Read on Twitter
So a few rambling thoughts in a thread I'll be returning to in between work this afternoon. Why vaccination for Covid-19 is, in world history, completely unprecedented. (1)
We've had vaccines for years. The first in 1796, Jenners smallpox vaccine. He noticed that those who had been infected with cowpox didn't get smallpox. He took fluid from a cowpox pustule, scratched a child with it, later tried to give the same kid smallpox it worked! (2)
The press was, initially, unconvinced (3)
But it had escaped no ones attention that dairy maids didn't have smallpox scars. Whats more their profession required them to be clean - they were rather fetishised as a result. (4)
It took 200 years to eradicate smallpox. But in 1980, it was declared gone. (5) https://www.cdc.gov/smallpox/history/history.html#:~:text=Almost%20two%20centuries%20after%20Jenner,achievement%20in%20international%20public%20health.
But we actually don't know when man first suffered from it. We kind of think we know when it first hit Europe, like a sledgehammer, wiping out whole communities and more than decimating the Roman army... (6) https://en.wikipedia.org/wiki/Antonine_Plague
There's some evidence that smallpox was around in India around 1500BCE, and that Ramses III died of it, but its a little speculative (7) https://en.wikipedia.org/wiki/Ramesses_V
And we know it played merry hell with every new territory it got to. I've talked before about the devastation caused when European diseases got to the Americas, I haven't mentioned how smallpox wiped out a third of the population of Japan (8) https://en.wikipedia.org/wiki/735%E2%80%93737_Japanese_smallpox_epidemic
Amazingly, one of modern mans old adversaries was wiped out by vaccination. But before widespread vaccination we also know what smallpox did - it killed tens of thousands every year, but it didn't continue spreading the same way in the same place wiping out a huge percentage (9)
...you were left, via the ongoing price of many thousands of dead and an initial down payment of a massive chunk of your population, with some level of resistance. Not enough, of course, but some (10)
Much of the same is true of measles. We don't know when that first infected people, but whenever it first found its way into new lands the damage was extraordinary. Alongside smallpox, typhus and the other diseases brought to the Americas it destroyed whole cultures (11)
But we can and should be able to defeat measles. Its got a tremendous and safe vaccine. Shame about the anti-vacc movement killing people. (12) https://www.who.int/news/item/12-11-2020-worldwide-measles-deaths-climb-50-from-2016-to-2019-claiming-over-207-500-lives-in-2019
But the thing is, they're old enemies of mankind. We know what they do in a population and we know that our overall chance of survival is. We also know very well what these diseases look like, we can diagnose them easily, we can identify them. (13)
Thats really easy because while they -can- attack people in all sorts of ways, we've quite literally killed off whole groups of people over thousands of years. We know what these diseases look like in -survivors- and -descendants of survivors- (14)
Covid-19 is new. Its shockingly new. Its taken mankind a year to have a whole pile of vaccines almost ready to roll. This is completely unprecedented. We still don't even know how Covid-19 is going to behave in human populations. We know its a problem, we know it will kill (15)
But the absolute marvel of modern science has allowed us to develop vaccination tools in lightning fast time. Nothing even close to this has ever happened before. Workable vaccines to a brand new pathogen (16)
If Covid-19 had been with us for centuries then we might have a better idea what it looked like in the descendants of the survivors. But it hasn't. What we're facing is a disease with little or no innate immunity and with enormously variable presentation (17)
But its also one without a lot of antigenic variation. So it CAN be eradicated. And I'm going to argue that it absolutely must be. But I've work to do, so I'll start making that argument later (18 - more later)
Back again. So, other vaccines against old diseases, like smallpox and measles, you've got a clear, visible indicator and they're both almost never asymptomatic. You can see it in a population (19)
And that makes them excellent targets for eradication. Well, its one of the things that makes them excellent targets. Smallpox was a perfect candidate because there was an excellent vaccine, it wasn't very variable, and you can't now know you've got it (20)
Measles should have been eradicated by now but, sadly, politics and idiots got in the way. But the next candidate people often talk about is polio, and I think in some ways its a better comparison for Covid-19 (21)
Polio is a HORRIBLE disease for some. It can paralyse, it can kill. Or, it can not. In about 95% of cases its relatively mild. In 70% its near or entirely asymptomatic (22) https://www.gosh.nhs.uk/conditions-and-treatments/general-medical-conditions/polio
About 25% of people with polio get flu-like symptoms. I mean, in this perspective its not that bad, right? Oh, and 1 in 25 get meningitis, 1 in 200 are paralysed, and about 10% of those die due to not being able to breathe. (23)
...and if you do recover, it can slap you down even 40 years later with post-polio syndrome. Make no mistake, this disease can wreck your life, and in years gone by it has killed vast numbers of people, (24) https://en.wikipedia.org/wiki/Post-polio_syndrome
...now we have safe and effective vaccines against smallpox, measles and polio. And we have managed to eradicate only one of them. Now why is this relevant to Covid-19? Momentum, thats why (25)
We've never had a disease like this where we've had a global pandemic and an immediate vaccine. This is brand new. This has never happened. There are things we know about it, there are things we don't. But we will -never- have this moment, with this pathogen, ever again (26)
Frankly we don't know what this disease looks like when its polio or measles. We don't know what Covid-19 looks like when we're talking about the descendants of survivors hundreds of years after. And we never should (27)
RIGHT NOW its a polio and not a smallpox. We know that so far its looking like a seriously bad disease for some but with a tendency to spread asymptomatically. If we don't eradicate it then for at least the forseeable future its a new equivalent of polio (28)
...if we don't eradicate it before we become as blase as we've become about polio, game over, we're not getting rid of it any time soon. We've a new recurring disease that'll keep coming back. For generations. Forever (29)
But this is a completely unprecedented moment in our history. New vaccines for a new pathogen - we CAN therefore jump on from here to kill it stone dead. There will never be the political will nor the public attention that we're seeing now, ever again (30)
We face a choice really. We're more vulnerable to this virus causing untold financial and social harm than, say, measles or polio can because its brand new and there is almost no immunity to it, in that way it IS like when measles or smallpox first arrived (31)
So where are we going to go with this? Do we want to let this disease ravage and become something identifiably awful for all of the rest of human history or will we, collectively, have at it and eradicate it for all time? It seems fairly obvious what we should be doing (fin)
