E23: 7 Domains of Vaccination

So we're going to do the "7 Domains of Vaccines." And I think it helps to understand how the word "vaccine" came from, because the very first vaccines on the planet came from an infection that came from cows, cowpox. It was called in English cowpox, but the French term is a vache for cow. And the stuff that was used from the cow for inoculation was called vaccine, and that came to be used in English for all kinds of inoculations.

So it turns out the term "vaccine" comes from the very, very first time that we used something from one kind of animal to help people not get infected with something. So that's how we got the word vaccine.

But let's start where we started with smallpox. We think that smallpox has been around infecting humans for more than 3,000 years. There are some Egyptian mummies that were found to have smallpox scars. And throughout human history, it's killed over a billion people. And since we've had records, in the 18th century Europe, it killed at least 400,000 people a year and killed between 20% and 60% of all those who were infected and 80% of children. People who didn't die were often scarred badly and blind. So during the 20th century, smallpox was responsible around the world for 300 to 500 million deaths.

So let's get back to cows. As long ago as 1500, there was a practice in China of taking the smallpox scabs from people who had just a mild case, and grinding them up, and blowing them up someone's nose to give them a mild form of smallpox, which they usually survived, and then they were immune for life.

And that practice spread to Europe, and to the Middle East, and to Asia, and to Africa, and colonial America, with the similar practice of scratching the skin of someone with a needle that had some material from smallpox. So you gave a little bit of smallpox to somebody. This practice was called variolation. It wasn't called vaccination then. It was called variolation, and it decreased the chances that someone would die from smallpox.

And this technique was used in colonial America, but there was a lot of controversy about it, a lot of pushback, a lot of magical thinking. And one of the most prominent church leaders of the time, Cotton Mather, supported it and Benjamin Franklin supported it and did some of his own epidemiologic studies, because he was a scientist, to show that people who had this variolation were less likely to get a big case of smallpox and die. He was planning on having this procedure done to his little son, but, unfortunately, his son died of smallpox before he could be vaccinated.

But back to cows. In the late 1700s, a British physician noted, as the milkmaids had noted, that milkmaids who got cowpox, which is an infection kind of like smallpox but happens in cows, didn't get smallpox and die. They got this little case of cowpox.

And in one of the great medical experiments of all time, this physician, Jenner, took some stuff from a scab from a milkmaid with cowpox and scratched it into a small boy. And that boy got a little case of cowpox, but he never got smallpox, even after he'd been exposed to it over and over and over.

 

Dr. Jones: Now, I'm going to introduce my talent. Honey, honey, come here sweetheart. Let's see you drop trou. Drop trousers. Are you going to drop trousers?

Chris Jones: Sure, why not. I always wanted to, really.

Dr. Jones: No, no, no. So my honey, my husband is showing me on his right hip . . . He's not dropping all of his trousers. He's leaving his small pants. He has his vaccine on his right hip. I have one on my right hip. And my son, our son, doesn't have a smallpox vaccine because it was eradicated before he was born.

So vaccine, name comes from cows, and that's where the first vaccine came from. And in the 1950s, there was a worldwide effort to eradicate smallpox, so vaccinations took place all over the world. The last case of naturally occurring smallpox occurred in a child in India in 1979.

So there we have the first vaccine, and it's near and dear to our hearts because we don't remember our smallpox vaccine because we were too young. However, we do remember the next big vaccine, and I'm going to have Chris come here and tell us. Tell me about the first vaccine that you remember.

Chris Jones: Oh, yeah. Well, my mother was all-knowing and just so wonderful. One day, she took me down to the city center where everybody was getting "shots." And it was made clear to me that this was very important because polio was bad for people, and it was much better to have a vaccine, so, "Chris, you really need to have a shot."

I started trembling, fearing the needle, and it was just my mother and a very smart nurse. I was crying and didn't really want a shot. I just knew that this was going to be awful. And then I said, "Okay, so when am I going to get my shot?" And the nurse said, "We already gave it to you."

