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Vaccine

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A modern kit to vaccinate against smallpox

A vaccine is a biological preparation. It is given to prevent a specific infectious or malignant disease. It only works against the microorganism for which it is prepared. It is usually given by injection, and called vaccination.

James Gillray, The Cow-Pock—or—the Wonderful Effects of the New Inoculation! (1802). Vaccinations eventually helped eliminate smallpox from the world.

At its best, vaccination gives immunity to an infectious disease caused by a particular microorganism (bacteria or virus). For example, the flu vaccine makes it very much less likely that a person will get the flu. The flu virus continually changes, and has many strains. That is why re-vaccination is needed every year.

At first, vaccines were usually made from something that is alive, or was alive. Now they may be built up by viral biochemistry. Each vaccine has its own history, and what is true of one might not be true of another.

The word "vaccine" comes from the Latin vacca, meaning "cow"). In 1796, Edward Jenner used a milkmaid infected with cowpox (variolae vaccinae) to protect people against smallpox.[1] The use of vaccines is called vaccination.

Vaccination had been done before Jenner.[2] Powdered smallpox material was blown up the nostrils of the subject.

History

Edward Jenner created the first vaccine in the 1770s. At this time, smallpox was a deadly disease. Jenner noticed that people who had already had cowpox (a disease that is related to smallpox) usually did not get smallpox. He thought that getting cowpox protected people against smallpox.

To test this idea, Jenner gave a boy cowpox. Then he infected the boy with smallpox. The boy did not get sick because he had already had cowpox. Jenner was right: having cowpox protected people against smallpox.

Because cowpox inoculation made fewer people sick than smallpox inoculation, England made smallpox inoculation illegal in 1840. In 1853, they made another law that said every child had to be vaccinated against smallpox using Jenner's vaccine.

In the 19th century, Louis Pasteur made a rabies vaccine.

In the 20th century, scientists created vaccines to protect people against diphtheria, measles, mumps, and rubella. In the 1950s, Jonas Salk created the polio vaccine.

However, vaccines still do not exist for many important diseases, like malaria and HIV.[1]

Many countries have passed compulsory vaccination laws – laws that require certain people to get vaccinated.[1] For example, in many countries, children have to be vaccinated against certain diseases in order to go to public school. On the other hand, there are some religions which ban all forms of vaccination: the Seventh-day Adventist Church is an example.

Types of vaccines

There are many different types of vaccines.[3]

One common type of vaccine is a "live vaccine". This type of vaccine contains a small amount of a live virus or bacteria. Before the vaccine is given, scientists weaken the virus or bacteria so it cannot make a person sick. When a person gets a live vaccine, their immune system learns to recognize and fight off that virus or bacteria. hen, if the person is exposed to the virus or bacteria in the future, their immune system will already "know" how to fight it off. Examples of live vaccines include vaccines for measles, mumps, and chickenpox.

Another common type of vaccine is an "inactivated vaccine". These vaccines contain dead viruses or bacteria. These do not cause the immune system to react as strongly as live vaccines. Because of this, people may need "booster shots" – extra doses of the vaccine, given at certain times, so their immune system can "learn" how to fight off the infection. Examples of inactivated vaccines include vaccines for pertussis (whooping cough), rabies, and hepatitis B.

In other vaccines, only a protein molecule from the virus or bacterium is injected into the patient. The protein is enough for the patient's immune system to recognize the whole germ.

With messenger RNA vaccines, only the messenger RNA (mRNA), which acts as a blueprint or recipe for the protein, is injected into the patient. The first mRNA vaccines were made in the 1990s, but scientists did not make large numbers of them until the 2010s. Some mRNA vaccines work against cancer and can make tumors smaller.[4][5]

Effectiveness

Vaccines do not guarantee complete protection from a disease.[6] In other words, a person can get a disease that they were vaccinated against.

Sometimes, this happens because the person's immune system did not respond to the vaccine (it did not "learn" how to fight off the disease after the person got the vaccine). This may happen because the person's immune system is already weak (for example, because of diabetes, HIV infection, old age, or steroid use). It may also happen because the person's immune system cannot make the particular B cells which make the antibodies that stick to the pathogen.

