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 VACCINES
WHAT EVERYONE NEEDS TO KNOW®
 VACCINES
WHAT EVERYONE NEEDS TO KNOW®

KRISTEN A. FEEMSTER

1
 3
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
“What Everyone Needs to Know” is a registered trademark
of Oxford University Press.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2018
All rights reserved. No part of this publication may be reproduced, stored in
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be sent to the Rights Department, Oxford University Press, at the address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication
Data Names: Feemster, Kristen A., author.
Title: Vaccines : what everyone needs to know / Kristen A. Feemster.
Description: New York, NY : Oxford University Press, [2017] |
Includes bibliographical references and index.
Identifiers: LCCN 2017033339| ISBN 9780190277901
(hardcover : alk. paper) | ISBN 9780190277918 (paperback : alk. paper)
Subjects: LCSH: Vaccination—Popular works. |
Vaccination—History. | Vaccines.
Classification: LCC RA638 .F44 2017 |
DDC 614.4/7—dc23
LC record available at https://lccn.loc.gov/2017033339
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medical or other professional advice. Treatment for the conditions described in this
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is designed to offer accurate information with respect to the subject matter covered
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and health issues is constantly evolving and dose schedules for medications are being
revised continually, with new side effects recognized and accounted for regularly.
Readers must therefore always check the product information and clinical procedures
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Hardback printed by Bridgeport National Bindery, Inc., United States of America
With love to James and our sunshines, TE and FM.
In memoriam to Mom, my greatest superhero.
 CONTENTS

ACKNOWLEDGMENTS xv
ABBREVIATIONS xvii
INTRODUCTION xix

1. What Is a Vaccine and How Do Vaccines Work? 1

What is an antigen? 2
What happens when the immune system is confronted by an antigen? 2
How do cells signal each other in the process of creating antibodies? 3
Which is better, natural immunity or immunity after vaccination? 3
What is the real risk of vaccine-​preventable diseases? 4
What is herd immunity? 5
What happens when immunization rates are not high enough to
achieve herd immunity? 6
How large are most outbreaks? 6
What is the difference between immunization and vaccination? 7
What are the different types of vaccines? 7
Why are there so many types of vaccines? 9
Why do most vaccines require more than one dose? 10
Besides antigens, what else are vaccines made of? 10
Even if these substances are necessary, are they safe? 12
viii Contents

What about thimerosal and autism? 13

Why was thimerosal removed from vaccines in 2001? 13
Do some vaccines contain animal products? 14
Do vaccines use cells from aborted fetuses? 15

2. A Brief History of Vaccines 17

When was the first vaccination delivered in the United States? 17

What is inoculation? 18
Why the controversy? 19
How did we get from inoculation to vaccination? 19
When did smallpox vaccine come to the United States? 20
How well did this early vaccine really work? 21
What was the public response to the new vaccine? 21
How did the public health community make early vaccines safer? 24
What were some of the key developments in vaccine science during
this time? 25
How did vaccine development begin to take off? 25
What were some other important developments for making vaccines? 26
What was the impact of vaccine introduction on disease incidence? 28
What about vaccine introduction in other countries? 28

3. Vaccine Development 31

What factors influence which vaccines get developed? 32

Once a decision to proceed with vaccine development is made, what
are the steps needed to bring a vaccine from an idea to production? 34
What is required for clinical studies? 35
Is there a similar process in other countries? 37
Are there protections for people who participate in clinical trials? 38
How many people are involved in vaccine trials? 39
What happens after clinical development is complete? 40
 Contents ix

What evidence do vaccine developers search for during

development to show that a vaccine works? 41
How long does this whole process take—​from the first exploratory
study to licensure of a new vaccine? 41
Is a vaccine ever approved or used without following these steps? 42
Who is involved in all of these steps from conceptualization
to development? 43
How many vaccine manufacturers are there? 45
What actually happens in vaccine manufacturing? 46
What quality controls govern vaccine manufacturing? 47
Who pays for vaccine development? 48
How much does vaccine development cost? 49
How do manufacturers know how much vaccine to make? 49
Are there vaccine supply shortages? 50
What happens when there are vaccine shortages? 50

4. Vaccine Financing and Distribution 51

How are vaccines distributed once they are licensed? 51

Are there other vaccines used in some places but not others? 52
How much do vaccines actually cost for immunization programs? 53
How large is the vaccine market? 54
Who decides which vaccine should be distributed? 54
What is the National Vaccine Advisory Committee? 56
How does the National Vaccine Advisory Committee impact
vaccine policy? 57
What is the National Vaccine Plan? 57
What are the Decade of Vaccines and the Global Vaccine Action Plan? 58
Once a vaccine is added to an immunization program, how does it
get to the people who need it? 59
What is required to be able to deliver vaccines in a clinic or
community setting? 60
x Contents

How are vaccines purchased by health care facilities? 61

How are vaccines purchased through public insurance? 61
How do people without insurance or who do not qualify for publicly
funded programs access vaccines? 63
Who purchases most of the vaccines in the United States? 63
Who sets priorities for vaccine distribution in non-​US countries? 64
What is the Expanded Program on Immunization? 64
How does the World Health Organization support other countries? 65
How does vaccine financing happen in non-​US countries, including
low-​to middle-​income countries? 66
How are vaccines made more accessible to lower income countries? 66

5. Vaccine Safety 69

What is a vaccine adverse event? 69

How can one determine whether an adverse event is really caused
by a vaccine? 70
How is safety monitored after a vaccine is licensed? 71
Who can report to VAERS? 72
How often are reports submitted to VAERS? 73
What happens when VAERS finds a signal? 73
What are active surveillance networks? 74
What is the difference between the information provided by VAERS
and that provided by these other active surveillance networks? 75
What kind of reactions can occur after vaccination? 75
How often do adverse events really occur? 77
Is Guillain–​Barré syndrome associated with vaccines? 78
What are contraindications to vaccination? 79
What are precautions? 79
Can a person be vaccinated if he or she is on an antibiotic? 80
If a person is immunocompromised because of chemotherapy or an
organ transplant, can he or she receive any vaccines? 80
 Contents xi

