Whispers from our past: The history of vaccinations
We have much to learn from the headstones that cluster around diseases of our past (and present). It's time to listen, remember, and learn from those stories, whispered into the wind.
On Monday, March 30th, John O’Marra died of pneumonia. The family gathered at the St. Mary Cemetery in Hartford, Kansas in early April for his funeral. The somber event was attended by his parents, James and Anna, who had traveled from the family farm seven miles south with his nine younger siblings, ranging in age from six months to 21 years old.
A cousin also traveled to the funeral from a neighboring town and unwitting brought a deadly gift for the grieving family.
Late in the following week, 9-year-old Julia O’Marra began to suffer from a fever, sore throat, and swollen glands. By Friday, April 10th, the bacteria grew thick, dark membranes around her tonsils and throat. She grew weak, gasping for air, until the membrane completely blocked her airway. On Tuesday morning, April 14th, Julia suffocated to death. She was buried the same afternoon.
On Saturday, April 18th, Annie (age 13) and James (age 4) followed their sister in death. On Sunday, April 19th, Nellie (age 17) also suffocated to death. James was buried in the same coffin with his older sister, Nellie.
William (age 21), Hanora (age 6), and Maggie (6 months) died on Monday, April 20th. Hanora, known as Nora, was buried in the arms of her older brother, William. Mary (age 18) died on Wednesday, April 22nd.
When Anne and James O’Marra woke on Thursday morning, April 21st, 1903, only Lizzie (age 11) remained from their once large family. Over the course of one week, they had lost eight of their children to diphtheria.
They were not alone. Approximately 200,000 cases of diphtheria were diagnosed in the United States per year, destroying families as it spread like wildfire through communities. Families like the O’Marras who were unable to do anything but watch their children and family members suffocate and die. This was the reality of diphtheria in the early 1900s.
Twenty years later, the diphtheria vaccine was developed by two scientists working independently: Gaston Ramon and Alexander Thomas Glenny. They, along with other scientists around the globe, had discovered that antibodies could be transferred from one person or animal to another person via an injected serum, passing immunity. The work of Ramon and Glenny was by no means a new idea, but rather a new method of delivery, and it has saved generations.
We do not often think about diphtheria or hear its name said aloud. To this day, diphtheria continues to be a killer around the world, stalking populations where vaccination protocols are not available. Since 2016, outbreaks have occurred in Bangladesh, Burma (Myanmar), Haiti, Indonesia, South Africa, Ukraine, Venezuela, Vietnam, and Yemen. So far, widespread use of the DTaP (Diphtheria, Tetanus, acellular Pertussis) vaccine combination has keep this killer quiet in the US for more than a century.
It is hard to imagine what James and Anna would say to those today who have chosen to not make use of the vaccine that would have saved their family. Perhaps Lizzie, the only child that survived that fateful week in April, would simply whisper the names of her lost siblings to us through time – Julia (age 9), Annie (age 13), James (age 4), Nellie (age 17), William (age 21), Nora (age 6), Maggie (6 months), and Mary (age 18) – and remind folks of what it’s like to say goodbye so many times.
In short: We’ve come a long way. Vaccines save lives. They save families. They save communities. We are at an enviable place in our country’s history where so many of these horrific stories can be relegated to our history books and graveyards. We’ve come this far because of vigilance and vaccine requirements. Let’s look at the numbers.
Historical Comparison of Morbidity [the rate of reported cases of a disease in a population] and Mortality [those who died from a disease] in the United States from the Journal of the American Medical Association.
Diphtheria: Pre-vaccine era annual deaths were approximately 13,000-15,000.
Now: The last case of confirmed respiratory diphtheria in the U.S. was in 1997. A small number of cutaneous cases associated with international travel have been reported since then.
H. Influenza (Haemophilus influenzae/Hib): In the pre-vaccine era, approximately 20,000 children younger than age 5 years were infected with severe Hib disease per year with around 1,000 deaths.
Now: Since use of the Hib vaccination became widespread in the U.S. for children in 1987 and for infants in 1990, the annual incidence of invasive disease in children younger than 5 years old has decreased by 99%. In the U.S., there are fewer than 35 cases of Hib each year with fewer than five deaths.
