Earlier this month, poliovirus was discovered in wastewater in counties outside New York City late last month, signaling the first domestic outbreak since the 1970s of that potentially deadly and crippling virus.
Covid. Monkey Pox. Now polio. If it seems like infectious diseases are coming at us faster, spreading more widely and persisting longer than they have in generations—well, it’s because they are, health experts say, largely because one thing that we can do to reliably prevent an outbreak of infectious disease—get vaccinated—is the one thing millions of people in the United States and across the developed world are failing to do.
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For the first time since the early 1990s, life-expectancy is actually dropping for many groups in the U.S. A fifth of Americans have refused the Covid vaccines for themselves or their children, according to the Centers for Disease Control and Prevention. And just 65 percent of residents of some counties outside New York City—Orange and Rockland Countries, for instance—are vaccinated for polio, compared to a nationwide average of 80 percent. It should come as no surprise that when polio reappeared in the United States last month—the first U.S. outbreak since 1979—the first diagnosed case was from Rockland.
We’re time-traveling, in a sense, returning to that dark time before vaccines. “The extent to which people are currently rejecting scientific findings, and expertise of all kinds, is scary,” said Mary Fissell, an historian of medicine at Johns Hopkins University.
And it’s safe to say most people have no idea how bad things could get if we continue along this path. “It used to be a lot worse!” Fissell said.
The developed world’s success in preventing disease seeded a kind of complacency—or worse, conspiratorial thinking—as whole generations just assumed those diseases would never, or could never, return. Misinformation on social media has made that problem worse, with many of the most strident anti-vaxxers actually blaming vaccines for the very diseases the vaccines prevent.
We as a species seem to have forgotten just how dangerous and frightening the world was before vaccines. “What is new now is that a couple of generations of American children have lived largely without risk of dying from infectious disease, or even getting gravely ill,” Fissell said. “Polio was probably the last big killer, and the generation that experienced that as children is now elderly.”
It was only in the 19th and 20th centuries, with their rapid advancements in public health, communication and—most importantly—vaccines, that we managed to consistently prevent, contain or even eradicate diseases like smallpox or polio, that, in previous centuries, could kill millions.
The Black Death, a form of bubonic plague spread by fleas and person-to-person contact, killed hundreds of millions of people in Europe and North Africa—as much as half of the population—in the 1340s and ‘50s.
There were no antibiotics and no vaccines. “When someone got sick, there was not a whole lot you could do,” said John Aberth, an historian and author of The Black Death: A New History of the Great Mortality in Europe, 1347-1500.
Desperate to slow the disease’s spread, local authorities would board up infected people in their homes for 40 days, a practice that gave us the term “quarantine.” (“Quarante” is French for “40.”) If you were lucky and well-liked, your friends and neighbors would slide food into your boarded-up house. If you weren’t lucky or well-liked, you’d go hungry.
For centuries, quarantine was humanity’s main defense against infectious disease. It was, at best, a stopgap, just like it was during those months of widespread social-distancing early in the Covid pandemic.
But quarantining is unpopular and hard to enforce whether it’s the 14th century or the 21st. Note the latest Covid guidance from the U.S. Centers for Disease Control and Prevention, which no longer recommends people isolate themselves after exposure to Covid. Keeping infected people in their homes didn’t end the Covid pandemic—and it didn’t prevent death on a massive scale 700 years ago.
Back when quarantine was the only means of prevention, infectious diseases were an ever-present danger—especially for kids. “Two or three hundred years ago, children under five died every summer from diarrheal diseases contracted from milk or water that harbored bacteria,” Fissell explained. “Epidemic diseases like smallpox and cholera—and centuries before that, plague—swept through communities, and everyday infectious diseases like whooping cough all took a constant toll.”
Then in 1798, British physician Edward Jenner invented the first vaccine—for smallpox. Slowly but steadily over the next 150 years, scientists developed more vaccines, and public-health authorities administered them to more and more people.
Jabs for smallpox, plague, tetanus, measles, polio and other diseases made those diseases much rarer and outbreaks of them more easily-containable—or even globally eradicated them, in the case of smallpox.
“We have over the past century or more—really since the 1860s—built up a set of institutions and cultures in public health that protect us from the worst that nature has to offer,” said John Brooke, a health historian at Ohio State University.
In the 1970s, humanity entered a new era of public health, most dramatically signaled by the eradication of smallpox in 1980. “The combination of vaccines and antibiotics has made life much much safer, as has basic public health infrastructure like sanitation,” Fissell said.
But the ‘70s is also when anti-vaccine attitudes hardened. In 1976, a U.S. government effort to vaccinate all Americans against swine flu collapsed amid protests by a vocal minority. “That’s when vaccine-skepticism first rears its head,” Aberth said. The swine-flu debacle came around 25 years after widespread childhood vaccination all but eradicated polio, a virus that spreads through fecal contamination and can cause paralysis or death. A generation later, people began to forget how devastating that disease—and other diseases subject to vaccination—had been.
Outbreaks could get a lot worse before they get better. Many of the worst infectious diseases are “zoonotic,” meaning they permanently circulate in animal populations and periodically jump to human beings. Accelerating deforestation and a rampant illicit trade in wild-caught animals for meat, false medicine and pets gives zoonotic viruses such as the novel-coronavirus and monkeypox more opportunities to infect people.
And declining vaccination rates make these outbreaks bigger, Aberth said. “Vaccination is the only answer to containing these emerging pandemics. We need to get a handle on vaccine-skepticism or make vaccines mandatory.” But he acknowledged that new mandates are politically unfeasible in countries he described as “divided.”
Global disaster isn’t inevitable, Brooke stressed. “Will frantic obsessions with the costs of government and personal freedoms lead to a collapse of the public health bubble that protects us from nature?” he asked. “Let’s hope not.”
Most people are still willing, even eager, to get vaccinated against the worst diseases, Brooke pointed out. “Anti-vax culture is a growing reality, but we should not let the journalistic mantra to give ‘both sides equal time’ obscure the weight of public opinion.”
But the trends—fewer vaccinations, more infectious diseases—aren’t encouraging. They point back to that time before vaccines, when we got sick more often, died younger and tried—and mostly failed—to contain viral outbreaks by locking people in their homes. “History does not repeat, but it does echo, and we should take heed,” said James Belich, a University of Oxford historian and author of The Prospect of Global History.
It’s going to take hard work to bend the arc of history back in the direction of longer, healthier lives. Back, in other words, toward widespread vaccination. “Understanding why people reject vaccines, for example, is complex,” Fissell conceded. “It draws upon politics and religious beliefs and a host of other factors.”
There’s no single thing anyone can do to fix our pandemic problems overnight. But there are lots of things everyone can do to help. Trust experts. Don’t spread fake news. And, most importantly, get vaccinated—and encourage friends and family to get vaccinated, too. Not just for Covid, but for every disease for which there’s a safe and effective vaccine.
“We as a society have to make a choice,” Aberth said. Vaccines. Or disease.
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