If a person was vaccinated before starting chemotherapy, will the

effect of the vaccine last? 81
Should pregnant women receive vaccines? 81
Do live attenuated (weakened virus or bacteria) vaccines ever cause
problems in healthy individuals? 82
What happens when a vaccine-​associated adverse event occurs? 83
What is the National Vaccine Injury Compensation Program? 83
Which vaccines are covered by NVICP? 84
How does NVICP work? 85
How does one qualify for compensation within NVICP? 85
What is the NVICP vaccine injury table and what is in it? 86
Who is responsible for updating the NVICP injury table? 87
Who serves on the ACCV? 88
How many individuals have received compensation from NVICP? 88
Has NVICP compensated any autism claims? 90
How is information about vaccine safety from NVICP communicated? 91
If NVICP depends on published evidence to develop the vaccine
injury table and adjudicate cases, how does one evaluate the
reliability and validity of a study? 92
Who evaluates the reliability of vaccine safety studies? 92
What is the National Academy of Medicine? 93

6. The Vaccine Schedule 95

Who makes the immunization schedule? 95

What is ACIP? 96
When was ACIP first established? 96
How are ACIP members selected? 98
What criteria are used to select members for ACIP? 99
Are members of ACIP paid? 99
How does ACIP make decisions about the immunization schedule? 99
What kind of evidence does ACIP use? 101
xii Contents

How long does it take for ACIP to develop recommendations? 101

What happens after a recommendation is made? 101
How are ACIP recommendations actually implemented? 102
Do states have their own vaccine advisory committees? 102
Why is there only one recommended schedule? 102
What is wrong with following a different schedule, such as
spreading out vaccines, rather than following the recommended
vaccine schedule? 103
Do the number and combinations of vaccines given in the
recommended schedule overwhelm the immune system? 104
How do we know the recommended schedule is safe? 104
How do immunization programs keep track of who needs what? 105

7. Laws and Standard Practices

for Vaccine Administration 107

What is vaccine policy? 107

What are the historical and legal precedents for mandatory vaccination? 108
What are the basic arguments that support immunization requirements? 110
What are the basic arguments against immunization requirements? 110
What kinds of vaccine requirements are employed in the United States? 111
What are the benefits of school-​entry requirements? 112
How does one opt out of school-​entry requirements? 113
What impact do exemption policies have on immunization rates? 115
Have exemption laws changed over time? 116
What has happened with vaccine-​exemption legislation since the
2015 measles outbreak? 116
What are other types of mandatory immunization policies? 117
Do any other settings require immunizations? 118
What other policy strategies are used to increase immunization rates? 119
Are there other countries that have mandatory immunization policies? 119
 Contents xiii

Are there ways to prevent the transmission of vaccine-​preventable

diseases other than vaccination? 120
What do health care providers do if patients or families refuse
a vaccine? 120
Are health care providers liable for vaccine refusal in any way? 121
Can health care providers ask a patient or family to leave the
practice if they refuse vaccines? 121
Why would different providers have different immunization policies,
especially if there is one routine recommended schedule? 122
Are individuals who choose not to vaccinate themselves or their
children ever held responsible for exposing other people to
vaccine-​preventable diseases? 123

8. Vaccine Hesitancy 125

What is vaccine hesitancy? 126

What is meant by the “vaccine confidence gap”? 127
How does vaccine hesitancy manifest? 127
What is the difference between vaccine hesitancy and the anti-​
vaccine movement? 128
Why is it important to define vaccine hesitancy as a spectrum of beliefs? 129
How common is vaccine hesitancy? 129
How is vaccine hesitancy measured? 129
Which individuals may be more or less likely to be vaccine hesitant? 130
Are health care providers ever vaccine hesitant? 131
What are the implications of vaccine hesitancy? 131
What are the practical and economic costs associated with disease
outbreaks that result from vaccine hesitancy? 132
How can vaccine hesitancy be addressed? 133
Where do people get information about vaccines? 134
What are the most reliable sources of information related to vaccines? 135
How can one evaluate the reliability of information? 136
xiv Contents

9. On the Horizon 139

What new vaccines are under development? 139

Vaccines during pregnancy 140
Why are group B streptococcus and respiratory syncytial virus
vaccines being developed for pregnant women? 140
What are the challenges to developing vaccines for pregnant
women? 141
Vaccines for emerging infectious diseases 141
Will we be ready for the next outbreak or pandemic for emerging
infections such as Ebola and Zika viruses? 141
Will there be a new vaccine for Zika virus? 143
Preparing for the next influenza pandemic 144
What is the difference between an epidemic and a pandemic? 144
How does antigenic drift and shift occur? Why does this not
occur with other viruses or bacteria? 145
Are we getting any closer to an influenza vaccine that does not
have to be changed every year? 146
Human Immunodeficiency Virus Vaccines 147
Are we getting closer to a vaccine to prevent human
immunodeficiency virus? 147
Therapeutic vaccines 148
Are vaccines being developed that can treat rather than prevent
illnesses? 148
Disease elimination and eradication 149
What is an endemic disease? 149
How do we achieve elimination or eradication of infectious diseases? 150
What is the Global Polio Eradication Initiative? 151
Can we expect eradication or near eradication of any other
vaccine-​preventable diseases in the next 20 years? 153

APPENDIX 155
SELECTED BIBLIOGRAPHY 167
INDEX 175
 ACKNOWLEDGMENTS

Thank you: To Karen Smith, for your activation energy and

for helping me find the right voice for this book. To my editor,
CZ, for your patience and enthusiasm for this project. To my
colleagues at the Children’s Hospital of Philadelphia Division
of Infectious Diseases and the Philadelphia Department of
Public Health Immunization Program—​I have learned from
your insights, perspectives, and advocacy. To PolicyLab, for
championing this important topic. To Bardia Nabet, Tunmise
Fawole, and Charlotte Moser for help with figures and the
appendix. To Paul Offit, for your critical feedback and guid-
ance throughout. To my sister, Kara, for cheering me onward.
And, most important, to my family for encouraging me to pur-
sue this opportunity and for all of your support every step of
the way.
 ABBREVIATIONS

