A Tale of Two Vaccines

Two elderly spinsters,  Grace Eldering (1900-1988) and Pearl Kendrick (1890-1980) lived together in a small house in Comstock Park, a down-market suburb of Grand Rapids, Michigan. They developed the first successful whooping cough vaccine.

I saw Grace a year before she died. She seemed anxious to talk to someone who somewhat understood the infection as well as the immunization practices.  I spent some time listening to this pleasant and iconic figure.

There is an excellent history of how two women developed the original whooping cough immunization. It leaves unexplained what got them making a whole cell vaccine and how they managed to get so much free cooperation.

They both had had whooping cough in childhood and had grim memories of the experience. The infection (called pertussis in medical circles) caused widespread community outbreaks before 1948.  The bacteria is extremely contagious.   It infects all age groups but in infants and very young children it can lead to death and, in the long-term, damage lungs producing slow lung destruction and bad breath. In the 1930s it killed around 6,000 children each year. It causes adults to have a chronic cough which is not otherwise damaging to their health and identifies them as carriers.

The State of Michigan had established four laboratories, one of which was in Grand Rapids. Doctors and public health officials in the area sent them cultures of contagious diseases such as typhoid, cholera, and pneumonia as well as dairy and food surveillance samples at a time when ordinary hospitals did not have this capability. 

Kendrick and Eldering undertook helping local physicians, mainly pediatricians and ENT specialists (who were very prominent 100 years ago) contrive a way to treat the “Michigan sinus.” Doctors would send swabs from afflicted patients to the lab which the two investigators would culture. After growth, colonies of bacteria, mainly ordinary streptococci and staphylococci, were harvested, exposed to merthiolate which killed the bacteria and left the surfaces of the bugs exposed as antigens. They send the resulting concoction back to the referring physicians who would inject the brew into their patients causing a moderate to severe inflammatory reaction. The resulting stress elicited hydrocortisone and epinephrine secretion which calmed the “Michigan sinus.”(Don’t try this!) 

One day shortly after meeting in 1932 they decided to do something significant and applied the same procedure to a strain of pertussis that they had just cultured in their laboratory. They gave each other the vaccine as a rough test for safety and then contacted the physicians with whom they routinely worked and asked them to immunize children in their practices with this vaccine. This seemed to work, and over the next several years they worked with the Public Health Service in the Grand Rapids area to immunize 5800 children who attended a vaccination clinic. They established a control group of similar children who are not immunized. They personally saw and cultured most of the study’s cases of whooping cough.  After three years they could show that the immunized children had only a miniscule possibility of developing whooping cough versus the unimmunized children. Their 1939 paper caused a sensation. Researchers from Harvard and Hopkins became involved. Over the next decade during the depression and World War II, despite only meager financial support,  they continued developing their vaccine, finding more immunogenic strains, exploring different concentrations of their vaccine and better methods to measure the protection that it conferred.  They combined their vaccine with the diphtheria and tetanus vaccines and this combination was accepted by the World Health Organization in 1948. Their whole cell preparation remained a standard in these immunizations for the next 45 years. 

The above account answers questions about how they got into the vaccine-making business and why they made it out of whole bacteria (that’s all that they had to work with.) It also explains how they got so much cooperation from the medical community; they were helping and interacting with the local doctors and public health officials on a daily basis. Grace emphasized several times to me that they were always treated as equals and with respect even though they were women.

However from the beginning the whole bacteria vaccine had several problems. In a tiny minority of children it caused seizures, in others a high fever and yet in others a day or two of continuous screaming, all of which was very disturbing to parents. None of the short-term complications ever led to long-term problems. In the early years it was widely understood that they were very acceptable compared to having potentially lethal childhood whooping cough. The vaccine generally protected children for five years and was first given shortly after birth. Kids got their one booster when they went to school at age five and  were protected until age ten. Whooping cough in older children did not cause serious problems although I can recall being miserable with it when I had it at age 11; the whites of my eyes were bloodshot from bleeding into the tissues, my head felt as though it would explode and I was barely able to move from the bed. Our general practitioner made a house call and prescribed an incorrect antibiotic, after which I promptly improved.  

The vaccines were fairly acceptable despite their toxicities to people who could remember having outbreaks of whooping cough and deaths but by the 1980s this was forgotten and many parents refused to have their children immunized. After this there were huge outbreaks of whooping cough because there emerged  large pools of susceptibles. 

There followed the development in 1996 of the second pertussis vaccine, the aqueous, which contained only some humors from the whole cell. This vaccine does not have the complications of seizures, crying spells and fevers that characterized the original vaccine but it only protects people for three years and it is thought to allow individuals to transmit the disease to others although they themselves are protected. Having to give the first booster at age three years is at an interval that is not very compatible with ordinary pediatric immunization practices. They can get their second booster when they enter school for a few more years of protection but then need a booster again. The aqueous pertussis vaccine protects for too short a time to do the job that the original vaccine did so well. 

Ideally adults get a routine vaccine that contains the aqueous antigen every 10 years (I haven’t had a booster in over 15 years) but it only protects for three years and probably does not eradicate the pertussis bacteria in carriers or impact the chronic cough conundrum much.

So after nearly 90 years of developing a vaccine against a bacteria that we can grow in any hospital laboratory, pertussis vaccination still falls short. We are still seeking a better vaccine after an 89-year effort created in part by the life’s work of two gifted women, by the results documented as billions of individuals received multiple doses and where every minor aberration is investigated by a malpractice lawyer.

I find the claim that the COVID-19 vaccines that have been developed  and deployed to lack credibility. Where is the record of safety and how long and against what do these concoctions protect? The claims and appeals to immunize by the NYT, NPR, and CDC under color of “science” appeal only to the credulous. 

And this old doctor ain’t having none of it.

Erwin Haas MD MBA, an Infectious Diseases consultant, a flight surgeon in Vietnam served as a city commissioner in Kentwood, Michigan. He is a policy advisor at the Heartland Institute. 

Image: Pixabay

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