Hepatitis A (HAV): In the pre-vaccine era, there were approximately 117,333 cases in the U.S. per year with 6,863 hospitalizations and 137 deaths. This was a particularly difficult disease to contain as viral shedding persists for one to three weeks with the infected person most likely to shed HAV one to two weeks before the onset of the illness. After the onset of symptoms, the damage has already been done.
Now: Since the introduction of the vaccine in 1995, cases in the US have decreased 91%.
Measles: Prior to the widespread use of the vaccine introduced in 1963 and updated in 1967 and 1968, there were 530,217 cases of the disease per year in the U.S. with 440 deaths. At its peak, the disease infected 763,094 per year, with 552 deaths.
Now: Although there has been a recent upswing in cases attributed to unvaccinated or under-vaccinated individuals, the cases of the disease dropped to an average of 55 cases reported with zero deaths, providing a 99% decrease.
Mumps: Prior to the introduction of the vaccine (as part of the MMR series) in the 1940s and updated in 1967, there were 162,344 cases reported with 39 deaths. At its peak, the disease infected 212,932 individuals, with 50 deaths.
Now: In 2024, there were 328 reported cases of mumps in the U.S. with zero deaths.
Pertussis (also known as whooping cough): Prior to the introduction of the vaccine (as part of the DTaP series) in 1914 and updated in 1941, there were 200,752 cases of pertussis in the U.S. per year. At its peak, there were 265,269 reported cases, accounting for 7,518 deaths.
Now: As of December, there were more than 32,000 cases of pertussis reported in the U.S. in 2024. This is the highest number in a decade and more than six times the number of cases reported during the same period in 2023. Why? There are many suspects. One is the move away from masking mandates that were common through COVID-19. Masking and social distancing not only reduced the spread of COVID but also other respiratory viruses, including pertussis.
The second is more problematic as it is centered in waning vaccinations. Infants under 1 year are especially vulnerable to this disease and it is that group that suffers the most. They are also the least able to protect themselves. This group is dependent on being surrounded by those who are immunized. Although for decades we enjoyed an 89% decrease in cases, pertussis remains a worrisome – and growing – threat.
Rubella (also known as German measles): Pre-vaccine, there were 47,745 cases of rubella per year in the U.S. At its peak, the disease infected 488,796 with 24 deaths. Although the death rate may seem small in comparison to other diseases, the hallmark concern with this disease is its impact on pregnant women, who are at risk for miscarriage or stillbirth and whose fetus is at risk for severe birth defects.
During the 1964-1965 epidemic, 11,000 pregnant people lost their pregnancies. 2,100 newborns died, and 20,000 babies were born with congenital rubella syndrome (CRS) which is developed by up to 90% of infants born to mothers who had rubella during the first twelve weeks of pregnancy. This syndrome can cause growth delays, cataracts, deafness, congenital heart defects, and problems with organ development, as well as mental and learning problems. The highest risk to the fetus is during the first trimester, although rubella remains a concern throughout a pregnancy.
Like pertussis, rubella can be passed prior to any symptoms being present.
Now: Since the widespread use in the U.S. of the vaccine in 1969, the reported cases of rubella dropped to 11 with no deaths. This reflects a 99.9% drop.
[Author’s note: Several years ago, I had a titer (blood) test to check my immunity levels prior to working as a volunteer in one of our local hospitals. I had been fully vaccinated as a child and followed recommendations for boosters. The test showed that I did not have immunity to rubella. Most likely my immunity had diminished over time. Without the test, I never would have known and could have contracted rubella and passed it unknowingly to immunocompromised patients in the hospital… and my own grandchildren. I got my rubella booster the same day that I received the test results.]
Smallpox: Annual pre-vaccine cases of smallpox were at 29,005, with 337 deaths. At its peak, there were 110,672 reported cases, with 2,510 deaths. Death came quickly to those infected, often within two weeks, and survivors were often left with permanent scars and in some cases, blindness. A smallpox epidemic in the Pacific Northwest in the 1770s killed tens of thousands of Native Americans.
