”, a side that is terrible and terrifying. “Marvelous” is anything astonishing, miraculous anything that is unusual, especially those events that are unexplainable. A monster may be miraculous and marvelous if it is astonishing and unusual, as many monsters are; for Ethan and Max’s father vaccination is monstrous, a monster that attacked but ultimately spared his eldest son. In 1722, in response to Mr. Maitland, Dr. Wagstaffe penned A Letter to Dr. Freind; Shewing the Danger and Uncertainty of Inoculating the Small Pox. Wagstaffe did not dawdle in calling for “fuller Evidence, both with regard to the Security of the Operation, and the Certainty of preventing the like Distemper from any other Cause” before physicians should be “encouraging a Practice, which does not seem as yet sufficiently supported either by Reason, or by Fact” (4-5). It is particularly stunning to me, as a scientist, that beside Wagstaffe’s xenophobic and sexist words is a strong appeal to the scientific method which can be appreciated even today. On either side, though flipped over the centuries, both doctors and non-doctors have weighed in for or against vaccination.
As miraculous, the possibility of two views arise, the beneficial and the detrimental. Vaccination is a saving grace, a gift, a guarantee, without which our modern society would be pock-marked, childless, crumbling. At least, this is the intonation of the vaccine-inclined: those that march to their doctor or pharmacist every year for the “flu shot”. Vaccination is also, to some, a blight, a poison, an irresponsible action that malforms children* and is an extension of unwanted governmental regulation. This is the view of the vaccine-hesitant: those who worry for the safety of their children and their own health, that delay or decline in full vaccine regimens. This post is not about convincing the hesitant to leap nor is it urging the inclined to step back: this post is about gaining perspective on vaccination, and the reality of viruses like Influenza and SARS-CoV-2. This post is about understanding that vaccination is not a “miracle cure”, a fact that is glaringly obvious with Influenza but generally unappreciated.
The WHO and health organizations around the world hoist smallpox as vaccination’s Pyrrhic victory: humanity eradicated a human pathogen through inoculation. Beginning in the mid-1900’s vaccines became our ultimate preventive weapon against disease and illness, against measles, mumps, and rubella, against types of cancer caused by viral infection, against polio, and bacterial invaders like tetanus. But there were bumps on the path to this view and use of vaccination: smallpox inoculations of the 18th century were dangerous, and so were early polio vaccinations that really did transmit the disease to some recipients. Smallpox took 200 years of inoculations to be eradicated, and polio is still endemic in African and Middle Eastern countries despite the advance in vaccine research and production.
The greatest complication to the view of vaccination as an all powerful and redeeming “miracle cure” is Influenza. Every year between 2000 and 8000 people die from the flu in Canada, and the average for the United States is 35,000 with some years reaching 60,000. News articles throughout North America state these numbers again and again, but the implication, or one of them, has not truly been driven home – or jabbed in the arm if you prefer. These articles generally end with, after throwing out concepts of herd immunity and altruism, a reassertion of vaccine as saviour: if you can get the flu shot you should. The vaccine-inclined agree while the vaccine-hesitant wonder why, after decades of flu shots being available, people still die. The hesitant may conclude that the flu vaccine simply doesn’t work, and by proxy, many if not all other vaccines are ineffective if not outright harmful. The flu shot is a ripe field for deconstructing vaccination as miraculous.
Virology and immunology give us a glimpse of the truth about the flu shot and vaccination as a whole. Readers may know that the reason a new flu shot is developed and administered every year is because a different strain of flu is present. In more scientific terms, the flu virus, Influenza virus A, undergoes genetic shift, a process wherein the viral genome is altered and thus viral proteins change – the viral proteins used by vaccines to train immunity in a human being. Genetic shift is, more technically, the recombination of viral genomes when a single cell is infected by two or more different strains of Influenza at one time, so that during viral replication parts of the viral genome come from two different strains, in effect producing a hybrid virus which antibodies do not recognize. Influenza is one of only a handful of viruses that is capable of genetic shift because of its unique genome packaging in segments rather than a continuous circular or linear genetic sequence. The result is that vaccination will never be a miracle cure, a one and done, a knockout punch, for Influenza, but that fact goes unappreciated, perhaps because we as a species have lived for millennia with Influenza. Influenza is the devil we know and to which we sacrifice globally over half a million lives each year.
But why does it matter that vaccination is constructed as miraculous in our mentalities, besides the constant struggle between vaccine-inclined and vaccine-hesitant to pull others to their side? The answer is “our current situation”, the SARS-CoV-2 pandemic, and the “new normal”. My own initial view of the pandemic with quarantine and social distancing and endless Zooming has been immeasurably affected by vaccination as miraculous, which can be summarized as this: a SARS-CoV-2 vaccine will fix all, will amend the dissonance of working from home/living at work, will repair the strife of loneliness and social imprisonment. The vaccine is what I need, not for my bodily health but for my mental, emotional, and social wellbeing.
Yet, as a student of virology with an ear to research on SARS-CoV-2, I know that this virus is also capable of genetic shift, not because of its genome packaging but because of its replication mechanism – discontinuous transcription and the production of subgenomic RNAs, which means that, in all likelihood as with Influenza, a vaccine will not defeat SARS-CoV-2. The vaccine as saviour is ripped from my hands. I am forced to accept the “new normal,” though ever evolving, as more than a passing year lost and as a lifestyle that may never leave.