 

So the polio vaccine was a miracle to our parents who feared of this awful disease called infantile paralysis. I have friends who had polio. The concept of vaccination at the time in the '50s was something that almost everybody was totally on board with. And the concept of having polio be eradicated from the United States was truly miraculous.

Our immune systems work to fight off infections from outside our bodies. Simplified, when we see a new substance, like bacteria or a virus, we make antibodies to it, so we're less likely to get sick from it in the future. And this understanding, although they didn't know why and they didn't know about viruses, was used in variolation and vaccination for smallpox.

As we don't want to get sick from the virus in the vaccine, new vaccines and the cowpox vaccines have also often used a member of the family of viruses that sort of makes you sick, and it sort of likes the one that you're trying to be protected against, but it doesn't make you very sick. Or maybe they take viruses or bacteria that make you sick, but they inactivate it so it can't multiply in your body and make you sick. But parts of the inactivated virus or bacteria can still make your body make an immune response. And that's how vaccines work.

Current vaccines are either inactivated viruses or viruses that are sort of like the viruses but not exactly like it. And that's how we currently planned vaccinations until 2020.

And in 2020, 2019 actually, by the end of 2019, we made vaccines in a brand new and totally amazing way, where we could give a little tiny bit of mRNA, messenger RNA, which doesn't last in our bodies very long. But we could take a little bit of mRNA, when introduced into our body, would tell our body to make a tiny little bit of the virus. Not the whole virus, just a little tiny bit, and then our bodies would make antibodies against that tiny bit and we would be partly or totally immune. It's an amazing new technology.

Now, all viruses are different, and they change their colors, so vaccines have to be developed for each virus. And some viruses change very little over time, like the chickenpox virus, and some viruses cause lasting immunity, like the chickenpox virus. But more on that later.

Some viruses change all over the map, like the influenza virus and the COVID virus that causes the common cold. So it's very difficult to get exactly one vaccine. You have to keep changing up your vaccines because the virus keeps changing.

And sometimes, for reasons that we don't understand, we don't build really strong lasting immunity. So we need new vaccines, like the flu shot, and we need boosters. So our immune system sometimes makes a permanent and terrific response and lasts a long time, and sometimes, like the tetanus vaccine, we need boosters every 10 years.

Now, all vaccines are tested in thousands of people before they're approved. Sort of unlike the original cowpox vaccine, which had no consent form, and no big trials and no approval. However, all vaccines have the potential to make a small number of people sick.

And sometimes that's because the technique of production of the vaccine. Maybe it's made in eggs, and it can cause an allergic reaction to those who have egg allergies. Or they're carried into the body by another virus that doesn't usually make anybody sick, but rarely someone gets sick, rarely meaning 1 in 100,000 people. And sometimes if you're giving millions of people a vaccine, and they get sick with something else at the same time, it's hard to know is it the vaccine, or was it just chance?

For example, that huge debate about whether the measles vaccine or the MMR, measles, mumps, rubella, can cause autism is clouded by the fact that young kids get MMRs and young kids who have autism show their autism about the same time they're getting the MMR. And there have been lots and lots of studies that have shown that MMRs do not cause autism, but the rumor, and the bad science, and the bad information still persist in some people's minds. And it's really, really hard to get rid of rumors. It's hard to get rid of bad information.

Now, the measles vaccine is a particular one close to my heart because measles in kids can cause a deadly pneumonia, and kids can die of measles. But pregnant women who get measles for the first time get rubella. That particular virus can affect the brain of the growing fetus and the heart. And babies that get rubella in utero from a sick mom can have blindness and deafness and congenital heart disease and mental difficulties.

So we mostly are very, very careful to make sure that women who are not immune to rubella when they're pregnant get the vaccine before they leave the hospital so that we know that they're immunized before their next pregnancy.

In the environmental domain, it turns out that most bacteria and viruses come from the environment around us and are passed by other humans or occasionally by farm animals. So most viruses are specific to a certain species.

