V IS FOR VACCINATE
Past, Present, and Future of Ethical Research
We’re introducing our “V is for” campaign, an interview series shining a light on trailblazing medical professionals in our community. The campaign explores topics in healthcare that conveniently begin with our namesake letter V.
V IS FOR | FEBRURARY 24, 2021
About Jordin, RN
Curiosity killed the cat, but satisfaction brought it back. Jordin, RN has an insatiable thirst for knowledge, which led to a pivot in her career path. She is a Houston research clinical trial nurse on a mission to improve patient care through nurse-driven innovation. On a given day, she sees patients, manages her own studies, and helps treat people in clinical trials who would otherwise not receive any treatment due to lack of access to care.
"I hope to produce nurse-driven tools, both digital and tangible, to improve patient care."
vaccines: a brief history
Since their inception, vaccines have had a tumultuous history. The first “vaccine” dated back to the early 19th century, which involved the practice of injecting patients with fluid from a cowpox blister. This led to the development of a vaccine to prevent the spread of smallpox. Despite the success, there was political backlash as well as skepticism regarding hygiene, sanitation, and cleanliness. Scientists developed more rigorous processes for vaccine formulation and injection with the novel practice of the aseptic technique starting in the mid 1800s. As medicine became increasingly advanced, several vaccines were rolled out, including the cholera, rabies, and polio vaccines. During this time, a live virus was still used to vaccinate individuals. Conversely, today's modern vaccines often use inactive or attenuated methods to yield safe and effective results, triggering an immune response rather than true infection. So where did it all go wrong, and how did everything become so polarized?
scars from the Cutter Incident
The Cutter Incident in the 1950s spearheaded a massive revolution in vaccination development. Several patients, including children, were infected with polio following vaccination. This resulted in 250 patients becoming paralyzed. The source of the vaccine was traced back to a single company: Cutter Laboratories. Despite safety testing and standard operating procedures, a manufacturing oversight led to a faulty production of these polio vaccines. This vaccine recall was the impetus for more robust government regulation.
After the incident, vaccine rates plummeted, and waves of doubt spread across the United States, expectedly so. As vaccines became mandated in certain cities, residents fought the court system (i.e. Henning Jacobson v. Massachusetts). Distrust, tension, and outcry mounted, creating a major fracture between the public and regulatory bodies. The bridge between the scientific process and the public opinion became increasingly disparate. Clinical trials adopted reform and regulation, as unethical experiments on people of color and undereducated individuals were rampant in a racist America (see Tuskegee Syphilis study and gynecological experiments). These horrendous experiments, among others, led to The Patient’s Rights movement of the 1970s, and later, the creation of the informed consent we still use today.
"The regulatory bodies that exist can make my job harder but, in retrospect, are necessary and valuable. Third-party monitors inspect for any protocol deviations and violations. Patients are allowed to exit trials at any time. While we still deal with the lasting effects of wrongdoings in the past, trials have the potential to help people with rare diseases. I want to make the field as honest and transparent as possible."
science vs. society
How did the past lead to today's atmosphere? In the early 2000s, former doctors like Andrew Wakefield and Robert Sears added to the wave of polarization despite years of medical advancement. Conspiracy theorists, sensationalists, and thought leaders still hold a massive following regardless of the huge body of scientific evidence that exists today. These individuals have profited off falsehoods that further the divide between the scientific community and the general public. Some of these claims can be attributed to the resurgence of diseases, like measles.
Today, science and medicine have advanced so much so that the general public arguably cannot keep up with the rhetoric. I understand why individuals would be skeptical of the language and confusing protocols of vaccine trials. Scientific verbiage is not easy to understand and isolates those outside of the community, further creating a gap between lifelong researchers and laymen. This dissonance can lead to distrust, fear, and spread of misinformation. Government mandates requiring children to be vaccinated in public schools also leads to apprehension among these groups. The topic of mandated vaccinations is one for another discussion – however, it is important for us not to discount nor dismiss the very real fear some individuals have on this subject.
While the SARS-CoV-2 (COVID-19) vaccine has not been studied widely in niche populations, we do know that nearly all major adverse events happen within the first two months of receiving a dose. What else can we learn? Well – a lot of things! We are not sure if fully vaccinated individuals can still transmit the virus asymptomatically. Scientists do not know if it is effective with emerging novel strains. Clinical trial coordinators did not test it on children during trials. All of these and more are extremely important to research. However, the highest priority is slowing the spread of a virus that has killed nearly half a million Americans in a single year. Although scientists have been testing mRNA vaccine technology for years, it is still relatively new. We have much to learn and improve on.
Ultimately, it is okay to have questions and hesitations about new science. For me, I trust modern science because my experiences and expertise brought me here. I am vaccinated to protect my patients, loved ones, and strangers alike.
towards a brighter and a more informed future
Perhaps the largest lesson we must learn together is how to create a trustworthy and open dialogue between the scientific community and the public at-large. As medical and science workers, we must be more receptive to populations who have been abused in the not so distant past, and consider the way we reference complex medical terminology and protocols. Medicine is tirelessly working to earn public trust. It is our duty to never repeat the careless and sometimes targeted actions of the past to ensure our world is filled with ongoing discovery and the chance at a better future together.
Plotkin, S., Gerber, J., & Offit, P. (2009, February 15). Vaccines and Autism: A Tale of Shifting Hypotheses. Retrieved January 21, 2021, from https://academic.oup.com/cid/article/48/4/456/284219
Centers for Disease Control and Prevention (CDC). Information about Thimerosal.
Institute of Medicine (IOM). Immunization safety review: Vaccines and autism. Washington, DC: National Academies Press; 2004. Accessed 01/10/2018.
Historical Safety Concerns. (2020, September 04). Retrieved January 21, 2021, from https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html
Resurgence of Measles, Pertussis Fueled by Vaccine Refusals. (2018, September 04). Retrieved January 21, 2021, from https://directorsblog.nih.gov/2016/03/22/resurgence-of-measles-pertussis-fueled-by-vaccine-refusals/
Lanzarotta, T., & Ramos, M. A. (2018). Mistrust in Medicine: The Rise and Fall of America's First Vaccine Institute. American journal of public health, 108(6), 741–747. https://doi.org/10.2105/AJPH.2018.304348
Overview of Testing for SARS-CoV-2 (COVID-19). (n.d.). Retrieved January 21, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html
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VACCINATE | Past, present, and future of ethical research