Humanity owes an eternal debt to Edward Jenner for the concept of vaccines and vaccination; thereby eradicating the scourge of small pox from the world. Until Jenner put forth his thesis, prevention of small pox consisted of a procedure called variolation. Dried scabs from small pox cases or vesicles from them would be rubbed onto superficial scratches on the skin, provoking a mild attack after which the patient became immune. With a case fatality of one in four, far higher than the current pandemic, a remedy was desperately needed.
Jenner observed that milk-maids who worked with cows with cow-pox vesicles on their udders, never suffered from small pox. When a dairymaid consulted Jenner with a cow pox rash on her hand acquired from a cow named Blossom, he seized the opportunity to test his hypothesis. Blossoms contribution to medicine is immortalized with her hide still hanging in St. Georges Medical School Library in Tooting. Jenner collected the material from the vesicles from the milk-maids’ hand and rubbed it onto a few scratches on the forearm of his gardeners eight-year-old son. The boy later proved immune to small pox. When Jenner published his first 23 cases, the list included his own 11-month-old son. After considerable debate and resistance, the British Government banned variolation and replaced it with vaccination. The “Vaccination Act” ensured it was free. However, the disease was more rampant in countries across the British Empire, like India, and it was in the interests of the colonial masters to introduce the vaccine across the realm. Transporting it to these distant lands was impossible in an era of primitive means of travel; no labs to grow the virus; and refrigeration unheard of.
If you enjoyed reading this article, you can help support our journalism by adding OHeraldo as a preferred source.
The problem was ingeniously circumvented by a rather impressive plan; developing a chain of patients who were inoculated and acted as carriers of the vesicles containing the material required. A person would be given the inoculation and transported to the next place where the material would be harvested from the pustule that developed for further on-going inoculation. In this manner, staged transport was achieved from London via Vienna, Constantinople (Istanbul), Baghdad, Bussorah (Bassrah), to Bombay. In spite of numerous failures, the first successful vaccination of 3-year old Anna Dusthall took place in 1802 in Bombay. From there, carriers took it to Chennai and thence to Bengal. The book “Report on the progress of vaccine inoculation in Bengal” by John Shoolbred, makes engaging reading of this unique journey.
Fast forward to the present. In spite of the quantum leap in science and technology, we are in the grip of a pandemic which has us totally befuddled. We barely understand the nature, behaviour and structure of the virus; the most effective line of treatment is still hotly debated; FDA approved testing kits currently number around 300 and counting, merely reflecting the uncertain levels of accuracy; and now we compound it with a completely muddleheaded approach to developing and administering a vaccine.
As of October 2020, there were 321 vaccine candidates in the pipeline. The development of a vaccine takes years, and there is no precedent for expedited development. Mumps for example, took 4 years. Most of them are in Phase I and II, with anticipated completion in 2021, but major hurdles remain. Some are just entering Phase III. Animal testing has been by-passed. Political proclamations of having a vaccine by August 15, 2020 merely proved to be hollow bombastic verbosity. The trial sequences for development of vaccines have been compressed in the interests of “first off the block” marketing hype. It is estimated that India will be faced with a cost of about Rs, 80,000 crores to vaccinate its population, and stratospheric demands in doses (6 crores in 1st 6 months); besides infrastructure requirements like cold chain storage at -800 (currently unavailable in India), transport, distribution and administration protocols.
The public policy target is 80% of the population by 2021, and herd immunity target of at least 67%. Electioneering slogans like “free vaccination for all” were childishly short-sighted; prompting a social media quip, that if the Rs.15Lakhs promised in the previous election was distributed, we could all purchase the vaccine! Though surveys have been initiated to develop priority lists, from past experience widespread queue-jumping and illegal trading are expected. (Small pox required inducements like rice and trinkets). Health-care workers are given top priority; but already in Maharashtra there has been an uproar over the exclusion of private practitioners. What would be the priority rating for the BPL population? Socialistic approaches have to accommodate the fact that people living in unhygienic conditions, with poor water quality as in Bihar and Assam, have much lower Covid fatality, compared to those in Maharashtra, Gujarat and Rajasthan. The “aam admi” will have to wait till 2022.
The success of any vaccination program depends on universal application; otherwise we risk the situation of a polio-free India, but still vulnerable to resurgence because of increasing transmission in Pakistan. Fortunately, India has a robust vaccine “culture” in place to make acceptance easier. Nevertheless, the task force set up has indeed got its’ work cut out.
No worries, we can always take refuge in virus resistant clothing, paints, furniture laminates and even spectacles!! I can’t help wondering how Jenner would have negotiated this minefield.
(The writer is a founder member of VHAG.)