Viruses, as it turns out, are pretty picky. They like certain kinds of parts of your body, and they like certain kinds of animals. But sometimes a virus changes, it mutates, and what only caused illness in pigs then causes illness in humans.

Now, not knowing where these viruses come from creates fear and often a hatred in one group who blames another. And we've seen this contemporaneously in terms of the COVID vaccine, but we certainly know that this has been happening all the time when people would come into town, and maybe they'd bring some virus with them, and then those people were shunned by folks who said, "It's your fault."

A great example is the dreadful 1918 influenza epidemic, which killed over 50 million people worldwide in about two years. And it's called the Spanish flu, but it probably did not arise in Spain. It arose in Kansas, in hog farms, and was spread to soldiers in army camps that were in Kansas, and then spread around the world as we shipped our soldiers around the world to fight World War I.

So we don't always know where in the environment the viruses come from, but given that we have people who travel all over the world, and given that we have industrial types of farming that put a lot of animals together so they can swap their viruses, and viruses and bacteria can change behaviors, we are going to have epidemics and viruses forever.

We certainly got rid of the smallpox vaccine, which was a miracle, and most all of the polio vaccines on the planet, which was terrific, and we almost got rid of measles, which was fantastic, but there are going to be new viruses coming.

It's hard for many people to know what information to believe because many people don't do numbers, and when faced with numbers, they have no way of processing numbers. And many people don't look at risk-benefit the same way that doctors do. They feel that they're protected in some magical way and they're not going to get sick, when in fact they may or may not really be protected. At least for those of us who practice medicine, we may not recognize the protection that they feel.

And at the beginning of the COVID-19 pandemic, we didn't really have numbers to tell pregnant women about the safety and efficacy of the vaccine. And the vaccines were approved back a year ago, almost a year ago, on emergency basis, and women were told that they should make their own decision about getting a vaccine.

We had a lot of data that suggested that women who got COVID when they were pregnant in the third trimester got pretty sick and were at greater risk of dying. And if they got really hypoxic, their lungs didn't work, their babies could die. So we knew that women got sicker than other women their age if they were pregnant. So we knew that COVID could make pregnant people sicker, but we just didn't know, and women were told that they should make their own decision about the vaccine, which I thought was a real cop-out.

Now the Pfizer vaccine has FDA general approval, and the CDC and the American College strongly have worded a recommendation that women who are pregnant or thinking about getting pregnant should get vaccinated.

But how do women make this decision? And early in the vaccine process, how did women make this decision?

 

Dr. Jones: So in the virtual studio is someone who can tell us with her story, and in the virtual studio, we have Hillary. Hillary, welcome to the "7 Domains."

Hillary: Thank you for having me.

Dr. Jones: So, Hillary, how far pregnant are you now, and when did you get the vaccine?

Hillary: So I'm 28 weeks and 2 days, so just starting my third trimester. And when I got the first vaccine, I didn't know I was pregnant yet. I think I was maybe two weeks, and then I had my second dose four weeks after that, so around six weeks.

Dr. Jones: Well, I think that you could then say that your vaccine was a fertility pill because you got pregnant about the same time that you got the vaccine. So if you put two and two together, you'd say, "Oh, I think everybody who's trying to get pregnant should get a vaccine because it makes you pregnant." Actually, some people are worried that it doesn't make you pregnant, and that is not the truth.

So you had this difficult question when the vaccine became available, and this was early on when the recommendations were pretty vague. It says let women decide. Well, how did you decide, and what information did you get?

Hillary: It was a very difficult time. I'd never been in that position before where there wasn't clear direction on should I or shouldn't I. People are like, "Just make the decision that you feel is right for you." And it's like, "But I'm not just making that decision for myself. I'm making it for me and my potentially unborn child." Would this have an effect on my fertility? Because we were trying to get pregnant. And so it was very daunting.

