[prologue]
Hello, Abhijit here, and this episode was originally written and recorded in August of 2020, but I wasn’t happy with the way it turned out.
I wasn’t happy with the story, I wasn’t happy with the way I read it, I wasn’t happy with my voice, I wasn’t happy with the music… and I wanted to dig into it and make it tighter, but I never found the time to do that. And I got busier, and the second wave of the pandemic hit in India and I threw myself into work and the episode just languished.
But recently I’ve had..
[car honk from the street]
Sorry about that, Indian main road.
Recently I’ve had to speak to someone who was vaccine hesitant. And a lot of that hesitation came from BS Instagram and Facebook nonsense. And when I explained the actual science behind vaccines, they felt more at ease. And I think it’s sad that it’s so easy to spread misinformation but it’s so difficult to get the right bit of news out, so I thought I’d do my bit and put this episode out there.
It tells the story of just one person who was involved with vaccines, of course a very influential person, and hopefully it makes people a bit more curious, and bit more… proud of what we’ve achieved.
So here it is. A lot of the facts and stats that I quote have changed, I haven’t edited or re-recorded any of this. This also means that I’m going to be starting work on more episodes of The Unsung. There are probably three people subscribed to the feed, but I enjoy the process, and I hope that you will enjoy this episode.
Be a little kind, because it’s not perfect, I know. Stay safe, and stay smart. Bye.
[actual episode begins]
What is the cost of forgetting?
Sometimes, it’s a choice. It’s tempting to “forget” that we’re living under a constant cloud of gloom. And so we try to distract ourselves from the ongoing pandemic by doing other things. It works, of course.
But forgetting can be tricky.
It’s one thing to consciously forget about the anxiety and fear of the pandemic. I would argue that that is healthy. It’s entirely another to forget about the pandemic itself.
[Excerpt from Trump speech]
Now the democrats are politicizing the Coronvirus.
You know that right? Coronavirus. […]
And this is their new hoax, and so far we have lost nobody to the Coronavirus to the United States, nobody
[end speech]
I get it, fear can be crippling. But fear can also be a tool, and how we use that tool changes everything about this sentence:
This has happened before, and will happen again
[theme music]
Fauci: We need to start thinking about that… even though it isn’t absolutely necessary to implement now
[end theme music]
In this, the third episode of The Unsung, I talk about a man who decided that he would fight Death. And did a decent job at it.
In April 1957, Maurice Hilleman read, in the New York Times, about an influenza outbreak in Hong Kong. Officials estimated that 10% of Hong Kong’s population was infected.
Hilleman was the Chief of Respiratory Diseases at the Army Medical Center in Maryland, just north of Washington DC. Now known as the Walter Reed institute, the Army Medical Center was arguably the first institute dedicated to preventive medicine.
He knew more about influenza than anyone else. Poetic in a way, because he was born during an influenza pandemic, one of the deadliest in history – the Spanish Flu.
[timewarp]
Maurice Hilleman was born in August 1919 to a farm family in Montana. He was thrown into this world in the middle of death. He later said that he always thought he’d cheated death. He had a twin sister with him who died at birth, and his mother died two days later.
His parents were deeply religious, but Hilleman was raised by his aunt and uncle, who were considerably more progressive and open to the world than his parents. Maurice loved the people of Montana but had no patience for their mythologies. To escape the church’s dogma, he immersed himself in scientific literature. He was caught in church reading Charles Darwin’s On The Origin of Species.
He says he read it mainly because the church was opposed to it.
Hilleman spent his formative years on the farm, picking berries and raising chicken, and selling them at the local market. It was a hard life, even at a young age. He credits his time on the farm for the person that he ended up becoming.
Most smart people in Montana at the time went on to become preachers, but that didn’t sit well with Hilleman. He instead got a scholarship at the Montana State University, and graduated at the top of his class in chemistry and microbiology.
Being from a poor family, he couldn’t afford medical school, but with a little help from his brother, and a full scholarship from the University of Chicago, he went on to a Doctorate in Microbiology. Even in college, Hilleman was clear that he wasn’t concerned about making a name in academia, he wanted to do things.
And so in 1944 when he graduated, he left to join the industry. He would oversee the manufacture of influenza vaccines, and 4 years later, move to his role at the Army Medical Center.
[end timewarp]
Where we find him, in 1957, reading about the outbreak in Hong Kong. He was concerned that it had the potential to be a pandemic.
For a disease to become a pandemic, we need to look at it’s potential to spread across the world There are two basic requirements, if you think about it.
- The disease is highly transmissible. That is, it can spread from person to person easily.
- A majority of the people have no immunity to it.
What Hilleman needed to confirm at this point was whether the virus had the potential to start a pandemic. He already knew from the NY Times report that the Hong Kong flu was highly transmissible, since 10% of the population was infected. Now he needed to check how much of the American population had immunity.
