• Daniel Ethan Finneran

On Vaccination

August 2019

The summer’s end is near. When inevitably it comes, a surfeit of twilight will be upon us—a waning of the day and an advent of the night. While we might hope with wishful dreams of warmth to delay its forward march, this changing of the seasons simply can’t be stopped. Darkness, especially in those parts of the country where the latitude stretches high and the sun—with unusual celestial timidity—sinks bashfully low, will arrive daily with ever-greater haste. Of long and of radiant days we’re soon to be deprived. We’ll be left here longing for their premature return.

But let us not, in the course of our slow and lifeless progression toward the winter season, neglect the autumn. It is, in my opinion, a lovely interlude through which we happily pass. Indeed, sooner than winter, it will be fall, and no later than at its outset, we’ll be importuned to purchase, to receive, or in some cases, to administer the vaunted “flu shot”. The shot, as it were, is seemingly the one intervention on which the majority of our healthcare providers is unanimously keen. It’s the annual remedy, amongst a nostrum of current remedies, behind which all doctors and nurses seem buoyed in placing their support. Nearly all are in agreement of its efficacy, and it’s with uncharacteristic unity that they join in encouraging its use.

The flu shot, shorthand for an inconvenience in the middle of ones’ day and in the upper region of ones’ arm, is an admittedly remarkable occurrence in the history of health. I belittle its annual advent if only to emphasize its historical importance. Appearing each year at the beginning of the fall, the influenza vaccine has safeguarded from the febrile clutches of this most noxious disease millions of people worldwide. It has made fleetingly banal that which was once devilishly fatal. We mustn’t forget that many in our species’ past succumbed to its ravages. Exposed to its innumerable viral variant forms, an extraordinary number of our own died because of it while we, the beneficiaries of so many centuries and so many sciences, think but little of it today.

But the vaccination, not just of the influenza virus but of countless other maladies once pervasive and now obscure, is an occurrence in the medical history of man of which we ought to take note. We first take note of the flu shot vaccine—a vaccine of which I’m generally in support, a preventive injection to which I’m personally opposed.

In general, the vaccine’s production is no easy task. Many minds and many dollars must gather and exert themselves to achieve its final, pharmaceutical end. With a heightened confidence, one atypical of their normally cautious bent, the medical and epidemiological communities will first agree on the type of influenza that will blight us this year. To this strand they’ll direct their efforts and concoctions toward an effective vaccination to which, in the best of circumstances, we’ll all be voluntarily exposed. We can do no more than hope that in so doing, their predictions prove themselves right. Our immunity and our longevity depend upon them being so. Ailing years have passed when they’ve missed their mark and failures linger longer than successes in the valetudinarian’s mind. As on the balance sheet of the gambler, losses are of greater impact than gains. No truer is this than when it comes to wagers of health.

Yet while we invest in them our blind and bodily faith, we can’t expect of them the same unshakeable certitude that roots our own convictions. Disease seems not to be so conformable to prediction. It’s a bit more Protean than that—insidiously transforming shape as soon as it’s grasped. How are they to know in advance the strand of influenza by which so variable a society as is ours will be afflicted? Surely, without hesitations and insalubrious second thoughts, they can’t. Much, then, is to be left to chance. It’s here that we hope for the synchrony of science and prescience, of medicine, foresight, and of luck. We’ll need the combination and the benefits of all if we’re to survive this and every subsequent viral year of the flu.

Momentarily secure in their knowledge of the winning strand with which this “flu” season will force us to contend, our dauntless scientists will produce a vaccination to this predetermined bug. Having made it, they’ll disseminate it to the pharmacies, democratize it to the people, and hope—with prayers of salutary piety to gods of healing above—for the very best of outcomes. It’ll be the primary advertisement of the apothecary, the ardent recommendation of the physician, and the breathless exhortation of both mom and pop. It will be requisite in most places of work, incumbent in all those of play. All are to be the flu shot’s happy recipients, none its mistrustful evaders.