Some vaccines work better than others at protecting people from a disease. The decrease in getting the disease is called efficacy. For example, if 80% fewer vaccinated people get the disease, 80% is the efficacy. There are many reasons for different efficacy:

  • Vaccination works better for some diseases than for others
  • The vaccine may be for a certain strain of a disease. If a person gets a different strain of the disease, they can still get sick.[7]
  • Vaccines usually do not have permanent effects, so a person might need many different vaccinations on a schedule. If a person missed a scheduled vaccine, they might lose their protection against a disease.
  • Some people are "non-responders" to certain vaccines. This means that their immune systems just do not create antibodies to fight off a disease, even after they are vaccinated correctly.
  • Other things, like ethnicity, age, and genetics, can affect how a person reacts to a vaccine. In some cases, larger doses are used for older people (50–75 years and up), whose immune response to a given vaccine is not as strong.[8]

Controversy

Since vaccines first existed, there have been people who did not agree with the idea of using vaccines.[9] Around the world, most scientists and doctors agree that the benefits of using vaccines are much greater than the risks. The adverse effects from vaccines are rare. Not vaccinating people is a much greater risk, because vaccines prevent suffering and death from infectious diseases.[10][11]

There have been controversies over using vaccines such as whether vaccines are safe, the amount of research and whether it is morally right to force people to get vaccinated.

Some religious groups do not allow uses of vaccines.[11][12]

Some political groups argue that people should be able to choose whether or not to get vaccinated. They argue that laws requiring people to get vaccinated violate individual rights.[9] In response, one study says: "Vaccine refusal not only increases the individual risk of disease but also increases the risk for the whole community".[13]

Some parents choose not to follow the regular vaccine schedule for their children. One study looked at parents of children ages six months to six years old. It found that 13% of these parents reported following an alternative vaccination schedule. However, of these parents, less than 1 out of every 5 reported refusing all vaccines. Most refused only certain vaccines, and/or delayed some vaccines until the child was older.

Parents who delay vaccines until their children are older are often concerned about their child's immune system being too young and weak to handle getting many vaccines at once. However, this is a technical issue which is best decided by experts.

Economics of development and patents

 
This 1963 poster features the CDC's national mascot of public health, the "Wellbee", encouraging people to get an oral polio vaccine.

One challenge in developing vaccines is economic. The diseases that most need vaccines today – HIV, malaria, and tuberculosis – exist mostly in poor countries. Companies that make vaccines would not make much money because many of the people who need them are too poor to pay for them. There would also be financial and other risks to these companies if they tried making new vaccines for these diseases.[14]

Throughout history, most vaccines have been developed by governments, universities, and non-profit organizations.[15] Many vaccines have been highly cost-effective and good for public health.[14] In recent decades, the number of vaccines given throughout the world has increased dramatically. This increase, particularly in the number of different vaccines given to children before they start school,[16] may be due to laws and support from governments.

Another obstacle to making new vaccines is that when a new vaccine is made, the maker usually files a patent on their vaccine. These patents can limit the process used to make the vaccine to the maker (in practice the right can be subcontracted). That way the patent makes money for the originator.[17]

Additional components in vaccines

Vaccines often contain other things besides the active vaccine (the weakened or dead virus or bacteria). For example, vaccines may contain:[18]

  • Aluminum salts or gels. These are added to help the immune system respond earlier, and more strongly, to the vaccine. They allow a lower dose of the vaccine to be given.
  • Antibiotics are added to some vaccines to prevent bacteria from growing while the vaccine is being made or stored.
 
Two workers make openings in chicken eggs as they prepare to make measles vaccines
  • Egg protein is present in influenza and yellow fever vaccines, because they are made using chicken eggs. Vaccines may also contain other proteins.
  • Formaldehyde is used to kill bacteria for certain vaccines. It is also used to kill unwanted viruses and bacteria that might get into the vaccine while it is being made.
  • Monosodium glutamate (MSG) and 2-phenoxyethanol are used as stabilizers in a few vaccines to make sure the vaccine does not change if it is exposed to heat, light, acidity, or humidity.
  • Thimerosal is a preservative that contains mercury. It is added to vials of vaccine that contain more than one dose, to keep harmful bacteria from growing in the vaccine.

Preservatives in vaccines, such as thiomersal, phenoxyethanol, and formaldehyde, prevent serious adverse effects. Thiomersal is more effective against bacteria, lasts longer in storage, and makes the vaccine stronger, safer, and more stable (less likely to be changed by things like heat). However, in the United States, the European Union, and a few other developed countries, it is no longer used as a preservative in childhood vaccines because it contains mercury.[19]

If no preservative is added to a vaccine, harmful bacteria may grow in the vaccine. For example, in 1928, Staphylococcus bacteria grew in a diphtheria vaccine that had no preservative in it. Of 21 children who got that vaccine, 12 died.[20]

 
A child is vaccinated against poliomyelitis. This vaccine can be given orally, such as a few drops of liquid on a piece of sugar.