He got in touch with a US army lab in Japan and asked them to send samples of the virus. They found a navy serviceman who had contracted the virus in Hong Kong, and made him gargle with salt water and spit into a cup.
The sample took a month to make the journey to Hilleman. He then readied some chicken eggs.
He used them as a breeding ground for his immunity experiments. To understand why, we need to know how epidemics stop.
For example, the Spanish Flu, during which Hilleman was born, is one of the deadliest pandemics in human history. At its peak, one in every three people was infected and it is estimated to have killed almost 50 million people.
At the beginning of the pandemic, people had no immunity to it. And so it infected people, and they in turn got sick and spread it more. As it spread, some people died, but also, many people recovered and became immune to it.
The pandemic ended when enough people had been infected and recovered, and so fewer people were potential carriers for the virus. The second requirement of a pandemic (a majority of people have no immunity) was no longer met, and the mathematics of its growth collapsed.
He took the sample of the virus and injected it into multiple incubating eggs, and into the same eggs injected blood serum from hundreds of members of the American Military.
The theory was that if they had antibodies to this virus, it would prevent growth of the virus in the eggs. If many people had antibodies, it meant that many people had immunity, and therefore it was not a pandemic threat.
But none of the Americans had antibodies. This was going to be a pandemic.
It took Maurice Hilleman 36 days from reading the headline and seeing an uncertain future to knowing with reasonable clarity what would happen. This includes the one month the samples took to reach him by boat.
He confirmed his findings by sending out virus samples to various other labs across the world to see if any populations had antibodies. Very few people did, and these were elderly people who had lived through a much older pandemic – the Russian Flu from 1889. It was the same virus, and everyone that had developed immunity to it then was either dead, or very old.
Hilleman was convinced of the danger, and so, in May, he sent out a press release, warning the world of the oncoming pandemic. He even predicted a date when it would reach the US – the first week of September 1957. He expected it to hit on the second or third day of schools reopening.
But no one seemed bothered. The American Influenza Commission ignored Hilleman’s samples and reports, and didn’t start work on a vaccine. Frustrated, he had to accost the head of the commission, Tommy Francis, at dinner. Hilleman waited at the door of a club in Washington DC for Francis to show up and forced him to look at his findings.
At which point, Tommy Francis realized his mistake.
But Hilleman was not content to hand this off the Influenza commission. He sent samples of the virus to six American vaccine companies. In doing this, he bypassed the American government and its regulatory bodies.
He took a decision to bypass a US government agency because of how time-critical development of the vaccine was, but also because he was willing to bet his reputation on what the data told him.
In September 1957, as predicted, the Asian flu hit the United States.
Vaccinations had already begun in July. By November, 40 million people were vaccinated in the US alone. Hilleman had saved millions of people across the world from contracting the virus. One source estimates that his actions prevented close to a million deaths, although this is only a prediction. It’s a what-if-he-hadn’t-acted situation.
Isn’t this the what-if situation that we’d rather have to imagine?
[hakuna matata song plays]
So Timon from the Lion King. He’s a Meerkat. Meerkats hunt and eat scorpions. And scorpions are venomous. If a meerkat pup with no experience is put in front of a scorpion, it would get stung and probably die.
So first, a meerkat parent brings a dead scorpion and presents it to its pup.
After a few times of this, the pup is challenged with a live scorpion, but one that has had its stinger removed. That way, the pup can learn to deal with the scorpion, but without the danger of being stung.
Only when the pup is comfortable hunting a scorpion in this controlled environment does it actually get to deal with one in the wild.
This is pretty much how vaccines teach our bodies to fight infections.
Our immune systems need training. Part of that training is knowing how to recognize hostile objects. If a virus or bacteria is introduced in its live, fully functional state into the body, our naïve immune system would not be able to stop it from growing in time, resulting in an infection. But by introducing something that is in a weakened state, like the dead scorpion, or one with its stinger removed, our immune system has time to learn that threat and produce specific antibodies to it.
In practice, this means introducing either live, but weakened pathogens or dead pathogens that can still elicit an immune response. The body sees this new object, called an antigen, and gets to work producing antibodies. In many cases, it remembers how to produce antibodies for the rest of its life. The next time this threat is seen, it can ramp up production quickly and prevent infection.
Hilleman was fantastically skilled at this process. The 1957 influenza vaccine is not even close to being Hilleman’s biggest achievement. That honour goes to his Hepatitis vaccine. But the one that most of us would be familiar with is the Measles vaccine.