Sill, I’m tempted toward truancy. The flu shot’s celebrated benefit, of which—I think—I’m right to be suspicious, doesn’t always justify the inconvenience by which it’s to be procured. I’m not in the least impressed by the discouragingly high rate of failure it’s been shown to bring. A frustratingly capricious disease, the influenza strand that ultimately ends up in circulation for the appointed year is often dissimilar to that for which the vaccine was originally built. That impotent strand now coursing through your veins is absolutely useless, and your vulnerability to another flu-like illness remains just as high. It’s also not unusual to become ill after the receipt of the flu shot for reasons beyond my grasp. This seems to me a risky, perhaps unnecessary exposure of one’s otherwise unmolested health.

It’s here that I risk sounding unappreciative of science. Nothing could be further from the truth, as science in every way is the truth. It’s not only one of the chief objects of my reverence, but an awesome fascination to whose study I’m humbly and continuously devoted. I’m especially appreciative of the confluence of history and science (less so of the science of history). I’m inspired by the slow, glacial development and recognition of what we now know objectively, verifiably, and immediately to be true. But how do we know this, and by whom are we taught? Enthralling is the process of reading about the men and women upon whom responsibility for our knowledge is to be bestowed. It’s a continual excitement to read of their rudimentary hypotheses, their primitive experiments, their daring, often impious presumptions, and the cautious conclusions to which they were led. Now diffident, now confident, these became the results upon which our modern standards of care and practices have been quietly built.

The development of the vaccine, in the general but also the particular sense, is one such fascination of mine—however stubbornly I might decline to receive that importunate little vaccination that is the flu shot. A succession of contributors, of whose names we recognize but a few, was responsible for lending both mind and hand toward its creation. That said, there must be one star upon whom our adulation rests. For the vaccine’s successful integration into the norms of modern medical care, we have the English physician, zoologist, and scientist Edward Jenner to thank.

This “Father of Immunology” as he deservedly was to be named, was—if not the most inventive—then certainly the most perceptive doctor of his time. Pastoral predecessors of his (by whom he was doubtless inspired while living at his Gloucestershire home) had shown a somewhat tenuous correlation between one’s exposure to cowpox (a milder, bovine version of the disease) and subsequent immunity to the human virus with which we’re better acquainted. That virus specific to homo sapiens is, of course, small pox. The name was a misnomer; nothing, sad am I to say, was small, subtle, nor diminutive about it. It was, perhaps outside of the Bubonic plague, the greatest and most persistent bane under which our species had the occasion to suffer. All but unknown to us today, small pox was a horrible viral disease for which there was no cure. What’s more, it found no confinement to one particular land; all nations were affected by its undiscriminating infectious glee.

Ever the humanitarian, the French philosopher Voltaire—balancing his roles as Europe’s preeminent controversialist and scientist—was very much distressed by the disease. Though not afflicted by it personally (though thin, for eight decades his health was invidiously robust), he saw with dispiriting clarity the thousands of people around him who were. Being that nothing human was alien to this most universal of men, he set upon exploring small pox’s cause and its possible eradication. A solemn interruption of his playful banter about regents and his nonpareil wit, Voltaire remarked in his Letters on the English that “in a hundred persons that come into the world, at least sixty contract smallpox; of these sixty, twenty die, and twenty more keep very disagreeable marks of this cruel disorder as long as they live”; that’s to say, the mortality rate was moribundly high and if you didn’t perish, your scars would forever persist.

Searching for solutions, he noted the universality of the practice of inoculation among the Circassian people. A population bordering the Black Sea, one since absorbed into the various hues of the Caucasian race, he observed with curiosity the infrequency with which they succumbed to the disease. It was surprisingly low. This act of inoculation, he rightly thought, not only immunized them to small pox, but beautified their daughters as well. So pretty were they, in fact, that these girls became the region’s chief export to the seraglios of Turkey and the harems of Persia (an amorous commerce that proved, then as now, unprepossessingly lucrative). Voltaire, as often was the case, was only half correct in his conclusion. Inoculation was affective, however dubious its ability to confer beauty might be.

