I saw a cartoon recently that I thought was very appropriate for our times. You may have seen it too, as it was circulating on Facebook. It made me sad and thoughtful, and nostalgic.

A boy standing in front of his mother asks, “What’s that mark on your arm?”  “That’s the scar from my smallpox vaccine,” she answers. “How come I don’t have one,” he asks. “Because it worked,” was her answer.

Smallpox Eradicated

Smallpox ravaged the world for more than 3,000 years, killing about 3 out of every 10 people who contracted it and leaving survivors with severe scaring. Edward Jenner published a treatise on vaccine inoculation in 1801, and the process became widely accepted. In 1959, the World Health Organization started a plan to rid the world of smallpox through mass vaccination. It picked up steam in 1967, and by 1980, the World Health Assembly declared  the world to be smallpox free. 

Polio Eradicated

Scientists think polio also plagued humans for thousands of years, with epidemics being observed in the 1800s. While most people infected recovered, about 1%–2% became paralyzed, some to the extent that artificial breathing support (an iron lung) was required to prevent death. It attacked mainly children, leaving many with deformed legs–a boy in my 4th grade class was such a victim–and terrified parents in the early 20th century. Effective vaccines were developed in the 1950s, leading to mass vaccination efforts, and by 1994, polio was eliminated from the Western Hemisphere. It is still observed in Afghanistan and Pakistan, and vaccination of children is still recommended because of the risk of the disease being imported.

I was too young to remember getting my smallpox vaccination, but I could see the result on my arm for a large part of my life. Now, it has faded with age, to the point that I can’t even tell which arm it was on. However, I do remember the polio vaccination. My elementary school classmates and I lined up in the school cafeteria to take our sugar cube with the purple medicine on it. No one questioned what was in it, or the government’s good intentions to implement public health and safety measures. Parents were thankful to have their children protected against this awful disease. 

The point is that we have eliminated these terrible diseases, and others (measles, whooping cough, diphtheria, typhoid) because of successful vaccine programs. They were successful because medical science did its part, government did its part, and the public did its part. In our battle against COVID-19, only two of those three elements are complete. 

Endemic COVID

Because such a large portion of the population is refusing to get vaccinated against COVID, we are missing our opportunity to crush the virus, maybe not eradicate it the way we did with smallpox and polio, but to reduce its transmission enough to allow society to return to some degree of pre-pandemic normal. That means we are facing a future of endemic COVID, where it continues to circulate, much like the flu. Such a future presents numerous consequences for our society. 

Our healthcare system is not designed to sustainably deal with an endemic condition such as COVID in its current Delta variant form that fills ICUs to overflowing and stretches staff and supplies to their limits. The system can do that for short surges, but in an endemic environment, the system would have to perform under those conditions constantly. Consider the effect that has on normal health services for things such as heart attacks, strokes, automobile accidents, and flu. It is not a pretty picture.

Endemic COVID in its current form and lethality will kill hundreds of thousands more. Consider this reduction of the available labor force and the available consumers, both of which have profound implications for businesses. Employers are already struggling to maintain staffing levels. Many restaurants have closed, and there’s serious concern that another surge like we experienced last year will be a death knell for many more. 

Admittedly, many experts who predict that endemic COVID is inevitable, that vaccinations cannot eradicate it, project that it will not retain its current level of lethality. They expect that, like many previous pandemics, the virus will have less impact over time as the combination of vaccines and natural immunity from people who have had COVID reduce where it can go and what it can do. Unfortunately, the cost to get to that point could be quite high. Historically, previous pandemics have been much more severe in their second or third year before ebbing to that endemic level. In such a case, a higher level of vaccination among the population will continue to save lives as it reduces spread. 

One could also argue that their projections don’t account for the degree to which COVID-19, when allowed to freely circulate in an endemic environment, will continue producing variants, one or more of which could be very deadly, beyond what might be seen in year two or three with current variants. Reducing endemic spreading will reduce the potential for such deadly variants.

Sad and Nostalgic

So the cartoon made me sad as I thought about how much improved our lives could be with greater acceptance of the vaccine. I have to admit though, and I’m not proud to do so, that I feel little sadness and shed no tears for those who have chosen not to get vaccinated and have gotten sick or died. They took a stand for “freedom” to play Russian roulette with a deadly disease and lost. They chose poorly. and I say that even though I have family members who are choosing not to get vaccinated. They’re willing to risk their lives and the lives of their children and grandchildren. I can only shake my head in disbelief.

and the cartoon made me nostalgic. For the public attitudes exhibited in the days of the polio vaccination program. When people didn’t feel they had to know what was in the vaccine to accept it. When they trusted public health officials and scientists who assured them the vaccine was safe and effective. When the public good trumped personal choice issues. When people were thankful to have a defense against a deadly disease. I don’t suppose we’ll ever see that kind of public attitude again. and that makes me sad all over again.