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We Need A Reminder Of What The Pre-Vaccine Era Was Like

A girl with polio meets one of the first children to get a polio vaccine.

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Of the more than 200 Americans infected by the measles outbreak in Texas and beyond, nearly all were unvaccinated — including a 6-year-old child who died — or had an unknown immunization status. While a measles epidemic affecting hundreds of people across state lines is hard to imagine in 2025, the vaccine fears that help fuel these outbreaks are as old as vaccination itself. Even when some of the worst diseases known to humankind threaten lives, there have always been those who fear the vaccine more than the disease.

In the early 1800s, some people rejected the smallpox vaccine because they didn't trust the doctors and scientists promoting them, or because they saw vaccines as an affront to God's will, or because they worried about dangers they'd heard or witnessed. That the early version of the vaccine occasionally spread infection only heightened those fears.

So governments increasingly made vaccination mandatory. Over a century ago, refusers could face quarantine, fines or even jail time. Vaccination objections grew. People argued that mandatory vaccination undermined individual liberty, or that the diseases the vaccines prevented weren't that serious.

A boy wearing a bandage typical for mumps patients, with his dog wearing a matching bandage.

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A boy taking part in the clinical trials for the live-virus measles vaccine.

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Those ideas persist today. Popular influencers are calling diseases like measles and mumps "no big deal."

The modern-day childhood vaccine schedule has allowed children to grow into healthy adults — something all parents hoped for in the centuries when diseases emptied towns, destroyed economies, ravaged battalions, overwhelmed hospitals and vexed nurses and doctors. For people who've never seen them, the worst manifestations of some of these preventable diseases are almost unimaginable. It's worth remembering their toll.

To understand how common these diseases were before vaccines, we reviewed historical surveys asking parents if their children had contracted them. The estimates are rough, but underscore just how much these diseases have faded from public memory.

Smallpox Vaccine created in 1798

Smallpox caused fever, headache, nausea, racking body aches and a rash of excoriating, pus-filled blisters. Sleepless victims suffered night terrors and delusions. In the worst historical cases, the pustules spread so densely that they covered the surface of the body, crusted over the eyes, and coursed over the mucous membranes until internal hemorrhaging led to certain death. A smallpox outbreak could kill up to 30 percent of people infected. Survivors were often left pock-marked and blind.

The smallpox vaccine, originally developed with virus from a milder animal disease, cowpox, led to smallpox's global eradication in 1980 — the ultimate vaccination success story.

Diphtheria Vaccine created in 1914

At its height over a century ago, diphtheria was often mistaken for a sore throat. Bad cases were identifiable only by the sweet-smelling, putrid-colored membrane of bacteria and decaying cells covering the patient's tonsils and throat. Diphtheria bacteria churn out a toxin that can cause paralysis, but in 19th-century epidemics, sick children often died of suffocation first. In the deadliest outbreaks, 30 percent to 50 percent of infected children perished.

Diphtheria was an unpredictable roulette of mild and deadly outbreaks until a vaccine was developed that could finally protect children from the disease's terrors.

Pertussis Vaccine created in 1914

Formally known as pertussis, whooping cough often begins like a minor cough or cold. Weeks later, the cough is still there, unrelenting. Before antibiotics or vaccines, the patient's cough would grow violent and uncontrollable, terminating in its namesake "whoop" sound. In young children, the whoop would often lead to vomiting. In a severe case lasting weeks, a child might whoop and vomit several times an hour. Babies couldn't forcefully take in enough air to whoop, and the lack of oxygen meant they'd turn blue.

The first pertussis vaccines were manufactured in 1914, and a modern version was developed in the 1930s. A combined diphtheria, pertussis and tetanus vaccine was created and given to many American children by the end of the 1940s.

Polio Vaccine created in 1955

The first U.S. Polio epidemic was documented in the 1890s and further outbreaks followed. It peaked as other infectious diseases, like smallpox and measles, were fading from view and concern. Most polio infections are minor, with some causing a fever and sore throat. In less than 1 percent of infections, the virus attacks nerve cells in the brain and spinal cord that control movement. Some patients are partly paralyzed. Others lose the ability to swallow properly, walk or breathe. The worst cases were fatal.