Jenner, freshly aware of Voltaire’s commentary and the Circassian success, began conducting his own experiments on the effects of inoculation. Hitherto, people were inoculated with the serum of the small pox pustule emerging from a fellow human being. As you can imagine, this was a quite dangerous approach. Often, this putrid infection was of a slightly milder type, and thus conceivably safe to be introduced into the system of another untarnished human being. An improvement on doing nothing but writhing and awaiting death, this method hadn’t an encouragingly high rate of success. But still, at the time (especially in Cotton Mather’s America where, at the behest of that progressive Puritan sect, the procedure became widespread) it was better than relying on divine intervention for the procurement of a cure.

As secular in his approach to small pox as he was careful of his scientific conduct, Jenner, this Father of Immunology, noticed the resistance to the disease enjoyed by an unassuming milkmaid to whom his attention now turned. Quite literally awash in dairy all the day long, this and every milkmaid in England were often exposed to the viral cowpox by which their bovine friends were regularly infected. Not nearly as dangerous in them as was small pox in us, cowpox offered very little threat to those in whom it was introduced—be it woman or cow.

After having come in contact with it, dairymaids were noticed very minimally to suffer because of it. Additionally, and this was of great empirical import, its human effects were equally mercifully mild. Consequently, however, it was noted that these same women would be immune to the cowpox’s small pox cousin—the plague of European society. This, to steal an exclamation from another famous scientist, was Jenner’s and Europe’s Eureka moment.

Sensing a watershed moment in the history of the health of man, Jenner proceeded with his ingenious experiment. He grabbed by the arm the eight-year-old son of his personal gardener—a guiltless boy by the name of James Phipps. We’d do well here, if only in passing, to take note of this boy’s name. Scientific scruples, as Phipps quickly was to learn, weren’t then what they’d become today. The reservations of a young flower boy were of no moment, certainly of no impediment to the inquisitiveness of a noble scientist’s aim. Surely, this wasn’t a venture to which Phipps, a boy of only eight, would consent with a full understanding of the risk it entailed. He was, however, chosen to be the experiment, the in situ medium in which this historic attempt was to take place. His health, we shamefacedly admit, wasn’t of overarching concern and history, as I said, would do well to acknowledge the sacrifice he unwillingly made. This innocuous boy was to be inoculated, and with all the involved peril, the world of science was to turn.

In both of his arms, the cowpox virus was to be administered. Jenner, likely ignorant, if not outright disdainful of the benefits of sterilization, scraped from the finger of a handy dairymaid some of the exudate of her cowpox mark. The cow, by the way, was named Blossom—a fitting name for so germinal and consequential a procedure to which she lent her pus. As a further aside, vacca, whence the word “vaccine” derives, means in Italian “cow”. Perhaps, after all, that culture to which we once affixed the epithet of “heathen” (the Indians) isn’t so wrong in venerating so highly these lowing beasts.

Having milked the milkmaid for her invaluable secretion, Jenner proceeded to inject it into both of the arms of Phipps—his stripling-turned science experiment. A fugacious fever ensued, but it was not so serious, certainly nothing about which the eager Jenner was inclined to worry himself. A few months passed, Jenner observed in the boy no deleterious effect, and he carried on with the boldest part of the experiment yet. Confident in his science and assured of the grandeur of his aim, Jenner injected into that same boy’s arms the terrible smallpox virus. The sample was as active and as virulent as it could be. This was an immense and, heretofore, un-trialed risk. Openly he introduced into a boy less than a decade old an ancient disease from time immemorial. Not only that, it was a disease by whose contagious indefatigability an entire continent had been decimated.

The risk was great, the reward far greater. After days of close and anxious observation, there was no evidence of an injurious result. The boy, as invested in his survival as was the good Dr. Jenner, showed no signs of anguish nor of pain. The predictable, odious pustules by which the skin would be covered never appeared. He remained afebrile and was manifestly okay. There was no lethargy, no emesis, nothing of the like. The conclusion, as Jenner realized it, was immunity—the consequence, as we perceive it, history.

It’s upon this extraordinary moment of the eighteenth century that my mind rests as the end of summer nears and as the flu shot season gets underway. I may still forgo the shot—obstinate as I am toward inoculation. But I assuredly won’t fail to acknowledge the origin, the importance, and the story of the vaccination. Insouciant in the face of illness, I have only Edward Jenner, Voltaire, and of course, the unforgettable James Phipps to thank.

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