AAFP American Academy of Family Physcians

AAP American Academy of Pediatrics
ACCV Advisory Commission on Childhood Vaccines
ACIP Advisory Committee on Immunization Practices
ACOG American College of Obstetricians and Gynecologists
ACP American College of Physicians
BCG Bacilli Calmette-​ Guérin
CDC Centers for Disease Control and Prevention
CEP Coalition for Epidemic Preparedness
CISA Clinical Immunization Safety Assessment
DTaP Diphtheria, Tetanus and acellular Pertussis vaccine
DTP Diphtheria, Tetanus and whole cell Pertussis vaccine
EMA European Medicines Agency
EPI Expanded Program on Immunization
EU European Union
FDA Food and Drug Administration
GAVI Global Alliance for Vaccines and Immunizations
GBS Group B Streptococcus
GBS Guillain–​Barré syndrome
GCP Guideline for Good Clinical Practice
HAV Hepatitis A virus
HHS Health and Human Services
HiB Haemophilus influenza Type B
HIV Human immunodeficiency virus
xviii Abbreviations

HPV Human papillomavirus

ICH International Conference on Harmonisation
IIV Inactivated influenza vaccine
IND Investigational New Drug
IOM Institute of Medicine
IPV Inactivated poliovirus vaccine
IVIG Intravenous immunoglobulin
LAIV Live attenuated influenza vaccine
MCV Meningococcal conjugate vaccine
MMR Measles, Mumps and Rubella vaccine
NAM National Academy of Medicine
NIH National Institutes of Health
NVAC National Vaccine Advisory Committee
NVICP National Vaccine Injury Compensation Program
NVPO National Vaccine Program Office
PATH Program for Appropriate Technology in Health
PCV Pneumococcal conjugate vaccine
PRISM Post-​licensure rapid immunization safety monitoring
QALY Quality-​adjusted life year
RSV Respiratory syncytial virus
SAGE Strategic Advisory Group of Experts
SIRVA Shoulder Injury Resulting from Vaccine Administration
Tdap Tetanus, diphtheria and acellular pertussis vaccine
VAERS Vaccine Adverse Events Reporting System
VFC Vaccines for Children
VSD Vaccine Safety Datalink
VZV Varicella Zoster Vaccine
WHO World Health Organization
 INTRODUCTION

Vaccines represent one of the greatest public health advances

of the past 100 years. Their development has brought about
the global eradication of smallpox as well as large reductions
in poliomyelitis, measles, tetanus, Haemophilus influenzae type
b (Hib—​a leading cause of childhood infections), and many
other infectious diseases.
However, the development and implementation of vaccines
has not followed a linear trajectory: Disparities in the adop-
tion of new vaccines continue to persist, and vaccination rates
in both developed and developing countries are not always
sustained. These disparities may be attributable to short sup-
ply, poor infrastructure, or low prioritization of vaccines in
public health spending. However, another important contrib-
utor to the success of vaccination programs is vaccine accept-
ance, a blanket term referring to the public cooperation with
public vaccination schedules. As the perceived risk of vaccine-​
preventable diseases decreases, concerns about vaccine safety
increase. This has contributed to a rise in vaccine hesitancy in
many communities. Health care providers today spend con-
siderable time and effort educating patients and families on
the importance of immunization.
It has become difficult to identify resources that can ade-
quately answer the public’s questions about the risk and ben-
efits of the ever-​expanding list of vaccines available today. This
xx Introduction

is further complicated by the rapid proliferation and dissemi-

nation of misinformation from sources as varied as social media
and scientifically unsound research articles. Recent outbreaks
throughout the world show that vaccine-​preventable diseases
such as pertussis and measles can occur as vaccine hesitancy
increases and immunization rates decrease. This highlights the
importance of communication and trust between health care
providers, patients, and the community to ensure the success-
ful implementation of immunization programs. Many coun-
tries also continue to face challenges in ensuring reliable access
to vaccines, which can further erode trust in the public health
and medical system.
Vaccines are a public health tool: The decision to vaccinate or
not vaccinate impacts both individuals and the people around
them. Accordingly, it is imperative that we are well-​informed
before making a decision about vaccination. This requires an
understanding of (1) how vaccines work, (2) the diseases that
vaccines prevent, and (3) why vaccines are important for indi-
viduals and society. Vaccines and their role in society represent
a complex interplay between sociopolitical systems, culture,
economics, individual beliefs, and health literacy—​and with
that, they provide a multitude of fronts for the introduction
of conflicting messages or incorrect information. This book
aims to provide an objective, informative tool to communicate
facts about vaccines as well as the challenges to implementing
immunization on a population level.
 1
WHAT IS A VACCINE AND HOW
DO VACCINES WORK?

A vaccine is a substance that is given to a person or animal

to protect it from a particular pathogen—​a bacterium, virus,
or other microorganism that can cause disease. The vaccine
prompts an immune response in the body that produces anti-
bodies, which are proteins that fight specific pathogens. The
goal of giving a vaccine is to prompt the body to create anti-
bodies specific to the particular pathogen, which in turn will
prevent infection or disease; it mimics infection on a small
scale that does not induce actual illness. A similar process does
occur when the body confronts actual pathogens, but vaccines
spare individuals from the dangers of disease.
A vaccine can be made from any one of a variety of sources: a
killed or weakened bacteria or virus, a protein or sugar from
the pathogen, or a synthetic substitute. For a vaccine to do its
job, the following need to happen: (1) The vaccine needs to
stimulate antibody production, and (2) the antibodies need to
have avidity (attraction to the specific pathogen). Antibodies
will not work if they do not bind to the invading pathogen.
Vaccine protection also requires that the body recognize the
pathogen and keep making antibodies when they are needed,
which is called immune memory. When this happens, the vacci-
nated body is ready to produce more of these antibodies right
away, whenever the body is exposed to the bacteria or virus.
2 Vaccines

What is an antigen?
Antigens are proteins on the surface of a pathogen that prompt
the production of antibodies by the immune system. Bacteria
and viruses are both covered in antigens, and during the proc-
ess of natural infection, these antigens are what the body rec-
ognizes. Depending on the pathogen, its antigen coating can
be made up of several proteins or several thousand.
Vaccines, on the other hand, are often made using just a
few antigens from a bacteria or virus. This is because some
antigens are better than others at sparking the immune sys-
tem. This is also because it is important to separate the parts
of a pathogen that cause disease and make one sick from those
that induce an antibody response. The ability to cause disease
is called virulence, whereas the ability to induce a protective
immune response is called immunogenicity.
The number of antigens in vaccines is actually quite small
compared to the number of antigens that confront the immune
system during an actual infection (or just from the environ-
ment on a daily basis). For example, the pathogen that causes
whooping cough contains more than 3,000 antigens; the vac-
cine that is used to protect against whooping cough contains
only 3–​5 different antigens. Our immune systems are stimu-
lated all the time, but all stimulation is not the same.

