Scientists developed vaccines less than a year after Covid-19 was identified, reflecting a remarkable advance in vaccine technology. Advances in vaccine distribution, however, are a different story.
Many questions that arose decades ago when vaccines were introduced are still debated today. How should local and federal authorities coordinate? Who should be vaccinated first? What should officials do about resistance in the communities? Should the most affected locations be prioritized? Who should pay?
Some answers can be found in the successes and failures of vaccine campaigns over the past two centuries.
When scientist Edward Jenner discovered that people infected with cowpox became immune to smallpox in 1796, doctors in England went from town to town, deliberately spreading cowpox by scratching infected material into people’s arms.
The rollout worked at the local level, but how could it be distributed to people in remote areas like America, where smallpox had ravaged the population? In 1803 the Spanish government put 22 orphans on a ship to their South American territories. Senior doctor Francisco Xavier de Balmis and his team injected two of the boys with cowpox and then, as soon as cowpox wounds developed, they would take material from the wounds and scratch it into the arms of two more boys.
When the team got to the Americas, only one boy was infected, but that was enough. The distribution of vaccines in the Spanish territories was unsystematic, but eventually members of the Spanish expedition worked with local political, religious and medical authorities to set up vaccination clinics. More than 100,000 people in Mexico received free vaccinations by 1805, according to a magazine article in the Bulletin of the History of Medicine: “The World’s First Vaccination Campaign.”
1947: Smallpox again
By the 20th century, when scientists figured out how to store and mass-produce the smallpox vaccine, outbreaks had generally been contained.
However, a 1947 outbreak in New York City, just before an Easter Sunday parade on a warm weekend, was a major problem. The city’s then health commissioner, Israel Weinstein, urged everyone to be vaccinated, even if they were vaccinated as children. Posters all over town warned, “Be safe. Be sure. Get vaccinated! “
The rollout was quick and well orchestrated. Volunteer and professional health care providers went to schools and delivered vaccines to students. At the time, the public had a strong reliance on the medical community, and the modern anti-vaccination movement barely existed. More than six million New Yorkers were vaccinated in less than a month, and the city recorded only 12 infections and two deaths.
1955: polio
On April 12, 1955, the U.S. government approved the first Dr. Jonas Salk developed a vaccine against poliomyelitis after scientists announced that day that it was 80 to 90 percent effective.
The next day, the New York Times reported in a front-page headline: “Supply is said to be low in time, but production is accelerating.”
State and local health officials were responsible for introducing children who were at greatest risk of developing the disease.
“Young African American children were hit but were not at the top of the priority list because of the social conditions at the time,” said Dr. René F. Najera, editor of the History of Vaccines project at the College of Physicians in Philadelphia. Dr. Noting that it was difficult for parents in worker jobs to take the time to be in harmony with children in clinics, Najera said, “You keep seeing this, history repeats itself.”
Shortly after the rollout began, the program was put on hold after reports that children had developed polio in the arms they received the vaccination in rather than the legs, which was more typical of the disease.
More than 250 cases of polio have been traced back to faulty vaccines caused by a manufacturing error from one of the drug makers involved in the effort, Cutter Laboratories in California, according to the Centers for Disease Control and Prevention.
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Answers to your vaccine questions
Am I eligible for the Covid vaccine in my state?
Currently more than 150 million people – almost half of the population – can be vaccinated. But each state makes the final decision on who goes first. The country’s 21 million healthcare workers and three million long-term care residents were the first to qualify. In mid-January, federal officials asked all states to open eligibility to anyone over the age of 65 and adults of any age with medical conditions that are at high risk of becoming seriously ill or dying of Covid-19. Adults in the general population are at the end of the line. If federal and state health authorities can remove bottlenecks in the distribution of vaccines, everyone over the age of 16 is eligible as early as spring or early summer. The vaccine has not been approved in children, although studies are ongoing. It can take months before a vaccine is available to anyone under the age of 16. For the latest information on vaccination guidelines in your area, see your state health website
Is the Vaccine Free?
You shouldn’t have to pay anything out of pocket to get the vaccine, despite being asked for insurance information. If you don’t have insurance, you should still get the vaccine for free. Congress passed law this spring banning insurers from applying cost-sharing such as a co-payment or deductible. It consisted of additional safeguards prohibiting pharmacies, doctors, and hospitals from charging patients, including uninsured patients. Even so, health experts fear that patients will end up in loopholes that make them prone to surprise bills. This may be the case for people who are charged a doctor’s visit fee with their vaccine, or for Americans who have certain types of health insurance that are not covered by the new regulations. If you received your vaccine from a doctor’s office or emergency clinic, talk to them about possible hidden costs. To make sure you don’t get a surprise invoice, it is best to get your vaccine at a Department of Health vaccination center or local pharmacy as soon as the shots become more widely available.
Can I choose which vaccine to get?How long does the vaccine last? Do I need another next year?
That is to be determined. It is possible that Covid-19 vaccinations will become an annual event just like the flu vaccination. Or the vaccine may last longer than a year. We’ll have to wait and see how durable the protection from the vaccines is. To determine this, researchers will track down vaccinated people to look for “breakthrough cases” – those people who get Covid-19 despite being vaccinated. This is a sign of a weakening of protection and gives researchers an indication of how long the vaccine will last. They will also monitor the levels of antibodies and T cells in the blood of people who have been vaccinated to see if and when a booster shot might be needed. It is conceivable that people might need boosters every few months, once a year, or just every few years. It’s just a matter of waiting for the data.
Does my employer need vaccinations?Where can I find out more?
The so-called Cutter incident resulted in stricter regulatory requirements and the introduction of the vaccine continued in the fall of 1955. The vaccine prevented thousands of debilitating disease cases, saved lives and ultimately ended the annual epidemic threat in the United States.
1976: swine flu
H1N1 influenza virus, also known as swine flu, native to Mexico, did not appear during the typical flu season in the spring of 2009.
By late summer, it was clear that the virus was causing fewer deaths than many seasonal strains of flu and that some of the early reports from Mexico were exaggerated. That was one of the main reasons many Americans avoided the flu vaccine when it finished that fall. It wasn’t just the anti-vaccination movement, though that was a factor.
The H1N1 virus was harsh on children and young adults and appeared to have a disproportionately high death rate in pregnant women. Because of these factors, the first groups to be vaccinated after healthcare workers were those at the highest risk of complications, pregnant women and children.
The last group eligible for the vaccine were healthy people over 65 who were the least likely to get the vaccine because they appeared to have some resistance to it.
Donald G. McNeil Jr. contributed to the coverage.
