EMS Hall of Fame: The Pioneers of Prehospital Care—The Vaccine Pioneers

The short history of EMS has been driven by the wisdom, foresight, and innovation of countless individuals. As the field ages into its second half-century and its origins fade to the past, it’s worth commemorating the greatest pioneers of prehospital emergency medical services. This series honors these trailblazers. 

Onesimus, Edward Jenner 

Smallpox vaccine

Considered eradicated since 1980, smallpox was once one of the most frightening, deadly, and disfiguring diseases out there. A vaccine can prevent it, but it has no cure, and advances in synthetic biology mean it’s a continuing bioterrorism threat.

The roots of the smallpox vaccine trace to the early 1700s, when an African named Onesimus had the pus of a smallpox victim rubbed into an open wound to help stave off the disease. At the time this was a common practice in various places around the globe. But Onesimus was later enslaved and brought to Boston, where he shared the practice with his owner, Puritan minister Cotton Mather. Mather became a staunch supporter and advocate of the practice, called variolation, during a smallpox outbreak in 1721. It is believed to have saved many Bostonians. 

Variolation became common in Europe during the 1700s. There English physician Edward Jenner observed that dairy workers who’d had cowpox—an animal virus not fatal to humans—also seemed resistant to smallpox infection. In 1796 he swabbed material from a milkmaid’s cowpox sore onto an 8-year-old boy, James Phipps. Phipps became ill for several days but then recovered. Two months later Jenner exposed him to pus from a smallpox sore, and Phipps did not become infected. Jenner coined the term vaccination from the Latin vacca, for cow. 

The most successful vaccine in history, the smallpox vaccine was given routinely to U.S. children until 1972, when the disease was eradicated in the U.S. 

Jonas Salk, Albert Sabin

Polio vaccine

Unlike smallpox, which requires direct and generally prolonged face-to-face contact to spread, polio is highly contagious. The CDC recommends a series of four vaccinations for children, who face its greatest threat. The U.S. eradicated polio four decades ago, but it persists in other parts of the world. 

By the 1950s polio outbreaks were causing more than 15,000 cases of paralysis a year. U.S. virologist Jonas Salk had studied the disease since the ’40s, and he came to believe a vaccine made from dead virus material, rather than live, as was the previous practice, could be just as effective and possibly safer. He developed a way to deactivate the virus with formaldehyde that still triggered the immune system to produce antibodies against it. Salk tested his invention on his family before its approval in 1955. Subsequently he chose not to patent or profit from it in order to maximize its global distribution. 

A competitor to Salk, Polish-American physician Albert Sabin developed an oral polio vaccine by 1961. This was a live-virus vaccine that used weakened poliovirus. It was easier to produce and administer, as well as cheaper, and quickly came into broad use. 

Following introduction of the vaccines, polio cases in the U.S. declined to less than 100 in the 1960s and fewer than 10 in the 1970s. Less than 25 years after Salk’s vaccine, its domestic transmission in the U.S. was eliminated. Globally cases have fallen from around 350,000 in 1988, when the Global Polio Eradication Initiative began, to the elimination of serotypes 2 and 3 in the last six years. The last evidence of wild poliovirus type 1 transmission was in Africa in 2018, and five of six World Health Organization regions are now certified polio-free. 

John Erich is the senior editor of EMS World.