What happens when the immune system is confronted

by an antigen?
When one’s body encounters an antigen (from either a vac-
cine or a natural exposure), it sparks a cascade of events that
constitute an immune response. This response requires com-
munication between several different types of cells and ends
in the creation of memory cells that are equipped to respond
to future invasions by the same antigen. When antigens are
introduced as part of a vaccine, the steps essentially are as
follows:
 What Is a Vaccine and How Do Vaccines Work? 3

1. Antigen is picked up by an antigen-​presenting cell that

shows the antigen to a type of immune cell called a helper
T cell.
2. Helper T cells activate B cells (these make antibodies) or
killer T cells (needed to attack pathogens such as viruses
that live inside of cells).
3. The activated B cells and killer T cells become memory
immune cells that will reactivate during actual infection
and keep the pathogen from invading.

How do cells signal each other in the process of

creating antibodies?
Immune cells emit signals through the secretion of cytokines.
Cytokines are crucial to our immune response in that they
recruit all the cells we need to attack antigens and create mem-
ory cells. Some cytokines are also responsible for the symp-
toms that are generally associated with infection, such as fever.
This is why we may experience a low fever after vaccination: It
means our immune system is in the process of making mem-
ory cells, and cytokines are being employed as part of the com-
munication between cells that contributes to this process.

Which is better, natural immunity or immunity after vaccination?

In general, natural infection results in a more robust, durable
immune response. This is because an actual infection usu-
ally results in a stronger immune response (not to mention an
actual illness), whereas we may need more than one dose of a
vaccine to achieve full protective immunity. After infection, we
make a greater number and greater diversity of antibodies—​
ones that may recognize different parts of a pathogen (i.e., its
antigens). In the case of some pathogens, such as chickenpox
and measles, infection results in lifelong immunity.
However, this is not the case for all pathogens. For exam-
ple, immunity decreases over time after a pertussis (whooping
4 Vaccines

cough) infection. Children younger than age 2 years who are

infected with a certain family of bacteria are not able to mount
an immune response that makes memory cells, so even after
infection, they have no long-​lasting immunity. If a virus or bac-
teria has multiple strains, infection with one strain may not
provide immunity against other strains.
Some vaccines induce a stronger immune response than
natural infection. One example is the human papillomavirus
(HPV) vaccines, which are made from a purified capsid pro-
tein that induces higher antibody levels than are seen in indi-
viduals who have had actual HPV infection. The same is true
of tetanus vaccines: Those who receive the vaccine have more
antibodies than those who survive infection.
However natural immunity may compare to vaccine immu-
nity for a given disease, it is important to remember that natu-
ral immunity comes with the cost of having to endure a disease
or infection, which depending on the illness can result in dis-
ability or death.

What is the real risk of vaccine-​preventable diseases?

Since the advent of vaccines, the incidence of vaccine-​
preventable diseases has decreased dramatically. The risk of
being exposed to many of these diseases is therefore quite
low, and some diseases (including polio and diphtheria) have
been eliminated from the United States. For other vaccine-​
preventable disease, overall incidence has decreased but cases
still occur because available vaccines do not cover all of the
different types of the bacteria or virus. For example, the bac-
terium Pneumococcus, for which a vaccine has existed since the
1980s, continues to cause tens of thousands of cases of pneu-
monia, bloodstream infections, and meningitis every year.
On the other hand, the incidence of some vaccine-​
preventable diseases has persisted and even increased in
recent years. Pertussis (whooping cough) cases have increased
steadily since the 1980s, with nearly 50,000 cases reported
 What Is a Vaccine and How Do Vaccines Work? 5

in the United States in 2012. Pertussis affects all age groups,

although infants have the highest risk of severe disease and
typically require hospitalization. There are also regular out-
breaks of vaccine-​preventable diseases such as mumps, vari-
cella, measles, and Meningococcus (which causes bloodstream
infections and meningitis) in the United States and interna-
tionally. In places where there is reliable access to a developed
medical system, the risk of death due to infection with any of
these pathogens is low, but severe disease can and does still
occur. The global risk of death due to pertussis among infected
infants is approximately 1 in 100; for measles it is 1 in 1,000;
and for Meningococcus across all age groups, the fatality rate
for infected individuals is 1 in 10.
Thus, the actual risk of contracting a vaccine-​preventable
disease is difficult to project. Outbreaks of vaccine-​preventable
diseases generally occur when there are clusters of susceptible
individuals or people who do not have immunity. When this
happens, there is nothing to stop the virus or bacteria from
moving between people. This is a larger issue for pathogens
that are easily spread from person to person, such as pertus-
sis or measles. Vaccination works by reducing the number of
susceptible individuals, thereby stopping transmission; the
bacteria or virus simply runs out of places to go. This is called
herd immunity.

What is herd immunity?

Vaccines work by protecting the individual who is vaccinated.
A vaccinated individual is less likely to become infected, and
if the individual is not infected, he or she cannot spread the
infection to others. When there are many vaccinated people
in a community, there is nowhere for the bacteria or virus to
go—​the group, or herd, becomes immune. So even if there
are a few individuals who are not vaccinated in the group,
they are protected because there is no one around to expose
them to the infection. This works better for some infections
6 Vaccines

compared to others. Viruses or bacteria that are easily trans-

mitted, including measles and pertussis (whooping cough),
require that almost everyone in a given group be vaccinated
in order to achieve herd immunity. Other infections require
close contact for longer periods of time in order for exposure
to result in infection. In these cases, a lower immunization rate
can achieve herd immunity. In this manner, vaccines have had
greater impact on disease rates than they would if every dis-
ease required uniform vaccination rates.