Now: After the smallpox vaccine reached widespread use, it saw its final victim in 1977. By 1980, the World Health Organization declared smallpox eradicated worldwide.
Polio (poliomyelitis, acute): This type of poliomyelitis attacked the nervous system and pre-vaccine, there were 19,794 cases reported annually in the U.S. with 1,393 deaths. At its peak in 1949, 42,033 cases were reported along with 2,720 deaths.
Polio (poliomyelitis, paralytic): Paralytic polio is broken down into three types including spinal polio which causes paralysis of the muscles and limbs; bulbar polio, which causes paralysis of the muscles involved in breathing, swallowing, and speaking; and bulbospinal polio which was a combination of both. Pre-vaccine, there were 16,316 cases of paralytic poliomyelitis reported annually in the U.S. with 1,879 deaths. At its peak in 1952, there were 21,269 reported cases with 3,145 deaths.
Now: The devastating 1952 outbreak of paralytic polio (following the 1949 outbreak of acute polio) led to a concerted effort to combat the disease and effective vaccines were introduced in the mid-1950s. Citizens clamored to protect their children. Early vaccinations were given orally and many recall lining up for their sugar cube, which contained the virus in a weakened form, training the body to build protective antibodies.
Since 2000, an inactivated polio vaccine (IPV), administered as a series of injections, is the only type licensed and used in the U.S. The oral polio vaccine (OPV) is still administered in many countries worldwide.
The last case of wild poliovirus was acquired in the U.S. in 1979 and by the early 2000s, there were no reported cases. However, this beast has continued to ravage families and communities worldwide. The fight continues to provide vaccinations, with hopes that someday it – like smallpox – will be declared eradicated and confined to headstones and the history books.
Tetanus: Known by its hallmark “locked” jaw and bone-breaking muscle spasms, tetanus had an estimated 580 cases annually in the U.S. with 472 deaths. At its peak in 1947-48, there were 601 reported cases, with 511 deaths.
Now: Since the introduction and widespread use of the vaccination – now as part of the DTaP (Diphtheria, Tetanus, acellular Pertussis) combination – there were 41 reported cases in the U.S. with four deaths. This shows a 92.9% decrease in cases and a 99.2% decrease in deaths.
Varicella (also known as chickenpox): Pre-vaccine, there were 4,085,120 cases that resulted in 10,632 hospitalizations and 105 deaths per year. At its peak in 1988, there were 5,358,595 cases, with 138 reported deaths.
Now: Following the 1995 rollout in the U.S. of the vaccination for varicella, cases have dropped to 48,455 annually, resulting in 1,276 hospitalizations and 19 deaths.
Why? Because science.
Vaccines do not cause autism. A 1998 “study” published by Dr. Andrew Wakefield, connected the MMR vaccine with autism. Its publication caused panic around the world, and his conclusion has since been soundly debunked. The Lancet, which published the paper, has since retracted it. Britain’s General Medical Council went on record stating that the children that Wakefield studied were carefully selected and that some of the “research” was funded by lawyers who were acting for parents involved in lawsuits against vaccine manufacturers. They continued with stating that Wakefield had acted unethically and shown “callous disregard” for the children in the study. Wakefield was subsequently stripped of his medical license.
Borne of overcaution, several studies were initiated to evaluate the Wakefield paper. They evaluated the original study and followed 657,461 children born in Denmark from 1999 through December 31, 2010 with follow-up from age 1 year through August 31, 2013.
The authors found “no increased risk of autism in those who received one or two doses of MMR vaccine compared with those who didn’t. The authors also found that the MMR vaccine did not increase the risk of autism in children with specific risk factors such as maternal age, paternal age, smoking during pregnancy, method of delivery, gestational age, five-minute APGAR scores, low birthweight, head circumference, and sibling history of autism.
“Further, by evaluating specific time periods after vaccination, the authors found no evidence for a regressive phenotype triggered by vaccination. The authors concluded that MMR vaccination did not increase the risk for autism or trigger autism in susceptible children.”