Most versions of anti-coronavirus are kept at very low temperature before use. That helps preserve the vaccine in its most effective state.

Use in veterinary medicine

Animals are vaccinated to keep them from getting diseases, and to keep them from infecting humans with diseases.[21] Pets as well as livestock are routinely vaccinated.

In some instances, populations of wild animals may be vaccinated. Sometimes, wild animals are vaccinated by spreading vaccine-laced food in a disease-prone area. This method has been used to try to control rabies in raccoons. Where rabies occurs, laws may require dogs to get rabies vaccinations.

Dogs can also be vaccinated against many other diseases, including canine distemper, canine parvovirus, infectious canine hepatitis, adenovirus-2, leptospirosis, bordatella, canine parainfluenza virus, and Lyme disease.

Several trends in vaccine development

  • Nowadays, vaccines are given to people of all ages.[22][23]
  • Combinations of vaccines are becoming more common. Vaccines containing five or more parts are used in many parts of the world.[22]
  • New methods of giving vaccines are being developed. Some of these new delivery systems include skin patches, aerosols given through inhalation devices, and eating genetically engineered plants.[22]
  • Scientists are designing vaccines to make people's natural immune responses stronger.[22]
  • Scientists are trying to make vaccines to help cure chronic infections, instead of only preventing disease.[22]
  • Public health officials might change their strategies for giving vaccines based on differences in how men, women, and pregnant women react to vaccines.[24]

Scientists are also working on vaccines against many noninfectious human diseases, such as cancers and autoimmune disorders.[25] For example, the experimental vaccine CYT006-AngQb has been investigated as a possible treatment for high blood pressure.[26]

Vaccine Media

  • Infectious diseases before and after a vaccine was introduced. Vaccinations have a direct effect on the diminishment of the number of cases and contributes indirectly to a diminishment of the number of deaths.

  • Graphic from part four in a series of explainers on vaccine development and distribution. Originally published on the World Health Organization, Newsroom, Feature stories, The race for a COVID-19 vaccine, explained.

  • Avian flu vaccine development by reverse genetics techniques

  •  :Share of children who receive key vaccines in target populations*Share of children of the relevant age category who receive the seven key vaccines, conditional on inclusion in national vaccine schedules. The eight vaccines include DPT3, measles, polio, Hep3B, Haemophilus influenzae type b, pneumococcal conjugate vaccine, and rotavirus vaccine.

  • A woman receiving a vaccine by injection

  • Goat vaccination against sheep pox and pleural pneumonia

  • Comparison of smallpox (left) and cowpox inoculations sixteen days after administration (1802)