What happens when immunization rates are not

high enough to achieve herd immunity?
When immunization rates are low, more individuals are sus-
ceptible to infection and are at risk of becoming infected. If
anyone does become infected, the lower the immunization
rate, the more opportunities there will be to spread the infec-
tion to other susceptible individuals in their group. When
several cases such as this cluster together, an outbreak occurs.
Outbreaks grow as long as there are more susceptible people
in a given community to become infected and expose others.
Outbreaks slow and eventually end when enough people are
immune—​either because of infection or because of vaccination.

How large are most outbreaks?

The size of an outbreak depends on the number of suscepti-
ble people, the infectivity (or contagiousness) of the pathogen,
and the severity of disease caused by infection. For example,
if a pathogen causes people to become very sick very quickly,
there may be less opportunity for those individuals to go out
and infect others. However, some pathogens, such as pertussis,
can be transmitted before people even know they are infected,
making these infections more difficult to control once they
have started spreading in a community. This is why vaccines
 What Is a Vaccine and How Do Vaccines Work? 7

are used as a response to outbreaks: They prevent people from

becoming infected in the first place.

What is the difference between immunization and vaccination?

Immunization refers to any exposure that provides immunity,
which means that it encompasses both vaccination and natural
infection. Immunization is often referred to as active or passive.
Active immunization occurs when an individual is exposed to
an antigen and then has an immune response that produces
antibodies. Thus, active immunization can take place through
vaccination or natural infection.
Passive immunization occurs when an individual receives
antibodies from other than a first-​hand immune response. The
most common form of passive immunity is pregnant moth-
ers passing antibodies to their fetuses through the placenta;
this provides immune protection to infants for the first sev-
eral months of their lives. Another form of passive immuni-
zation occurs through medical intervention, particularly for
people with immunodeficiencies that keep them from mak-
ing their own antibodies. In these cases, the immunodeficient
individual may receive a blood product that contains antibod-
ies pooled from other people. In cases of exposures to certain
infections, including rabies, a person may be injected with a set
of rabies-​specific antibodies to provide immediate protection.
These antibodies are short-​lived and do not activate immune
memory cells, so the immunization is considered passive.

What are the different types of vaccines?

A vaccine’s composition influences the type and durability of
the immune response it elicits. In this regard, vaccines are clas-
sified into one of six categories: live attenuated, inactivated (or
killed), protein subunit, polysaccharide, polysaccharide conju-
gate, and recombinant.
8 Vaccines

Live attenuated virus vaccines are made from a virus that is

weakened to the point that it cannot cause disease. As viruses,
they act as parasites that depend on other cells to live. With
live attenuated virus vaccines, a weakened virus enters a cell
and reproduces just enough to induce an immune response but
not enough to infect many other cells and cause illness. Three
different methods are available to weaken viruses for vac-
cines. First, a virus could be grown in nonhuman cells. Viruses
that infect humans grow best in human cells, so using nonhu-
man cells, such as chicken cells, as a growth medium ensures
that the virus then will not reproduce very well in humans.
This method is commonly used for chickenpox, measles, and
mumps vaccines. A second method grows virus at tempera-
tures lower than body temperature, thereby robbing the virus
of its ability to reproduce well at body temperature. The third
method combines elements of nonhuman and human viruses,
retaining human virus components that induce the immune
response while the nonhuman parts of the virus ensure the
virus does not reproduce well enough to cause true infec-
tion and illness. This method is used for one of the rotavirus
vaccines.
Inactivated or killed vaccines are made from a whole virus or
bacteria that has been killed or neutralized through the appli-
cation of a second substance—​usually, a tiny amount of formal-
dehyde. Inactivated or killed viruses are not able to reproduce
and cannot cause infection or disease, but because the body is
still exposed to the whole virus, it is able to mount an immune
response. The hepatitis A, polio, and most influenza vaccines
utilize this method.
Protein subunit vaccines work by isolating the antigens or
proteins on bacteria that are known to be important for induc-
ing a protective immune response. Some protein subunit vac-
cines target antigens known to act as toxins. Diphtheria and
tetanus vaccines, for example, are made by inactivating the
toxins that these bacteria produce, creating inactivated toxins
called toxoids. Pertussis vaccines are made from two to up to
 What Is a Vaccine and How Do Vaccines Work? 9

five different proteins that are either toxins or are part of the
bacteria itself (compared to the 3,000 proteins contained in a
whole pertussis bacterium). The inactivated proteins cannot
cause infection or disease, but they will lead to an immune
response to recognize and inactivate the bacteria or toxin when
actual infection occurs.
Similar to protein subunit vaccines for bacteria, recombinant
vaccines are made from individual viral proteins that are known
to induce a protective immune response. To make recombinant
vaccines, the gene that is responsible for making the selected
protein is inserted into the DNA of a yeast cell. As the yeast
reproduces, so too does the DNA, and the resulting protein is
purified to make a vaccine. Both hepatitis B and HPV vaccines
are made using this technique.
Polysaccharide vaccines target a certain group of bacteria that
have a special capsule on their surface made of sugars or poly-
saccharides. Because their capsule is what the body interacts
with first, it is also what the immune response targets. Thus,
vaccines for encapsulated bacteria are made using this capsule
rather than any proteins from the bacteria.
However, polysaccharide capsules do not induce immune
memory well, nor do they work well in children younger
than age 2 years. This is a problem because the bacteria with
capsules—​ pneumococcus, meningococcus, and Haemophilus
influenzae b (Hib)—​can cause severe disease in young children.
This led to the development of conjugate vaccines, in which the
polysaccharide capsule is attached to a protein that is able to
turn on memory cells.

Why are there so many types of vaccines?