The support for the original, debunked “study” included twelve children with developmental delays – eight diagnosed with autism – who had intestinal complaints and developed autism within one month of receiving their MMR vaccination. These children were from England, where 90% of children of that age had received their MMR vaccination. The study and control group to choose from was wide – estimated at just under 3.57 million – and yet claims were based on twelve participants. This, with 3,213,000 million vaccinated children to work from.
Additionally, although the authors of the original “study” claimed that autism was a consequence of intestinal inflammation, intestinal symptoms were observed after – not before – symptoms of autism in all eight cases where there was a concurrent diagnosis. Simply put, the author who had his study retracted, who lost his medical license, and who was completely debunked created an anti-vaccine craze that left millions – if not billions – of children worldwide susceptible to diseases that had ravaged the population. Because of a debunked study of twelve children.
Vaccinations do not cause SIDS. A variety of memes has circulated on social media platforms for years, claiming that 79.4% of infants died on the same day as they received a vaccination. This caused the usual bubble-up of concern but was quickly – and soundly – debunked. The line in the article that was the basis – and “proof” – included the statement “for child death reports, 79.4% received >1 vaccine on the same day.”
Martha Sharan of the CDC explained that meant that 79.4% of the babies who died had at some stage in their lives received more than one vaccination during a day visit to a clinic. In short, they had received more than one vaccination on that day which is very different from saying they had had the vaccination and died on the same day. But again, parents clamoring to find a reason to assuage their (very real) terror of SIDS accepted the misrepresentation of the data presented and shied away from life-saving vaccination regimes for their children, putting them (and their communities) at risk.
Pediatricians are not making millions off “pushing” vaccinations for children. To start with, pediatrics is not where you go after completing a decade and a half of education and training and investing hundreds of thousands in educational costs if you want to make money. Pediatricians are among the lowest paid medical specialists in the U.S.
At the same time, vaccines are the second highest expense for a pediatric practice after employees. It is estimated that it takes 35 office visits and a cost of around $2,500 (if not more) to fully vaccinate a child through age 18. That includes direct costs including vaccine purchase, storage, staff time to handle, and overseeing and administering the vaccine, as well as indirect costs such as carrying specific insurance to protect against vaccine loss – this, when the average reimbursement cost for delivering a vaccine by public insurance is less than $10 and with private insurance, only slightly higher. Vaccines are not a cash cow by any means.
That said, pediatricians are also on the front line of protecting children (and their communities) from diseases that can be prevented. Imagine, if you will, the O’Marras’ family doctor, providing the diagnosis of diphtheria with the knowledge that it was a death sentence. Imagine that, as a medical practitioner, the only thing that could be provided was a shoulder to cry on while eight children suffocated to death. Then think of that same doctor, twenty years later, with hands on a vaccine that would have prevented that horrific scenario altogether.
The ingredients are not harmful in the amounts found in vaccines. Meme after meme has circulated across social media, suggesting that the ingredients found in vaccines are harmful to humans. Study after study has approached this concern and yet the memes persist. One study (linked below) reviewed data on thimerosal, aluminum, gelatin, human serum albumin, formaldehyde, antibiotics, egg proteins, and yeast proteins, many of which have been called out as harmful and even dangerous.
Like all other scientific studies on the subject, researchers found that although egg and yeast proteins can be harmful if ingested by a very small percentage of our population who are highly allergic to them, all the others are consumed in such small quantities in a vaccine that they are not harmful in humans or experimental animals. It’s not to say that consuming large quantities of any wouldn’t cause problems, but the microscopic amounts used quickly pass through the human body – even the littlest human body – and the benefits of immunity to disease far outweigh their use in such minute quantities.
Yes, there are more vaccinations given in childhood than you had as a kid. No, that increase is not harmful. No one looks forward to those first few months of a child’s life when they seem to receive constant pokes. However, it is during this time that infants are the most vulnerable to disease because of their immature immune system. It is a time when they’re swimming in a new world full of viruses and bacteria that in the past could have killed them. Each of the diseases mentioned earlier carries the cruel reality that our young are the most at risk.
