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No good reason to resist COVID vaccine

MY TURN

By Herbert Rakatansky

The success of the new COVID-19 vaccine depends both on it being effective and on a critical number of people taking it. But some people say they will not take a vaccine.

History teaches us that we ignore this warning at great peril.

Consider smallpox, a terrible disease that killed about 30% of those who caught it and left permanent scars on those who recovered. Evidence of smallpox has been found in Egyptian mummies (Ramses V, d. 1145 BC). There is no effective treatment and recurrent pandemics raged repeatedly throughout human history. In the 20th century alone, 300 million people died from smallpox.

Deliberate exposure to small doses of the smallpox virus (variola) was long known, first in Asia, to produce mild cases (1-3% mortality) of smallpox. The survivors became immune to further attacks of smallpox. This procedure was called variolation.

Lady Mary Montague, the wife of the British ambassador to Constantinople in 1717, observed variolation there and after some trials (on “prisoners and abandoned children”) had her 2-year-old daughter variolated by a Dr. Maitland.

Lady Montague was a fiercely independent and free-thinking woman who fought for many years against religious and medical conservatism to popularize variolation in England.

In the American colonies the Rev. Cotton Mather in Boston learned from his slave, Onesimus, of variolation as practiced in Africa. Dr. Boylston of Boston variolated seven persons including his son in 1721. But variolation was considered dangerous and provoked significant public opposition.

Modern vaccination for smallpox started in 1768 when an English Dr. Brewster and two colleagues used variolation and noted that the patients in whom variolation failed (no mild cases of smallpox) were farm workers who had previously suffered from a mild disease called cowpox. When they reported this “failure” a young apprentice, Edward Jenner, was in attendance.

Jenner’s biography describes Jenner’s ”eureka moment” as a result of a conversation with a beautiful milkmaid who explained to Jenner that milkmaids who got cowpox did not get smallpox.

But this is an apocryphal story created by Jenner’s biographer. Jenner published a pamphlet in 1798 describing the protective effect of cowpox. It received a “mixed reception” but over time established Jenner as the “father” of vaccination.

But the smallpox story has a happy ending. Assiduous worldwide vaccination has totally eliminated smallpox. The last case was in 1977. That great killer was laid to rest — the only human disease totally vanquished — ever!

(Rinderpest, a disease of cows, has also been eliminated.) Why tell this old story now? We are in the midst of a worldwide pandemic for which we have no specific treatment. But we are on the verge of having an effective vaccine. Not discovered by accident like the smallpox vaccine, the COVID-19 vaccine is the result of science. Based on the genome (molecular structure) of the virus, the vaccine tells our body to make a molecule (antibody) to neutralize the virus. We may not be able to totally eliminate this virus from our society but we will be able to abort the pandemic, save countless lives and avoid economic devastation.

But a serious problem stands in our way. Recent reports document resistance to taking the vaccine in about 40% of the population. And that figure increases in some groups who, because of previous discriminatory and unequal treatment, do not trust that our society will act in their best interests.

We must strive to educate all parts of our diverse world of the vaccine’s life-saving potential. We must assure everyone that “science” is and will be universally free of bias. We must distribute the vaccine in a demonstrably equitable fashion without even a hint of invidious discrimination. Modern science can prevent worldwide disaster. And we will control COVID-19 much faster than smallpox, which took 3,000 years from the first known case.

We are all in this together.

Herbert Rakatansky is clinical professor of medicine, emeritus at Brown University.

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