Vaccine development has evolved as scientists learn more
about how the body responds to certain pathogens and anti-
gens; the ultimate goal is to produce antibodies that are spe-
cific to the pathogen but will not attack healthy cells in the
body. These antibodies also need to target the right parts of
10 Vaccines

the pathogen, both so the pathogen does not persist to cause

infection and so the antibodies persist and are remembered as
long as possible.

Why do most vaccines require more than one dose?

Some vaccines, particularly live attenuated virus vaccines, are
efficient in generating a protective immune response because
they turn on the immune system in a way that mimics natural
infection. In these cases, one dose of a live virus vaccine is gen-
erally protective for most people. Inactivated or protein vac-
cines are not quite as efficient, so these vaccines require more
than one dose to achieve complete protection. The additional
vaccine doses, often called “boosters,” help boost the immune
response. The first dose is called a priming dose: Because it is
the first time a person experiences the antigen, it is the first
time the body starts to make the memory cells. The subsequent
doses increase the number of memory cells and also help the
body maintain circulating antibodies.

Besides antigens, what else are vaccines made of?

To keep vaccines safe and help increase their effectiveness,
they may include other substances besides antigens. These
include the following:

• Preservatives such as phenol and thimerosal (which is

also known as ethylmercury) prevent vaccine contami-
nation from any bacteria in the environment during and
after production. These substances are especially impor-
tant in preventing contamination after a vaccine vial has
been opened for use. For this reason, preservatives are
required in vials that contain more than one dose.
• Stabilizers, such as sugars, amino acids, or proteins, keep
the vaccine functional for longer periods of time. Without
stabilizers, vaccines’ antigens would be degraded during
 What Is a Vaccine and How Do Vaccines Work? 11

the temperature changes that take place during produc-

tion, transportation, and storage.
• Inactivating agents such as formaldehyde inactivate
viruses or bacterial toxins for inactivated virus or bacte-
rial toxoid vaccines (see previous discussion about vac-
cine types). Formaldehyde is used during production of
some vaccines to inactivate a virus or bacteria. Although
the formaldehyde is removed after the virus or bacteria
is inactivated, there can be a small residual amount left
behind in production. The allowable residual is much
lower than the amount of formaldehyde that naturally
occurs within the body.
• Adjuvants, or substances that help enhance the immune
response to vaccines, are especially important for eld-
erly and immunocompromised patients who may have
a weaker response to vaccination. Adjuvants also help
enhance the immune response to vaccines that use
only a few antigens; they are not needed in weakened
or killed whole virus vaccines that induce a more com-
plete immune response. Aluminum salts are most com-
monly used in US licensed vaccines. Aluminum is the
most widely used vaccine additive because it helps boost
the immune response, either by stimulating the uptake
of antigens by immune cells or by slowing the release of
an antigen at the site of injection to promote a more sus-
tained antibody production. Vaccines containing alumi-
num adjuvants have been in use the longest and have a
uniform track record of safety.

Adjuvants, preservatives, and inactivating agents are neces-

sary to ensure safety and effectiveness in vaccine production.
The fact that these substances include aluminum, formalde-
hyde, and thimerosal—​substances that can be associated with
toxicity above certain levels in the body—​has raised safety
concerns among some, particularly those who are hesitant
about vaccines.
12 Vaccines

Even if these substances are necessary, are they safe?

There is no evidence that exposure to any of these sub-
stances in vaccines results in toxicity or illness. The use of
any vaccine additive is regulated by the US Food and Drug
Administration (FDA) and must follow strict requirements for
allowable amounts. The details related to these additives are
also a central focus of the licensing application for any vac-
cine, and these details cannot be changed without submitting
an amendment to the FDA. As per federal requirements, the
type and amount of all vaccine additives must be listed on a
vaccine’s label.
Heavy metals such as aluminum and mercury are pres-
ent in the environment and can also be found in many foods
that people eat. (Mercury, for example, can also be found
in infant formula.) Human bodies excrete the heavy met-
als to which they are exposed, and every human has a small
but detectable level of aluminum and mercury in his or her
bloodstream at all times. The very small amounts of these
substances found in vaccines do not increase these circulat-
ing levels, and the exposure that occurs with vaccination
is negligible compared to what individuals encounter on a
daily basis.
Formaldehyde, which is used to inactivate viruses or
bacteria during vaccine manufacturing, has been shown to
damage DNA in animal cells, which is the same process by
which cancer cells are made. However, the tie between form-
aldehyde and damage to cell DNA is based only on animal
models and laboratory experiments, and formaldehyde is not
considered a human carcinogen. It is important to note that
formaldehyde is a necessary component of human metabolic
pathways, including DNA synthesis. For this reason, every
individual has a detectable amount of formaldehyde in his
or her bloodstream that far exceeds the amount found in
vaccines.
 What Is a Vaccine and How Do Vaccines Work? 13

What about thimerosal and autism?

Because mercury toxicity can affect the nervous system, there
has been a concern that thimerosal (ethylmercury) could be
linked to neurodevelopmental disorders such as autism (vac-
cines and autism are also discussed later). This concern arose
after the 1998 publication of an article in the medical jour-
nal The Lancet in which British gastroenterologist Andrew
Wakefield and colleagues presented a series of 12 patients
who developed autistic behaviors and gastrointestinal symp-
toms after receiving the measles, mumps, and rubella (MMR)
vaccine, which at the time contained thimerosal. The article
hypothesized that the MMR vaccine may have prompted the
production of antibodies that attacked the nervous system and
led to the behavioral changes. On the coattails of the Wakefield
study, others soon hypothesized that thimerosal could cause
autism.
In the years that followed the publication of the Wakefield
study, journalists and other scientists unearthed flaws in
Wakefield et al.’s research, along with multiple professional
conflicts of interest and ethics violations, that together discred-
ited the study’s findings and the authors’ allegation of a link
between MMR and neurodevelopmental disease (e.g., autism).
In 2010, The Lancet took the extraordinary step of retracting the
paper, with the journal’s editor-​in-​chief telling The Guardian
that the editorial board had been “deceived” by the authors’
representation of their methods. Since initial publication of
Wakefield et al.’s article and the journal’s retraction, several
subsequent studies have found no link between MMR, thimer-
osal, or any vaccine and autism.