The first polio vaccine was approved for use in 1955, and the disease was eliminated from the Americas by 1994. Today, polio regularly circulates in just two countries, but outbreaks crop up where war and deprivation allow it to take root.

Measles Vaccine created in 1961

When the first European colonists brought measles to the Americas, it was so infectious that it spared almost no one. It caused a vivid red rash and fevers that spiked so high and for so long that the sick searched desperately for relief from measles' fiery heat. In populations that had never seen the virus before, measles could kill up to a quarter of people. In previously exposed populations, it could still kill 20 percent of children.

In the mid-20th-century United States, thanks to overall improvements in nutrition, hygiene and medical care, measles death rates remained low. But the virus can have alarming complications, including pneumonia, brain swelling, rare but terrifying brain inflammation and an altered immune system that lasts long after the disease itself resolves.

The scientific developments behind the first polio vaccine helped make the first measles vaccines possible in the 1960s. With the vaccine's growing use, cases began to tumble.

Mumps Vaccine created in 1967

A military doctor caring for 18th-century British infantrymen was troubled by what happened when his troops caught the "gangrenous" sore throat that was spreading across Europe. In his patients, jaws and testicles swelled to an alarming size. At least one of his men died; others recovered with their testicles permanently atrophied. After two more centuries, doctors eventually agreed mumps could similarly affect women's breasts, ovaries and other reproductive organs. By the mid-20th century, scientific focus shifted to children, whose mumps led to huge and painful swelling of the salivary glands, which could spread to the brain and leave a child deaf.

The measles vaccine inspired one for mumps, and by the end of the 1970s it was recommended for all American children, with cases diminishing over the next decade.

Rubella Vaccine created in 1969

Children used to catch rubella without much fanfare, developing little more than cold symptoms. But when contagious children passed the disease to pregnant women, the fetus was at grave risk. The virus, which typically invades the airways, can travel to the placenta and disrupt the fetus's rapidly dividing cells. Before children were given the vaccine, rubella infections resulted in many miscarriages and stillbirths. Many children were born with birth defects such as cataracts, hearing loss and severe heart and bone deficiencies. In very rare cases, children developed neurological deficits, leaving them with chronic seizures and physical and intellectual disabilities.

A 1964 epidemic affected 20,000 infants and prompted research for a vaccine that was ultimately folded into the combined M.M.R. Vaccine in 1971. Today, the United States sees only a few cases a year.

How we came up with these estimates

Data on the number of cases for these diseases from the pre-vaccine era is hard to come by, and even the case counts are extremely unreliable. Many estimates suggest that perhaps only 10 percent of cases for most of these diseases were reported. As a result, we turned to historical surveys.

For mumps, rubella, diphtheria, measles, and whooping cough we used two surveys from before 1930, one that surveyed 14 communities and another that surveyed three.

For smallpox, we relied on secondary references to the prevalence during the 18th century. For polio, we made a rough calculation of the probability that a child would contract polio over his childhood based on average annual case rates acquired from Project Tycho.

All of the rates given are for approximately how many kids got each disease at some point during their childhoods.

Breakthrough In Next-generation Polio Vaccines

A more affordable, lower-risk polio vaccine is on the horizon, research led by the University of Leeds has found.

Researchers have taken a major step towards producing a more affordable and lower-risk polio vaccine using virus-like particles (VLPs). These particles mimic the outer protein shell of poliovirus, but are empty inside. This means there is no risk of infection, but the VLP still causes the immune system to respond.

Now, a research project led by Professor David Rowlands, Emeritus Professor of Molecular Virology at the University of Leeds, has tested the effectiveness of using different yeast, insect, mammalian and plant cells as expression systems to generate VLPs.

In a paper published in Nature Communications, the findings show that VLPs produced in both yeast and insect cells can perform equally or better than the current inactivated polio vaccine (IPV), which creates an immune system response by using a killed version of the poliovirus.

