Iowa State vaccine historian: 'It really has never been done before'

Amy Bix discusses smallpox, polio, COVID-19 and vaccine public relations

Staff nurse Rachel Lewis administers the Pfizer-BioNTech COVID-19 vaccine to emergency room nurse David Conway on Dec. 1
Staff nurse Rachel Lewis administers the Pfizer-BioNTech COVID-19 vaccine to emergency room nurse David Conway on Dec. 14 at the University of Iowa Hospitals and Clinics in Iowa City. Conway was the first person in Iowa to receive the vaccine. (Andy Abeyta/The Gazette)

As health care workers locally and nationally this past week rolled up their sleeves to receive the first doses of a long-awaited COVID-19 vaccine, they reported feeling the monumental import of the moment and sensing their place in the history books.

Iowa State University professor Amy Bix, in a conversation with The Gazette, confirmed their historical hunches — given her expertise in the history of science and medicine.

“Of course, the history of vaccines is a major part of the broader subject of the history of medicine, which is something that I teach at Iowa State,” Bix said.

She talked with The Gazette about that history and what lessons it might offer in the current moment.

Q: What was the first vaccine deployed?

A: The story starts in the 1790s with worries about smallpox — a potential deadly infectious disease that had been circulating for centuries.

“It killed something like one-third of the people who got it,” Bix said. “Those who survived, a lot of them were left with terribly scarred faces. And some even committed suicide because of that.”

In the late 1700s, a British doctor began noticing those who got the related but less severe “cowpox” did not contract smallpox.


“So he did some experiments that would probably be considered unethical today,” Bix said. “He basically took a small kid and exposed him to cowpox. And then it turned out that he did not get smallpox.”

Q: How widely was the cowpox-smallpox technique used?

A: “Use of them spread in Europe and the United States,” Bix said, noting the “cowpox” origin story is tied to the word “vaccine.”

“That’s actually where the word comes from,” she said. “It’s related to the Latin word for cow,” which is “vacca.”

Q: Was everyone willing to take the novel vaccination approach back then?

A: By the mid-1800s, she said, the United States was pushing people to get the smallpox vaccine — particularly children. But not all were interested.

“There are actually some fairly nasty episodes in that history, around 1900 … where they basically forced people to get vaccinated,” Bix said. “There were a couple of nasty cases where they forced people at gunpoint to get the vaccine, or they grabbed them, pulled their arm and jabbed it into them.”

Q: What were other early vaccines?

A: French scientist Louis Pasteur “did some very nice working coming up with preventatives for rabies.”

“And then of course the big one that everybody thinks about is the polio vaccine,” Bix said.


Q: Can you talk more about the history of that disease and efforts to eradicate it?

A: “The name for it used to be infantile paralysis because it disproportionately hit kids,” she said. “There are cases where adults certainly got it. The most famous case, of course, is President Franklin Delano Roosevelt, who picked up polio when he was an adult, and it left him partially paralyzed for life.”

But parents were terrified.

“The most nasty cases paralyzed kids so bad that they literally couldn’t breathe for themselves, they didn’t have the muscle ability anymore,” she said. “So they had to be put on those notorious iron lung machines, where the machines were basically keeping them alive.”

Scientists produced a pair of polio vaccines after World War II, in the 1950s and ’60s, with tests beginning as early as 1950 but trials and results taking a decade before licensure.

“Ever since then, you have a worldwide campaign to try to eradicate polio,” Bix said. “And it’s been pretty much erased from a good part of the world. But the battle for that isn’t quite over.”

Q: Was that polio vaccine similar to the smallpox one? Or how did it work?

A: “There were different versions,” she said.

One version used de-constituted live virus, which typically worked well.

“But if something goes wrong, then you can actually get contaminated,” she said. “And there were a couple nasty episodes where they sent out batches of contaminated polio vaccine.”

Q: Did they find a way to make it safer?

A: “They came up with an oral vaccine instead of an injectable one, which is a lot easier for kids to take and it’s a lot easier for health care workers to give,” Bix said.

Q: Was it in a liquid or pill form?


A: “Actually, they gave it on a sugar cube,” she said, adding, “You know the movie ‘Mary Poppins,’ with the spoonful of sugar? I’ve read that the song was inspired by the songwriter’s kid coming home and telling him about getting the polio vaccine on the sugar cube.”

Q: Do you have any concept of how many vaccines we have today?

A: “Overall, there are around 20, maybe 22, vaccines to the U.S.,” she said. “In addition to polio, the ones a lot of people are familiar with are the vaccines against measles and mumps — the MMR vaccine against measles, mumps and rubella. That’s the one that has caused the most controversy among people who oppose vaccination.”

Q: Can you talk more about that anti-vaccination movement?

A: Opposition to vaccination existed centuries ago, as far back as smallpox.

“And, of course, back then you didn’t even really have a full scientific explanation of why vaccines worked.”

The issue actually went to the U.S. Supreme Court in 1905, asking the question of whether the government can compel people to get vaccines. The 1905 decision found it could, “because of the community interest.”

Q: But there are exceptions, correct?

A: “There are some kids and some people who can’t take vaccines who are allergic or have other medical contraindications.”

Vaccination laws carve out those exceptions.

“And then, controversially, some states have also had exceptions for people who have religious or philosophical objections to vaccination.”

Q: What have been ramifications of widespread doubts historically?

A: More people get infected and in some cases die, she said.


“In terms of building up that herd immunity, vaccination is the quickest and safest way,” Bix said. “The question is just getting enough of the population willing to have a vaccine in order to break that chain of spread.”

Q: What are ways the government countered vaccination doubts historically?

A: “The federal government wanted a big public relations push to emphasize the importance of everybody getting the polio vaccine,” Bix said. “So they asked who’s the biggest celebrity we can find who’s going to make the biggest public relations splash? And the one they found was Elvis.”

Backstage, before performing on a 1956 episode of “The Ed Sullivan Show,” Elvis got the polio vaccine, making headlines nationally.

Q: Seems similar to what we’re seeing today, right?

A: “Former presidents Obama, Clinton, and George W. Bush have said that they’re willing to get the vaccine publicly in order to show faith in it.”

Q: What other public relations tools do we have today?

A: “Social networks,” Bix said. “When people see friends and family getting vaccinated, that’s going to make them more comfortable with it.”

She stressed social media today “gives us the power to spread information faster than ever at the push of a button.” But, because of viral spread of disinformation too, Bix said she’s not sure whether social media will prove to be helpful or hurtful in encouraging widespread vaccination.

“In some ways it’s kind of an arms race itself — information versus misinformation.”

Q: Is there anything to theories about harm caused by vaccines?


A: “There were some really scientifically unjustified studies suggesting a link between certain childhood vaccines and autism,” she said. “And it turns out the evidence wasn’t there, but the damage had already been done in terms of people getting suspicious.”

Q: Historically speaking, just how quickly has this COVID-19 vaccine been developed?

A: “If you had asked a lot of people in the scientific community, ‘Can we get a vaccine this fast?’ a lot of people would have been skeptical — because it really has never been done before.”

Q: What are viruses and diseases for which researchers haven’t yet found a vaccine?

A: “We still don’t have a vaccine against HIV,” she said. “We still don’t have a vaccine against malaria. There are a whole number of diseases that we haven’t got vaccines for yet. And even ones that we do — like the regular flu shot … they have to keep redoing it every year because the virus itself evolves.

“So it’s definitely a tricky science.”

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