Living in our 21st century contexts, we tend to see measles as a harmless illness of the past. But the irony is that we only see it this way because we are shielded from its effects. In 1980, before vaccination for measles was common, there were 2.6 million deaths worldwide from measles. For context, the estimated death toll from COVID-19, a pandemic that has put a screeching halt to the entire world in 2020, is 685,000, as of August 2nd, maybe a million if you compensate for undercounting. By comparison, measles still killed more than twice as many people that year than COVID has till now.
And this was when the world’s population was just half of what it is now.
And most of these deaths from measles were children under the age of 5.
Because before vaccines, measles was an inevitable disease. Like chickenpox, it infected nearly every child before the age of 15. But unlike chickenpox, it had a death rate of 0.2%. That means 2 out of every 1000 children would die from it.
A vaccine for the measles virus was first developed by John Enders and Thomas Peebles, who were also instrumental in isolating the polio virus.
Enders and Peebles took the Measles virus from David Edmonston, a 13 year old boy, and weakened it by successively growing it in human tissue, and then hens eggs.
The idea is, that as the virus adapts and thrives in these new, specific, environments, it loses its adaptation to function in its original environment.
Enders took human kidneys and placentas that would otherwise have been discarded as medical waste and allowed the virus to incubate in them, over and over again. 24 times in kidney cultures, 28 times in placentas, six times in eggs and six again in chicken embryos.
To do the actual test in humans, Enders went to a school for children with mental retardation. This sets off alarm bells by today’s standards, but we’ll revisit this at a later point.
They injected the weakened virus into eleven children with mental disabilities. And waited.
Eight of them had a fever, nine got a rash. But all of them had produced protective antibodies without actually contracting measles. In 1960, they repeated this experiment in another school. This time with 46 children. 23 were given the weakened virus and 23 a placebo.
This trial turned out to be well-timed, because just six weeks later, there was a measles outbreak in the school. None of the 23 children that got the vaccine were infected.
Enders and Peebles’ Measles vaccine worked. It caused a high fever and rashes, and even seizures in some children but it provided immunity from a deadly disease.
A vaccine that prevents millions of deaths a year and tens of millions of hospitalizations, even at the cost of fever and seizure, seems like a good trade to make. And it was the trade that was made for a long time. But for Maurice Hilleman, it was too toxic.
Now working with the pharmaceutical company Merck, he wanted to make the Measles vaccine safer.
He had another concern. Being a chicken farmer, he also suspected that the eggs Enders used to weaken the measles virus could contain another virus, one that caused cancer in chickens. This virus could also find its way into the final vaccine. There was no evidence that these chicken viruses would also cause cancer in humans, but that was not a risk Hilleman was willing to take. To add to this, there was no way at that time to detect this chicken virus in the final vaccine.
He found a source of uncontaminated chicken eggs that could be used instead, and worked on a method to further weaken, or attenuate, the measles virus. When he was satisfied that his version of the vaccine was as safe as he could make it, Merck brought it to market. To this day, Hilleman’s version of the vaccine is the one being used around the world, and it has an impeccable safety record.
Let’s look at the data about measles.
In 1980, before vaccination was common, the world saw 2.6 million deaths because of measles.
In 2014, after sustained vaccination efforts, there were only 73,000.
And measles is only one disease that we have a vaccine against.
We are living in a what if. Notwithstanding the pandemic that has us worried right now, we are in an epidemiological bubble. Vaccines have supercharged our immune systems, giving it the capacity to fight diseases that were routinely deadly.
We have the knowledge and the tools, and that is only improving.
But the real danger right now, is not being able to communicate this story to people.
Instead, socially engineered claims trigger our fears, short-circuit our brains, and spread with less resistance from person to person. Just like a virus.
What’s dangerous is a WhatsApp message that claims that vaccines cause autism. The truth is that the one scientific paper that is cited as a source for this used falsified data and was later retracted by the journal for research fraud. It was pushed into the news by a lawyer that abused it to file lawsuits against vaccine manufacturers.
What’s dangerous is Instagram celebrities with no medical knowledge telling millions of their followers that they will not vaccinate against COVID when the time comes because vaccines contain mercury. The truth is that some vaccines contain ethylmercury as a preservative, and ethylmercury behaves differently from mercury, which behaves differently from methylmercury.
Consider sodium. In its natural form, it is one of the most reactive elements, to the point that it can’t be stored in open air because it reacts with the moisture in the air and forms caustic soda and flammable hydrogen gas. But the salt that we eat is Sodium Chloride, and it behaves very differently. Ethylmercury is safely eliminated by the body in the quantities that it is used.
In 2004, because of increasing popular concern, a review of 200 studies conclusively showed that thimerosal, the mercury compound used as a preservative, had no link to autism.
[editor’s note]
Hi, future me again. I want to point out that from 73,000 deaths in 2014, there were 207,000 measles deaths in 2019, 5 years later. The number has gone up because of misinformation and vaccine hesitancy.