Professor Nicola Stonehouse is Chair in Molecular Biology at the University of Leeds School of Molecular and Cellular Biology and one of the senior authors on the paper. Professor Stonehouse said: "Any vaccine is only as effective as the number of children that it reaches. The key is to make vaccines universally accessible, as all children have a right to be protected from diseases such as polio, no matter where they live. Ultimately, VLPs would significantly contribute to vaccine equity.

"Thanks to research like this, we are already working with commercial partners to produce the next generation of polio vaccines. Although we don't yet know when these will be widely available, we are getting much closer to a polio-free future."

Today's polio vaccines

Currently, IPV is relatively expensive to produce because it requires high levels of bio-containment to minimise the risk of leaks of live poliovirus, which could result in outbreaks. VLPs are non-infectious and would not need to be handled under such stringent bio-safety conditions.

Oral polio vaccine (OPV), which contains live but weakened vaccine-virus, is also used in vaccination against polio.

Future polio vaccines

However, once all remaining strains of wild poliovirus have been successfully eradicated, OPV use will need to stop to eliminate a small risk of circulating variant poliovirus that can be associated with its use.

In populations where large numbers of people are unvaccinated and sewage disposal is poor, such strains can cause an outbreak through contact with faeces, often via contaminated water.

At this time, IPV will be the only polio vaccine available to populations, but expensive manufacturing procedures make it unaffordable for lower-income countries.

Non-infectious VLPs are easier to produce than current IPVs and the research has shown they are more temperature stable, thanks to genetic alteration of the outer shell. As they are non-infectious, this means they will be less expensive to produce, helping to improve equitable access to vaccination.

Dr. Martin Eisenhawer is the WHO focal point for the development of Polio VLPs and the VLP consortium led by the University of Leeds. Dr. Eisenhawer said: "The WHO, when looking at research and development priorities for new generation Polio vaccines, has early on identified VLPs as a technology that could be an ideal tool especially for the post-eradication period with the aim for Polio VLPs to be ultimately produced as a very cost effective and safe vaccine by developing country manufacturers for the benefit of a global supply.

"Through an extensive collaboration with the research consortium, vaccine manufacturers and the Global Polio Eradication Initiative (GPEI), we are approaching this goal with the new developments. This research shows that a critical new polio vaccine solution is on the horizon. It would be a critical new tool to not only achieve but sustain global polio eradication, and ensure -- in an equitable way -- that no child anywhere will ever again be paralysed by any poliovirus. It is about ensuring that once polio is eradicated, it will stay eradicated."

The international research collaboration, which was funded by the World Health Organization, also included researchers from the University of Oxford, the Medicines and Healthcare products Regulatory Agency (MHRA), the John Innes Centre, The Pirbright Institute, the University of Florida and the University of Reading. The structural data was collected using a cryo-electron microscope at Diamond Light Source.

VLPs are already used in vaccines for hepatitis B and human papillomavirus (HPV) -- and researchers have been working for over a decade to apply this successful technology to help eradicate polio.

The next generation of polio vaccinations are likely to be produced in yeast or insect cells, as the research showed these were effective when tested on rats and mice. These cell expression systems are also favoured by companies and are used for existing vaccinations, due to their low cost.

Dr Lee Sherry was one of four lead authors on the paper while working at the University of Leeds. Dr Sherry, who now holds a position at the University of Glasgow, said: "Following the success of using VLP vaccines in preventing hepatitis B and HPV-related diseases, it is very exciting to see this research being taken forward by industrial partners as a safer vaccine production strategy as we move towards a polio-free world."

Turkana, West Pokot, Wajir Risk Outbreak Of Polio And Measles Due To Low Immunisation, Says MoH

Oral poliovirus vaccines (OPV) are the predominant vaccine used in the fight to eradicate polio. [File, Standard]

The Ministry of Health has warned that counties with low uptake of childhood immunisation are at high risk of measles and polio outbreaks.

Among the counties at high risk include Turkana, West Pokot, Wajir, Mandera, and Garissa.

