Standing up against disease together—or not

Eliminating or lowering rates of communicable disease often requires that we participate together in the battle against infectious disease. Historically, communities—and sometimes even nations—have united to fight malicious microorganisms, with political and scientific leaders inspiring ordinary citizens to join in this battle. Here are three historic stories which illustrate the tensions and difficulties in persuading people to unite to help stamp out threatening illnesses.

Depending on everyone's participation: Eradicating smallpox

At the height of the Cold War, Soviet and American scientists and physicians united to call for a new and very different war—one on infectious disease. Arguing that smallpox would be one of the easiest of infectious diseases to kill permanently, delegates at the 1959 meeting of the World Health Organization (WHO) aggressively called for the worldwide eradication of smallpox.

Colorful cartoon poster showing scene with horses, men with backpacks, woman with child, and general village scene. One man sits on ground with dots all over his body, attended to by doctor. World Health Organization logo in center. Doctor attends to baby in mom's arms. Colors are bright yellow, terra cotta orange.

To break the global chain of infection, scientists estimated that 1.5 billion people would need to be vaccinated. Because many of these people lived in some of the most remote and inaccessible areas of the world, it took eight years for the WHO to develop a campaign which would reach all of these people.

During the planning stages of the campaign, WHO leaders looked for an easy and cost-effective way to administer the vaccine. By the official start of the campaign in 1967, the WHO had found the answer: the jet injector. A gun-like device that administered painless injections without needles, the injector was the brainchild of Robert Hingson, an American physician. Public health practitioners gleefully noted that this method was so painless that it could be used on a sleeping baby. Even better, the jet injector could hold 500 or more doses of vaccine, meaning that hundreds of doses could be delivered within an hour.

Metal case with handle, open to show contents. Contents include medical "gun" with tube, baggies with contents, and small bottles.

The jet injector played a crucial role in the early stages of the smallpox eradication program. Unfortunately, because wear and tear often damaged these injectors, their use required the WHO to maintain staff to care for these devices. As a result, jet injectors were used only in places like Brazil where the campaign was highly organized. In other areas, a bifurcated needle, which could be easily used and sterilized, delivered the vaccine.

As vaccinators crisscrossed the world using both the jet injector and the bifurcated needle, the WHO carefully tracked smallpox outbreaks and cases. In 1980, two years after the last case of smallpox had been documented, WHO officials proudly announced "Smallpox is Dead!"

Is participation really necessary?

In 1926 seven-year-old Belema Siegfried was turned away from school. The reason? Her parents had refused to submit paperwork proving that she had been vaccinated. Several months later, her father, a Brooklyn chiropractor named Louis Siegfried, was arrested. Siegfried's arrest may have been calculated as he had recently launched a new journal, The Quest (Against Vaccination and Cruel Vivisection). Like many of his fellow chiropractors, Siegfried advocated a non-interventionist approach to health, seeing vaccination as an "inherent poison" that was introduced into a healthy body.

Scan of front cover of publication titled "The Quest: Against Vaccination and Cruel Vivisection." Date printed in red on cover is June 1926. "Ten cents." Vignette images of a baby sucking thumb and a collie-type dog looking friendly. Bordered in fancy scroll-work. Blue ink.

Compulsory or mass vaccination can arrest an epidemic, protecting those who are too young to be vaccinated or those who have suppressed immune systems. In early 20th-century America, where epidemics of potentially lethal diseases such as smallpox often ran rampant, compulsory vaccination made a great deal of sense as it protected large segments of the population.

The Quest was just one of many journals founded to oppose vaccination. Even as vaccination against smallpox became increasingly common in the 19th century, many people viewed this procedure with skepticism. Part of the problem stemmed from the fact that, while the smallpox vaccine worked, scientists and physicians could not explain just why vaccination worked. The development of vaccines against a variety of other diseases, including rabies during the mid-19th century, did little to assuage many people's concerns.

In 1879 Americans opposed to vaccination founded the Anti-Vaccination Society of America. Other smaller and more local anti-vaccination groups such as the New England Anti-Compulsory Vaccination League also emerged during this period.

From the 19th and well into the 21st century, Americans have debated and rejected vaccination on religious and political grounds while still others have argued that vaccination not only fails to protect people against disease, it actually causes disease.

Participating to protect the unborn

In the early 1940s, researchers discovered that women exposed to rubella (German measles), a fairly mild childhood disease, in early pregnancy are at high risk for miscarriages and still births. Surviving infants could be born with visual and hearing impairments, heart defects, neurological damage, and other lifelong disabilities. This condition, known as congenital rubella syndrome (CRS), rose to national attention after the U.S. rubella epidemic of 1964–65, which resulted in an estimated 20,000 cases of CRS and another 20,000 fetal deaths.

Following this outbreak, American scientists raced to produce an effective vaccine, and in 1969 the United States was poised to launch a nationwide vaccination campaign to dramatically reduce the incidence of the disease. Public health officials decided that vaccinating all preadolescent children was the best way to protect pregnant women from contracting the virus.

The rubella vaccination campaign presented unique challenges. Parents were being asked to have their children vaccinated in order to protect unborn babies—the health benefit to the vaccinated child was not the issue. Instead, the campaign appealed directly to the individual’s sense of responsibility to the wider community.

Metal clip pin that could be worn on t-shirt. White background. Center image shows a dragon (green with red spots) laying on its back, defeated. Text "Rubella Hero."

Poster with white background. "Free Clinic - Dec. 6, 1969" "Let your child be a rubella hero." Image of defeated dragon.

Thanks to federal support, aggressive vaccination programs by state and local governments, and the participation of about 23 million American children, the U.S. campaign in the early 1970s was largely successful and the expected rubella epidemic (and attendant rise of CRS) of the mid-decade did not occur.

Black text in all caps: "America Participates." A circle, half red and half blue, partially encircles the text. Graphic.

Alexandra M. Lord, Ph.D., is chair of the History of Medicine and Science Division. Diane Wendt is associate curator in the History of Medicine and Science Division. 

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