[end editor’s note]
The President of the United States pointedly did not wear a mask until 123 days into the pandemic and made it a political statement. Even though the data says that wearing a mask has a huge impact on community transmission and severity of infection.
The Government of India recommended Homeopathic solutions as a preventative against the Coronavirus. Homeopathy was a theory of medicine that has long since been disproved, but continues to be employed and advocated as a placebo because of a strong traditional distrust of modern medicine.
The most powerful tool we have is information. Information allows us to shape our reaction to the world.
At one in the morning in March 1963, Maurice Hilleman’s daughter, Jeryl Lynn, came to her father’s bedroom. She had woken up with a pain in her throat. Hilleman looked at the lump in her neck, went through a medical manual at his bedside and recognized it as the mumps.
He was now a single father, his wife had died a few months earlier. His reaction was to drive down to his lab, find cotton swabs and a nutrient broth. He came back home, swabbed his daughter’s throat, and got to work.
4 years later, Merck was manufacturing a Mumps vaccine made from those swabs.
Time and again, Hilleman’s reaction to bad things happening was: He tried to fix it.
[hilleman speaking, excerpt from a documentary]
There’s a great job in being useful, and that’s the satisfaction that you get out of it. Other than that, it’s the quest of science and winning a battle over these damn bugs, you know. That’s the scientist’s war. And when there’s a spinoff to help mankind, that’s fine. I like that.
[end excerpt]
So was he perfect? No.
Hilleman was a man known to be forceful and intimidating. He famously cursed at work. That style of management is frowned-upon today. Still, his most telling endorsements were from his employees, who were fiercely loyal to him.
What Hilleman did would be impossible now. No one should be able to bypass medical protocols. And for good reason. A lot of what he did would be considered unethical today. Testing vaccines on children with mental retardation, for example, was commonplace in the 1950s. Hilleman was unapologetic, and his reasoning was sound. He said, “My vaccine gave all of these children the chance to avoid the harm of that disease. Why should retarded children be denied that chance? Retarded children are perceived as more helpless; but their understanding of the shot that they were given, and their willingness to participate in the trial, was no different than [that of] healthy babies and young children.“
Mentally disabled children often lived at group homes that were breeding ground for disease, and therefore they were more susceptible. You can see how starting testing with them seemed like a win-win.
But consent from children with mental disabilities without direct supervision from their parents was ripe for abuse, and it was abused, in a school called Willowbrook, on Staten Island in New York, a medical researcher named Saul Krugman performed an experiment where he fed children with MR stool samples of other children in an effort to understand how the hepatitis virus spread.
This led to public outrage, and such experimentation was banned. Just so you know, Hilleman called this “the most unethical medical experiments ever performed on children in the United States”. His aim was to eradicate all diseases that killed children; and having them suffer in the quest for that was unacceptable.
We now have the benefit of hindsight, ethically and scientifically. With genetic engineering and newer technologies like RNA vaccines, we are reaching the point that we can have a one-size-fits-all technique in the near future.
On Jan 11th, the gene sequence for SARS-COV-2, the medical name for the novel coronavirus, was shared by the Chinese Government.
Two days later, an American biotech firm, Moderna, had a vaccine candidate called mRNA-1273.
Ten years ago, this stage, called the exploratory stage, would have taken at least 2 years. mRNA vaccines have the potential to reshape these timelines. But they are as-yet unproven.
[editor’s note]
Quick note. It’s 2021, and obviously this is no longer true. The mRNA vaccines by Pfizer-Biontech and Moderna have been approved. In fact, the Pfizer one has been approved for general use as well.
[end editor’s note]
In Hilleman’s time, they might have been tested on children with intellectual disabilities.
But today we have a more robust process. It involves testing on animals first, then on a small group of people, and then on larger groups of people.
This isn’t perfect either, but it is an improvement. And 50 years from now, we will look back at today’s science as primitive and barbaric.
Hopefully.
Hilleman is far from an unknown. In 2005, his obituary in the LA Times credits him with “saving more lives than any other scientist of the 20th century”. But there’s an irony in his success. People have forgotten how bad it used to be.
And people around the world seem to be forgetting many things, by choice.
The cool kids call it the ‘post-truth’ world. People find it difficult to come to terms with an increasingly more diverse and confusing world, and so they give up and create their own, comfortable, subjective reality. The truth is not a comfort anymore, your identity is. And so we have climate change denial, holocaust denial, race and religion supremacy.
It feels like in an uncomfortable present, people are looking to the past for glory. Maybe we should look to the past for lessons instead.
I find comfort in knowing that always were, and always will be, people like Hilleman, the quiet and functional side of humanity, moving us towards an ideal version of ourselves. Even right now. Among all this noise.
Because this has happened before, and will happen again