Dr Lucy Mecca, the head of the National Vaccines and Immunisation Program(NVIP) said the outbreak of the diseases is evident due to low immunity among children who missed out on childhood jabs.

"We are likely to report disease outbreaks like measles, and polio due to children who missed out on vaccination coverage," said Dr Mecca.

According to the 2022 Kenya Demographic and Health Survey (KDHS), the rate of childhood immunisation in Kenya has increased, with at least 80 percent of children fully immunised, from 79 percent in 2014.

But counties of Turkana, West Pokot, Wajir, Mandera and Garissa recorded 60, 49,49, 29 and 23 percent respectively.

The counties recorded an outbreak of measles last year, whereas Kenya remains on a high alert, following polio outbreak in Malawi.

Dr Mecca reiterated the need to have county leadership in counties with low immunisation to put more focus on immunisation, to reach hard-hit areas.

"Some of the counties might have recorded low uptake of the jabs because of drought, but more focus needs to be put to find the missed children," said the official.

She added, "The departments of health need money allocated to immunisation by the county leadership".

In December last year, the ministry launched a measles' rubella vaccination campaign in the wake of an outbreak reported in six counties.

The ten-day campaign was conducted in Marsabit, Wajir, Garissa, Nairobi, Turkana, Mandera and West Pokot, and targeted 1.2 million children aged between nine and 59 months.

"It is worrying that we had a measles outbreak last year, the same counties, which have reported low uptake of vaccination. More campaigns were also conducted in the counties," Dr Mecca said.

In Kenya, routine childhood vaccines are supplied by the national government, through Kenya Expanded Program Immunisation (KEPI).

Vaccines under the program include Bacillus Calmette-Guerin (BCG)- administered at birth, Tuberculosis (issued at birth), Rotarix (rotavirus vaccine), Diphtheria, Pertussis (DPT), whooping cough, and tetanus.

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Others are Hepatitis B, Haemophilus influenzae type B (Hib), Pneumococcal and Measles and rubella.

Mecca added that vaccination is done to prevent childhood diseases, that contribute to infant morbidity and mortality.

According to KDHS, eight in 10 children aged between 12 and 23 months were fully vaccinated with the basic antigens.

The coverage rate for the Oral Polio Vaccine (OPV) administered at birth, co-administered with bacille Calmette-Guerin (BCG) as per the national schedule, was 86 percent.

The BCG coverage was slightly lower among children whose mothers have no education, (89 percent), than among those whose mothers have more than a secondary education, at 99 percent.

"With respect to individual vaccine antigens, 97 percent of the children have received BCG, the first dose of pentavalent, and the first dose of Oral Polio Vaccine (OPV), and 89 percent have received the first dose of Measles-Rubella (MR) vaccine.

The coverage rate for the Oral Polio Vaccine (OPV) birth dose, co-administered with BCG as per the national schedule, was 86 percent.

Uptake of polio jab was 11 percent lower than BCG, while BCG coverage was found to be slightly lower among children whose mothers have no education, representing 89 percent, than among those whose mothers have more than a secondary education, at 99 percent.

However, at least two percent of children across the country, aged between 12 and 13 months, had not received any vaccination during the survey period.

Contrary to laxity in the counties with low uptake of the jabs, Vihiga County applied several strategies to attain the 96 percent coverage

Among the measures applied were the motivation of healthcare providers in kind and by word of mouth, community mapping from house to community strategy to ensure each household member receives desired health attention respectively vaccination included.

"Regular constructive support supervisions with regular feedback to the facility staff has helped conduct more vaccine coverage," said Edith Anjere, the Vihiga county immunisation coordinator.

She added, "There is good political will too towards health services in general. Regular collection and distribution of vaccines and other commodities to the health facility, for example, ensuring readily available commodities. Regular defaulter tracking by use of diaries we are able to readily tell who has not come on the appointed date,"

Mecca noted that the ministry will continue to sensitise the community on the importance of childhood immunisation, to uphold gains made in fighting childhood-related diseases.

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