I will say especially given the political climate that we were in at the time and how fast the vaccine got the emergency approval by the FDA, yeah, I wasn't sure what the right thing was to do. But my husband was a huge advocate for me getting the vaccine and was I wouldn't necessarily say upset with me for even considering not getting the vaccine, but he felt strongly one way.

And then I reached out to my doctor's office to ask, "Is this something that I should get given that we are trying to get pregnant?" And their immediate response was, "Yes, get the vaccine," which made me a little nervous, but in the end, I just had to trust the advice that I was being given. I had to trust that if they responded that quickly to get the vaccine, that they must have talked about this, that they've obviously looked at whatever data was available, and came to the conclusion that this was the right thing to do.

All honesty, I felt like if I didn't get the vaccine, I would be alone in that decision because my husband wanted me to get it. My doctor thought I should get it. And so if I didn't get it and I got COVID, and God forbid not only made me really sick, but my baby, or caused me to lose the pregnancy, I would never be able to forgive myself or live with that guilt, especially knowing that my husband wanted me to get it.

So I'm going to try not to get emotional here, and this might sound selfish, but if I did get the vaccine, and I had some kind of side effect or there was some kind of birth defect, I wouldn't be alone in that decision, because my husband wanted me to do it, my doctor told me to do it. And so I could kind of share that burden, if you will, of this isn't all my fault, where if I decided not to get the vaccine, that would be completely 100% my decision.

Dr. Jones: So that was really an emotional decision. I mean, they didn't have many numbers to give you, and they didn't blackmail you into it, but it felt like you were really making a really hard decision. And they said it's up to you, but they were looming over you with their advice. That sounds hard, Hillary. That sounds hard. It makes me sad to know that you were alone with that.

Hillary: Yeah, it was stressful. It was very, very stressful. But when you're in a situation where you don't know what the right thing to do is, all I could do was what I felt was the most right thing. Yeah, I could have side effects from a vaccine. I don't know what effect that would have on my growing fetus. But the alternative is if I got COVID, the repercussions of that just seemed like it would be so much worse.

And I've never been an anti-vaxxer. I believe in getting vaccines. I've always gotten my vaccines that I should have. I think for me I was just worried about how quickly the vaccine was pushed through, and given how politicized the pandemic had gotten, it was just like I didn't know which way to go.

Dr. Jones: Right. So it was an emotional decision. It had some social overtones as well, and you weren't given a lot of numbers, so it couldn't be an intellectual decision. And then you had to face the decision about getting the second vaccine, which had some side effects potentially.

So you got the first one, and now you're pregnant, thanks to the vaccine, which I think made you get pregnant. I mean, I'm a fertility doctor and if I had a patient who danced in half a skirt in the middle of the bright moon and they got pregnant, I said, "You've really got to try that." But now you're faced with this second vaccine. Was that similar, or how did that go?

Hillary: I would say the second vaccine was maybe even a little bit more stressful, just because I knew I was pregnant then. The first time we were trying to get pregnant, but I didn't know that I was yet. With the second one, I was for sure pregnant. But again, my doctor was recommending that I go ahead and get it.

Even with the second vaccine, I would say that my husband started to teeter just a little bit. He wasn't quite as passionate as he was the first time. I could tell. He was a little unsure too of like, "Should we or shouldn't we?" And in the end, we relied on the advice from our doctor, because they have my best interest at heart. They wouldn't lead me astray, and they obviously have looked at the data and have dedicated their careers to medicine and know a lot more about it than I do. And so I just had to let go and just kind of trust in that medical advice.

Dr. Jones: So you were actually a very early adopter in the sense that you had a vaccine as soon as it could be available to people your age. Did you get any pushback? Thinking about the social domain and how we all swirl around with people that we know, and we sometimes share the same ideas with people that we know, did you get any pushback from people you knew, or were you private about this?