The timing is carefully timed to provide protection when the natural immunities inherited from the mother are fading and when the child’s immune system is ready, but before the child is most likely to come in contact with the germs that cause infection. They are grouped to minimize the number of shots and trips to the doctor necessary to achieve full immunity. They are at the absolute minimum dosage necessary to teach the body how to fight each disease. There are more vaccines in the schedule than there were even twenty or thirty years ago as science has determined ways to defeat these quiet, old killers and the new ones that show up.
Delaying or intentionally leaving out specific vaccinations just opens a child to infection at a time when they most need to be protected. Refusing vaccinations altogether puts not just your own child at risk but also risks the lives of everyone they come in contact with. We’re truly all in this together.
The Devil Is in the Details
Why are debunked “studies” so dangerous to vaccination campaigns worldwide? In short, it’s not because of what is said – or retracted – it’s about what is heard and remembered. The “study” that tried to link the MMR vaccination to autism was an excellent example of this. Regardless of the publication’s retraction, the loss of the author’s medical license, and subsequent studies, a seed was planted, and it grew furiously.
It’s not hard to spread fear about a solution when the problem has been forgotten. Our citizens do not personally know a family today who was devastated by diphtheria. They do not have neighbors who lost their children to measles or mumps. They did not experience a devastating miscarriage because of rubella. They don’t know what it’s like to visit a loved one encased in an iron lung or struggling with leg braces because of polio. Those stories are relegated to overgrown graves, congregated in huddles of families who lost child after child – one after another – with no way to stop a deadly disease.
We would do well to never forget the O’Marra family and the devastation that they suffered in that one week in April. We have those tools now that would have changed that outcome. We can save lives. Thousands – if not millions – of lives. But to do that, we need to continue to work together as parents and communities, as scientists and practitioners, as compassionate and thoughtful humans.
References
Staresinic-Deane, Diana. Lessons from a Kansas Graveyard: What a 1903 outbreak of diphtheria can teach us today. Link here.
Cooper, L.Z. The history and medical consequence of rubella. National Institute of Health Pub Med. Link here.
History of the polio vaccine. World Health Organization Health Topics. Link here.
Acosta, Anna, Sarah Bennett. Diphtheria: CDC Yellow Book 2024. Link here.
Tetanus Surveillance and Trends. 2024, November 13. US Centers for Disease Control and Prevention. Link here.
Vaccines: The myths and the facts. American Academy of Allergy, Asthma, & Immunology. Link here.
Jefferson, Tom. Vaccination and its adverse effects: real or perceived. National Center for Biotechnology Information. Link here.
Hansen, Vinslov, Frisch, Morten, & Melbye, Mads. 2019, March 9. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Annals of Internal Medicine. American College of Physicians. Link here.
Whooping cough. Mayo Clinic. Link here.
Cherry, JD. 1999. Pertussis in the pre-antibiotic and pre-vaccine era, with emphasis on adult pertussis. PubMed. NIH: National Library of Medicine. Link here.
Iannelli, Vincent. 2024, June 30. Tetanus Deaths Before We Had Vaccines. Vaxopedia: An A to Z guide to Vaccines. Link here.
Roush, Sandra W., Murphy, Trudy V., & the Vaccine-Preventable Disease Table Working Group. 2024. Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States. JAMA Network. American Medical Association. Link here.
Do Vaccines Cause Sudden Infant Death Syndrome? 2023, November 10. Johns Hopkins Bloomberg School of Public Health. Link here.
Vaccines and Sudden Infant Death Syndrome (SIDS). 2019. Children’s Hospital of Philadelphia: Vaccine Education Center. Link here.
Yang, Y. Tony & Shaw, Jana. 2018, January 29. Sudden infant death syndrome, attention-deficit/hyperactivity disorder and vaccines: Logitudinal population analysis. Science Direct. Link here.
Eggertson, Laura. Lancet retracts 12-year-old article linking autism to MMR vaccines. 2010. National Library of Medicine. Link here.
Offit, Paul A. & Jew, Rita K. Addressing parent’ concerns: do vaccines contain harmful preservatives, adjuvants, additives, or residuals? 2003, December. National Library of Medicine. Link here.
Multiple Vaccines at Once. 2024, December 20. CDC Vaccine Safety. Link here.