  • An early 19th-century satire of antivaxxers by Isaac Cruikshank

References

  1. ↑ 1.0 1.1 1.2 Stern A.M. & Markel H. (2005). "The history of vaccines and immunization: familiar patterns, new challenges". Health Affairs. 24 (3): 611–21. doi:10.1377/hlthaff.24.3.611. PMID 15886151.
  2. ↑ Williams G 2010. Angel of Death. Palgrave Macmillan. ISBN 978-0-230-27471-6
  3. ↑ "The Main Types of Vaccines". Archived from the original on 2010-11-23. Retrieved 2010-12-21.
  4. ↑ Joanna Roberts (April 1, 2020). Five things you need to know about: mRNA vaccines. Horizon. https://horizon-magazine.eu/article/five-things-you-need-know-about-mrna-vaccines.html. Retrieved May 1, 2020. 
  5. ↑ Norbert Pardi; Michael J. Hogan; Frederick W. Porter; Drew Weissman (January 12, 2018). "mRNA vaccines — a new era in vaccinology". Nature Reviews Drug Discovery. 18 (4): 261–279. doi:10.1038/nrd.2017.243. PMC 5906799. PMID 29326426.
  6. ↑ Grammatikos, A.P.; Mantadakis, E.; Falagas, M.E. (2009). "Meta-analyses on pediatric infections and vaccines". Infectious Disease Clinics of North America. 23 (2): 431–457. doi:10.1016/j.idc.2009.01.008. PMID 19393917.
  7. ↑ Vernazza, Pietro L.; Galeazzi, Renato L.; Osterwalder, Joseph J.; Schlegel, Matthias (7 August 1999). "Comparative efficacy of three mumps vaccines during disease outbreak in eastern Switzerland: cohort study". BMJ. 319 (7206): 352. doi:10.1136/bmj.319.7206.352. PMC 32261. PMID 10435956 – via www.bmj.com.
  8. ↑ "Adapting Vaccines For Our Aging Immune Systems". NPR.
  9. ↑ 9.0 9.1 Wolfe R, Sharp L (2002). "Anti-vaccinationists past and present". BMJ. 325 (7361): 430–2. doi:10.1136/bmj.325.7361.430. PMC 1123944. PMID 12193361.
  10. ↑ Bonhoeffer J, Heininger U (2007). "Adverse events following immunization: perception and evidence". Curr Opin Infect Dis. 20 (3): 237–46. doi:10.1097/QCO.0b013e32811ebfb0. PMID 17471032. S2CID 40669829.
  11. ↑ 11.0 11.1 Demicheli V.; et al. (2005). Demicheli, Vittorio (ed.). "Vaccines for measles, mumps and rubella in children". Cochrane Database Syst Rev. 19 (4): CD004407. doi:10.1002/14651858.CD004407.pub2. PMID 16235361.
  12. ↑ Sinal S.H; Cabinum-Foeller E & Socolar R. (2008). "Religion and medical neglect". South Med J. 101 (7): 703–6. doi:10.1097/SMJ.0b013e31817997c9. PMID 18580731. S2CID 29738930.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ↑ Saad B. Omer et al 2009. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine. 360:1981-1988 (original), 2009 reissue. [1] Archived 2010-02-13 at the Wayback Machine
  14. ↑ 14.0 14.1 Goodman, Jesse L. (2005-05-04). Statement of Jesse L. Goodman M.D., M.P.H. Director, Center for Biologics, Evaluation and Research Before the Committee on Energy and Commerce United States House of Representatives. http://www.fda.gov/ola/2005/influenza0504.html. Retrieved 2008-06-15. 
  15. ↑ Olesen O.F; Lonnroth A; Mulligan B. (2009). "Human vaccine research in the European Union". Vaccine. 27 (5): 640–5. doi:10.1016/j.vaccine.2008.11.064. PMC 7115654. PMID 19059446.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ↑ Ihara, T. (2009). "The strategy for prevention of measles and rubella prevalence with measles-rubella (MR) vaccine in Japan". Vaccine. 27 (24): 3234–3236. doi:10.1016/j.vaccine.2009.02.075. PMID 19366578.
  17. ↑ Hardman, Reis T. (2006). "The role of intellectual property in the global challenge for immunization". J World Intellect Prop. 9 (4): 413–25. doi:10.1111/j.1422-2213.2006.00284.x.
  18. ↑ CDC. "Ingredients of Vaccines – Fact Sheet". Retrieved December 20, 2009.
  19. ↑ Bigham M. & Copes R. (2005). "Thiomersal in vaccines: balancing the risk of adverse effects with the risk of vaccine-preventable disease". Drug Saf. 28 (2): 89–101. doi:10.2165/00002018-200528020-00001. PMID 15691220. S2CID 11570020.
  20. ↑ "Thimerosal in vaccines". Center for Biologics Evaluation and Research, U.S. Food and Drug Administration. 2007-09-06. Retrieved 2007-10-01.
  21. ↑ Patel, J.R.; Heldens, J.G. (2009). "Immunoprophylaxis against important virus disease of horses, farm animals and birds". Vaccine. 27 (12): 1797–1810. doi:10.1016/j.vaccine.2008.12.063. PMC 7130586. PMID 19402200.
  22. ↑ 22.0 22.1 22.2 22.3 22.4 Plotkin SA (2005). "Vaccines: past, present and future". Nat Med. 11 (4 Suppl): S5–11. doi:10.1038/nm1209. PMC 7095920. PMID 15812490.
  23. ↑ Carlson B (2008). "Adults now drive growth of vaccine market". Genet Eng Biotechnol News. 28 (11): 22–3.[dead link]
  24. ↑ Klein SL, Jedlicka A, Pekosz A (May 2010). "The Xs and Y of immune responses to viral vaccines". Lancet Infect Dis. 10 (5): 338–49. doi:10.1016/S1473-3099(10)70049-9. PMC 6467501. PMID 20417416.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  25. ↑ Spohn G, Bachmann MF (2008). "Exploiting viral properties for the rational design of modern vaccines". Expert Rev Vaccines. 7 (1): 43–54. doi:10.1586/14760584.7.1.43. PMID 18251693. S2CID 40130001.
  26. ↑ Samuelsson O. & Herlitz H (2008). "Vaccination against high blood pressure: a new strategy". Lancet. 371 (9615): 788–9. doi:10.1016/S0140-6736(08)60355-4. PMID 18328909. S2CID 38323966.

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