Hillary: I was actually very private about it. So other than my husband and my doctor, I really didn't reach out to anyone for advice. My mother is a registered nurse, but I just . . . Because everything surrounding the pandemic and the vaccine was so politicized . . . I mean, my parents have different political views than I do, and I just didn't want to go there. This was just about my health. It wasn't about anything else, and so I just kept it private, just between us, so that we could figure out the right thing to do.

Dr. Jones: As I say, you're now a vanguard. Now we have lots more information in the past five or six months, and now the FDA and the CDC and the American College of OB/GYN is quite strongly recommending that women who are thinking about getting pregnant, or who are pregnant, and who are breastfeeding get vaccinated.

So you were out there making a decision, and I think we think people like me would always make decisions based on the numbers. I look at the numbers, and I know numbers, and I know how to manipulate numbers, and I know what they mean, but sometimes you can see how people might decide not to get a vaccine because it's an emotional decision in a different direction for them.

Hillary: Yeah, definitely. I mean, I never thought I'd be in a position where I would be questioning on whether or not I should get a vaccine. I never really thought that the decision would be so ambiguous. Usually, it's like, "This vaccine has been around forever. It's what you do." So to have not only lived through a pandemic . . . I didn't think that could ever happen in this day and age with our technology and advances in medicine. It's like, "How is this happening?" But then to also be offered this vaccine and question whether I should take it or not was just such a surreal experience to be in.

 

Well, vaccines of all kinds have become a social flashpoint. And I'm a boomer from a middle-class educated family, and I grew up with the miracle of the polio vaccine, which we talked about. I've been a big vaccine fan because of the polio experience, even though when we got the polio vaccine, it was very early in the polio vaccine experience. But I trained in OB knowing about the horrible birth defects that came from a mom getting measles during pregnancy. So I am a total pro-vaxxer because I look at the numbers. I look at all the numbers.

And kids of my generation all carry a little scar on their hip, or their shoulder, from the smallpox vaccine. My child and your child will never have a smallpox vaccine, and they'll never die of smallpox.

 

Dr. Jones: Chloé, you're there. Chloé is my other favorite millennial. Chloé is my producer. Chloé's parents and Chloé came from Vietnam. Chloé, can you talk about your family, your parents, and thinking about the social domain, how they might think about being vaccinated?

Chloé: Yeah. I mean, this answer is going to be very short and simple and boring, but they're very much pro-vaccination. My parents, both of them, are kind of like the vaccine that you have available to you is the best one, regardless of the brand, regardless of . . . I guess unlike you, Kirtly, they don't really look at the data. They're normal people. They don't read medical journals and stuff like that. And so it's kind of just by gut and by feeling.

So I've always grown up not really knowing that there were people that were anti-vaccination until I got older and I got into my career and being a health communicator. There are actually people that are against vaccinations and giving vaccines. So it was a little bit of a new world for me, which is fine. I mean, everybody is entitled to their own opinion. But I have all of my vaccines. I'm up to date. My parents, they are all up to date.

And it was interesting earlier in the episode you had mentioned about the . . . smallpox? Is that what it is?

Dr. Jones: Smallpox, yeah.

Chloé: Yeah. But I actually have a scar on my shoulder.

Dr. Jones: Well, that's because it turns out that we eradicated smallpox in the U.S. in a matter of maybe 10 or 15 years after the first vaccine big push that started in the '50s and early '60s. But there was still smallpox in Southeast Asia, and there was still smallpox in India. So you got it when you were just a little tiny girl in Vietnam because they were still vaccinating back then.

Chloé: So I'm unlike the other millennials in America. I actually have one of those scars.

Dr. Jones: Yes. Worldwide, it was hard to spread vaccines out to all parts of the world where everyone, no matter what their socio-economic status, no matter what their ability to read and write . . . People all over the planet had to get vaccinated so we could eradicate this horrible, horrible disease. And people did it.

Some people, they didn't know numbers, and they didn't even understand viruses, and they didn't understand vaccines, but the people in their villages told them to do it, and people did it. And that's how we got rid of it.

