The development of vaccination in Ireland
First introduced more than 200 years ago, vaccines have now saved more lives worldwide than any other medical interventions. Indeed, with the single exception of the provision of clean water, vaccines are the most cost effective and safest of all health interventions and save more lives every year than antibiotics and surgery. Measles, tuberculosis, rubella, polio are just some of diseases that at one time or another resulted in significant loss of life in Ireland. In fact, the infant mortality rate in Dublin in 1900 was 169.5 per 1,000 live births. That means that there was a nearly 17% chance that your child would die before they reached their first birthday. Whilst some of this high death rate could be attributed to malnutrition, the overwhelming driver of death in this context was disease. However, today, thanks to national immunisation schemes, parents are in the unique position of being able to offer protection to their children from these debilitating illnesses, something that previous generations simply could not do.
As with most countries worldwide, the first vaccine introduced in Ireland (in 1863) was against Smallpox. Smallpox was a deadly disease caused by the variola virus, that had a major impact on world history. This disease spreads rapidly, was rife in Europe throughout all of history, and killed upwards of ½ a million people in Europe each year during the 17th and 18th centuries. Some protection against smallpox infection was initially offered through a process of variolation. Infectious material, perhaps scabs or pus from an infected person, were applied to a small scratch in the skin. The patient would, hopefully, develop a less severe infection from which they would recover – and develop immunity. This was as risky as it sounds, with many people catching smallpox from the variolation process and an estimated risk of death of between 2-3%. It wasn’t surprising therefore that Edward Jenner’s discovery that inoculation with cowpox – a harmless disease caused by the vaccinia virus – conferred protection against smallpox was adopted in preference to variolation.
We had to wait another 70 years for the next vaccine in Ireland, which was the BCG vaccine in 1937. This resulted in a dramatic reduction in the severe illness and death caused by TB. Vaccines were introduced as they were developed; for example, the 3-1 vaccine against diphtheria, tetanus and whooping cough in 1952, the polio vaccine in 1957 (just after the severe outbreak of polio in Cork in 1956), up to the most recent vaccines against the human papilloma virus which causes cervical and other cancers (2010 for girls and 2019 for boys) and the meningococcal B vaccine in 2016 and of course SARS-CoV2 vaccines against COVID19 in 2021. Ireland is no stranger to issues with unethical practice in the development and testing of vaccines, and some of these issues will be signposted to in this project.
Unless a disease has been completely eradicated, vaccination depends on achieving ‘herd immunity’. Depending how contagious an infection is, usually 50% to 90% of a population needs immunity before infection rates start to decline. Serious diseases such as measles will again become a serious threat if we do not maintain vaccination rates and vaccine uptake.
Anon (2021). Previous vaccine schedules. [online] HSE.ie. Available at: <https://www.hse.ie/eng/health/immunisation/whoweare/vacchistory.html> [Accessed 10 May 2021].
UCC Historian Michael Dwyer has extensively researched the history of diphtheria in Ireland, and his book, Strangling Angel: Diphtheria and Childhood Immunization in Ireland, argues that it was likely to have been more common that was reported, and traces childhood vaccination initiatives in the Irish state.
Dwyer, M. (2018) Strangling Angel: Diphtheria and Childhood Immunization in Ireland. Reappraisals in Irish History. Liverpool: Liverpool University Press.