Why was thimerosal removed from vaccines in 2001?

Wakefield et al.’s article prompted a public outcry about thi-
merosal’s possible ties to autism, including demands for the
14 Vaccines

removal of thimerosal from vaccines due to the concern for

potential toxicity. Although there was no evidence of any
adverse effects or mercury toxicity related to vaccination, the
decision was made to remove thimerosal from all vaccines so
that vaccination would not contribute to any exposure and,
one could reasonably assume, to assuage any concerns and
prevent vaccine acceptance from suffering. Today, thimerosal
is used only in the multidose influenza vaccine in the United
States. Because of the excellent preservative properties and lack
of evidence of adverse effects, the World Health Organization
continues to recommend thimerosal for use in multi-​use vials
in developing countries.
The bottom line is that using preservatives, stabilizers, and
adjuvants allows us to use vaccines safely and effectively. Even
if adjuvants such as aluminum were removed from vaccines, it
would not decrease individuals’ exposure to these substances
in any significant way; it would, however, decrease vaccine
effectiveness and safety.

Do some vaccines contain animal products?

Yes. Some vaccines contain weakened viruses, which can grow
only in animal cells. The animal cells are used as a medium
to grow the vaccine virus, which is then purified before being
packaged as a vaccine. Purification takes place outside of the
animal cell, but there may be very small amounts of animal
protein or DNA in vaccines.
Gelatin, an animal product that is made from the skin or
hooves of pigs, is also present in some vaccines. Gelatin is used
as a stabilizing agent in some live virus vaccines (varicella,
zoster, live attenuated influenza, and rabies), which may con-
tain a sizable amount of it. This is an important consideration
for those with severe allergy to gelatin—​a very rare allergy
(one case per 1 million doses) but still the most commonly
identified cause of a severe allergy to vaccines. The presence
of gelatin may also raise concerns for certain religious groups
 What Is a Vaccine and How Do Vaccines Work? 15

that have dietary restrictions regarding the ingestion of pig

products. On this matter, religious leaders from most denomi-
nations have sanctioned the receipt of gelatin-​containing vac-
cines because vaccination does not involve ingestion, and the
modified gelatin used in vaccines is substantially different
than natural gelatin.

Do vaccines use cells from aborted fetuses?

Some do, especially in cases in which the animal cells that
are used to grow other vaccine viruses are insufficient.
Because fetal cells act the same as human cells, they are more
likely to support the replication of human viruses. They are
also effectively sterile, having not been exposed to other
viruses or bacteria as some animal cells can be. Because fetal
cells reproduce indefinitely and without limit, they can be
grown continually from a single source, and they are used
extensively throughout biomedical research. In addition to
vaccine development, human fetal cells have been used to
develop treatments for HIV/​AIDS, spinal cord injuries, can-
cer, and neurologic conditions such as Parkinson’s disease
and autism.
Fetal cells used for vaccine production today are grown
from two different elective abortions that took place in Sweden
and England in the 1960s. The fetal cells from Sweden were
sent to the Wistar Institute in Philadelphia, where they were
first used for rubella and rabies vaccines; this became known
as the Wistar Institute-​38 cell line. The cells from England
were sent to the Medical Research Council and are known as
MRC-​5 cells. Currently, four vaccines are made using these
cell lines: varicella, rubella, hepatitis A, and one of the rabies
vaccines.
The use of fetal cells may pose a very difficult ethical
dilemma for those who oppose abortion. In 2005, the Pontifical
Academy for Life, a Vatican organization that considers bio-
ethical intersections between science and faith, made a formal
16 Vaccines

ruling on this issue, determining that the receipt of vaccines

manufactured using fetal cells is acceptable: “Clearly the
use of a vaccine in the present does not cause the one who is
immunized to share in the immoral intention or action of those
who carried out the abortion in the past.”
 2
A BRIEF HISTORY
OF VACCINES

The conceptual foundations of vaccination were first docu-

mented in ancient Greece, where physicians observed that get-
ting infected with a virus could prevent reinfection with that
same virus. In 900–​1000 a.d., early forms of the modern vaccine
were developed in China when physicians first noted that peo-
ple exposed to smallpox scab tissue would be protected from
getting smallpox or would develop milder disease. Smallpox
scabs were often crushed into powder and inhaled through
the nose, and similar interventions were employed for hun-
dreds of years thereafter in Asia, the Middle East, and Africa.
In 1715, Lady Mary Montagu, the wife of England’s ambassa-
dor to Turkey, learned about the practice after she developed
smallpox and was in search of a way to protect her children.
She is credited with bringing inoculation to England when she
had a physician inoculate her 2-​year-​old child in 1721.
However, it was not until the early 18th century that the
first vaccine came to the United States.

When was the first vaccination delivered in the United States?

The Boston smallpox epidemic of 1721 began when small-
pox was brought to US shores on a ship from the Caribbean.
Although it was not the first smallpox epidemic in colonial
America, it was the first time an intervention was attempted
18 Vaccines

to prevent disease. The intervention occurred through a prac-

tice called inoculation, also known as variolation. At the time,
the use of inoculation was somewhat speculative because it
occurred long before there was a good understanding of the
multiple pathways of the immune system or even germ theory.

What is inoculation?
The Merriam–​Webster Dictionary defines inoculation as “the
introduction of a pathogen or antigen into a living organism
to stimulate the production of antibodies.” During the 1721
smallpox epidemic, fluid from an infected individual’s small-
pox pustule was introduced to healthy individuals through a
small cut in the skin. The person who received the inoculation
would develop smallpox but generally a milder case. The indi-
vidual would then be protected from subsequent infections
through antibody protection, although the role of antibodies
was not understood at the time.
The introduction of inoculation was fraught with contro-
versy. Cotton Mather, a Boston minister known for his cham-
pioning role in the Salem witch trials, made the first call for
inoculation in response to the 1721 epidemic.
Mather first learned of inoculation and its benefits from both
incoming slaves who had the procedure performed in their
home country and texts from the Royal Society of Medicine in
Britain. Mather had previously portrayed smallpox in religious
terms—​an act of Providence or a reflection of man’s sin—​but
during the 1721 epidemic, he chose instead to intervene, citing
the will of God.
Interestingly, Mather found almost no support within the
medical community, save for one physician named Zabdiel
Boylston, who agreed to offer inoculation. By the end of the
epidemic, Boylston had inoculated 248 patients, mostly in
secret. However, by the time the next smallpox epidemic hit
Boston in 1730, the practice was beginning to gain traction.
 A Brief History of Vaccines 19

Why the controversy?