Chloé: You hear something, "My neighbor isn't getting it. I shouldn't get it," or, "My friend is not getting it, so I'm not getting it either." And it really isn't based on data, or numbers, or anything like that. It's just all on feelings. And numbers don't really mean anything to people if they're not even looking at it.

Dr. Jones: No. In fact, often people don't understand numbers. They don't know how to bring numbers into the context of their lives. And in fact, that's really not how people make decisions.

 

I'll tell a little story about the flu vaccine in that I didn't always get the flu vaccine. I was working really hard. It was too busy. I just didn't have time to go to Smith's or wherever I was going to get it. And then one year I got influenza, and I was as sick as I'd ever been as a grown-up. And I went to work every day. I mean, I was pretty sure I had influenza, and I was coughing, and I went to work, and I spread that around. I didn't wear a mask every day. This is a long time ago when doctors just went to work.

And then the hospital decided some years ago that anybody who worked at the University Hospital had to get vaccinated against influenza. It was a requirement. If you bumped up against patients, you had to get vaccinated.

For me, it was a little bit of a guilt trip because I thought, "Well, yeah, I could get flu and get sick again," but mostly the reason they did this is that we were not supposed to as healthcare providers make our most vulnerable patients sick. And for me, it was OB patients and OB women who were pregnant can die from influenza. And they do. So for me getting the flu vaccine every year as a provider, the University Hospital had to kind of lean on me a little bit because I thought, "Oh, it's not that big a deal." But it is a very big deal.

So now I'm an old person. I'm officially old, and now I get the flu vaccine because I'm one of those vulnerable people. But mostly now if you work at the University Hospital, you do not have a choice. You have to get the vaccine or you don't have a job. That's just how it goes. And it's to protect the most vulnerable people we take care of -- the elderly, the immunocompromised, the sick, the pregnant, and the little ones.

So I feel humble in the face of the diversity of life in this planet. I am a biologist and I think viruses are beautiful, quite frankly, and the coronavirus is a physically beautiful little virus. I'm also humble in terms of what we know and what we don't know about our immune system, which is an incredible gift that allows us to live in the world that is populated by bacteria and viruses.

I am grateful that the smallpox virus is no longer a plague among humans. But the chickenpox virus has a very interesting behavior. I got chickenpox. In fact, when I was little, my parents wanted all of us to get chickenpox together, so if we were all going to get sick, we should all get sick. And that's now discouraged because once a kid gets chickenpox, they can spread it to pregnant women or teenagers, who can get very sick.

But once you've had chickenpox, you don't get chickenpox again, but the virus is with you forever. And the chickenpox virus hides out in your spinal column in some of the sensory nerves. And when you get old, or stressed, or your immune system drops, and your antibodies go down, this chickenpox virus wanders out onto your skin and makes shingles.

So I carry this memory in an actual virus from my 6-year-old chickenpox. This living thing called a virus is with me the rest of my life. And now I will get a shingles vaccine because I've had shingles and it's no joke. It's no fun and no joke. But I kind of like the idea that I share my body with some viruses that have been with me forever. It ties me to the world. It's bigger, and I feel that it's really an amazing thing to have an immune system and to live on a planet with so many interesting creatures and viruses. But that's just me.

So we are just going to finish up this "7 Domains of Vaccination" with a thank you to Chloé and a thank you to Hillary.

And before we finish with our "7 Domains" haiku, I want to shout out to all of you who are wanting to have conversations with people you love about difficult topics. You can share our podcasts wherever you get your podcasts, or at womens7.com. There are many topics that might be able to spark a conversation with you and the women you love and the people you love. So join us and listen to some of our other episodes that might make you smile, like "7 Domains of Chocolate" or "7 Domains of Travel." Join us wherever you get your podcasts.

We're going to end with a "7 Domains" haiku.

 

Complicated gift
A gift we gave to each other
The end of smallpox

 

Thanks for joining us on the "7 Domains."