In the 1700s Lady Sarah Montague, six death row inmates in Newgate prison and eight-year-old James Phipps shared a common experience. In 1992, that same experience was endured by a group of HIV-negative volunteers with a history of injected drug use, and again by a German researcher operating out of a biosafety lab in Hamburg in 2009. They were all exposed to particles of an infectious disease in an experiment that aimed to inoculate mass populations. In 2020, such experiments are rarely far from anyone’s mind and they are known as vaccine trials.
James Phipps was in fact the very first human to be given a vaccine. He was the gardener’s son in the English village where Edward Jenner was conducting his research into smallpox and in 1796, he was injected with a sample of cells from a milkmaid who had contracted cowpox. Dr Jenner anticipated that immunity to cowpox – a mild virus – would allow humans to build up immunity to the disease’s far more vicious cousin, smallpox.
James developed a few localised pock-marks and a mild fever after his inoculation, but made a full recovery. And so, a few weeks after his initial injection, he was exposed to the far more deadly disease, smallpox. He didn’t develop any symptoms. Dr Jenner called his discovery a vaccine (after the Latin word for cow from which the cowpox illness had originated) and published a paper which set a precedent for immunisation in the 21st century.
But though young James was the first vaccine trial participant, he was certainly not the first to develop immunity through exposure to disease. The idea was first proposed by the ancient Greeks around 400 BC. They correctly theorised that the human immune system could prepare itself to fight off an infectious disease if it had previously been exposed to a small quantity of the particles which cause that disease.
And from the early second century onwards, physicians have been putting that theory into practice. In the earliest known form of inoculation, Chinese therapists crushed up extracts of a smallpox sore and blew it up the nose of citizens. In some cases, it worked, but the doctors responsible for delivering the treatment were also exposed to the virus and it often caused more illness than it prevented.
Knowledge of inoculation spread with smallpox down the Silk Road, arriving in Europe in the early 1700s when infectious diseases were raging. European doctors sought to make the early Chinese treatments more civilised, and used a needle to push disease extracts into the skin. Lady Sarah Montague, who had been left horribly scarred by a bout of smallpox was a keen advocate of the technique. She and her husband sponsored a trial in which six death row prisoners were infected with smallpox particles before being exposed to the disease (if they survived, they were pardoned, if they died, the outcome was no different to if they had remained on death row). All six survived and the trial – though ethically ambiguous – was deemed a success.
But the needle process of inoculation still presented big safety problems. Those who were exposed to particles of smallpox were in danger of developing the illness and dying or becoming carriers of the virus and sparking an epidemic.
It took the proliferation of cowpox among milkmaids in rural England for a scientist to identify the best way of vaccinating humans against diseases: exposure to a non-deadly version of an infectious disease is a safe and effective way of building up immunity. Edward Jenner’s vaccine spread globally and in 1976 the last known case of smallpox was reported in Somalia. In 1980, the World Health Organisation declared smallpox – a disease which had killed 300m people in the 20th century alone – officially extinct.
Since the smallpox breakthrough, scientists have successfully developed vaccines for 27 diseases, including cholera, measles and influenza. Most children in the western world are inoculated from birth against illnesses that were previously incredibly common, while viruses which normally only impact specific sub-sections of the population – HIV and HPV, for example – now have readily available vaccines.
But smallpox is the only illness that a vaccine has successfully eradicated. A lesson, perhaps, for those betting that the huge investment into a coronavirus vaccine will eradicate the disease immediately.
Timing matters
It’s also worth noting the importance of timing in major vaccine breakthroughs and the significance that has in commercialisation. The measles vaccine was created when a team of scientists successfully isolated virus cells after taking a blood sample from a school boy named David Edmonston in the 1960s after a serious outbreak of the illness in Boston. A vaccine for Ebola had been in development for more than two decades before the 2014 epidemic sparked global demand for funding to push it past the finish line.
Vaccines are often developed in response to immediate need from western populations. That means drugs companies are encouraged to give those medicines away at cost price, at least until the initial danger has passed. And once the immediate need or media storm has died down, demand for those vaccines isn’t so high. That is why few drugs companies have ever made much money from them.
And so, lessons from history teach us that the likelihood of a successful coronavirus vaccine any time soon is very slim. The notion that the eventual vaccine will deliver major profits for the pharma company that sponsors it is even slimmer. And the prospect that the vaccine will eradicate coronavirus in time for Christmas? Virtually non-existent.