From a medical perspective, although it had been practiced in
many countries throughout the world and was described in
medical texts, the available literature did not provide much
evidence of the efficacy of inoculation or its safety when it was
first introduced. People who developed smallpox after inocu-
lation could still infect others, so quarantine was important.
It was difficult for many people to accept making themselves
intentionally ill as a preventive measure: People accepted
some interventions, many dangerous, to treat an illness, but
it was more difficult to accept a new intervention that made
them willfully ill (albeit less ill than if they contracted small-
pox through traditional contagion routes) when they were
otherwise feeling well. There were also those who feared that
inoculation could lead to chronic health problems and others
who had moral and spiritual reservations. Many of these senti-
ments resonate today among individuals who have concerns
about vaccines.
Controversies aside, infections associated with inoculation
appeared to be less severe and provided protection from sub-
sequent infection. Adoption remained slow, but the medical
community did eventually embrace it, sometimes adding a
string of preparatory (and largely unnecessary) interventions
prior to inoculation. In 1757, an English surgeon and his son
developed a simpler procedure (use of a thin needle rather
than a lancet) and established a society of 200 inoculation
practitioners worldwide. Despite this organization, inocula-
tion remained against the law in many colonies through the
Revolutionary War, but it was practiced extensively in larger
cities such as Philadelphia and Boston.

How did we get from inoculation to vaccination?

Again, smallpox. In 1796, Edward Jenner, a doctor in the
English countryside, was treating a milkmaid who claimed
20 Vaccines

that she never got smallpox because she had been exposed to
cowpox, a viral disease similar to smallpox but milder and less
common. Cowpox was mostly limited to farmworkers who
acquired the disease through cow udders. It was not as severe
as smallpox, but it still caused inflamed joints, skin ulcers,
fever, and limb pain. As opposed to smallpox, cowpox did not
cause disfigurement or death.
Jenner’s first field experiment was to find a group of farm-
ers who had a history of cowpox and inoculate them with
smallpox; he did so, and none of the farmers developed small-
pox. In May 1796, he performed the ultimate test: He took fluid
from lesions of a milkmaid who had just developed cowpox
and then inoculated a young boy with it. Several weeks later,
Jenner inoculated the boy with smallpox and nothing hap-
pened; the boy never showed symptoms of the more serious
disease. Jenner had demonstrated that cowpox gave immunity
against smallpox. By 1801, 100,000 people throughout Europe
had received the first cowpox-​based smallpox vaccine.

When did smallpox vaccine come to the United States?

Interestingly, cowpox did not affect cows in the United States,
so there was no access to the fluid needed to make the vac-
cine that had been successful in the United Kingdom. Some
domestic doctors received samples from the United Kingdom,
but this limited supply could not keep pace with the massive
demand. This paved the way for fraudulent and black-​market
vaccines, the use of which led people who thought they were
protected to still contract smallpox. The proliferation of these
incidents almost completely halted smallpox vaccination in
the United States until Thomas Jefferson intervened to estab-
lish the widespread import of cowpox fluid (or vaccinia). He
also worked with doctors to conduct studies to show that vac-
cination was indeed effective (see https://​www.historyofvac-
cines.org/​timeline).
 A Brief History of Vaccines 21

How well did this early vaccine really work?

Today, we can hypothesize that the cowpox virus was similar
to smallpox and could therefore lead to cross-​reactivity—​that
is, the antibodies made to fight cowpox also recognized and
worked against smallpox.
Neither Jenner nor his contemporaries had any firm con-
cept of bacteria or viruses, and presumably they understood
little about the mechanisms behind their observations. Their
evidence was based on the number of vaccinated individuals
who developed (or did not develop) smallpox after exposure.
Although the vaccine did prevent disease, the lack of under-
standing led to errors in vaccine administration, including use
of nonliving virus (which would produce no immune reaction
and would provide no protection) and patients’ development
of skin infections from bacteria or tetanus due to vaccine con-
tamination. The occurrence of these problems lessened as the
medical and scientific community learned more.

What was the public response to the new vaccine?

Support for vaccination developed more slowly in the United
States than in the United Kingdom. By the early 19th century,
US vaccine uptake was mostly limited to larger cities, in which
the population was at higher risk for smallpox epidemics com-
pared to rural communities. In response to frequent outbreaks,
Boston was the first US city to enact a mandatory vaccination
law in 1827, and Massachusetts was the first state to do so
in 1855.
As the century progressed, the US Civil War and the
Franco-​Prussian War offered evidence on both continents for
the importance of vaccines: Armies that required vaccination
had lower numbers of smallpox cases and deaths compared
to civilian populations or armies that did not require vaccina-
tion. This led to a more concerted post-​war effort to ensure a
stable vaccine supply and to mandate vaccination. However,
22 Vaccines

enforcement remained uneven, and because vaccine supply

was inconsistent, acceptance of such laws was uneven as well.
In Europe, where cowpox was common, vaccine farms
were created to help ensure a more stable and consistently
effective supply of vaccines that did not require fluid from
lesions of infected people. This practice soon caught on in the
United States as well, and throughout most of the 19th cen-
tury, smallpox vaccines were created “direct from the cow”
on vaccine farms via fluid recovered directly from cowpox
lesions on calves. Initially, the United States imported these
cowpox strains—​the first to be widely propagated was called
the Beaugency vaccine strain from France. Eventually, vaccine
farms were established in the United States after 1870, when a
physician from Boston imported the Beaugency vaccine strain
and inoculated several cows. Over time, the practice was
upgraded to include techniques that minimized risk of con-
tamination from other bacteria. Despite these improvements,
most people generally avoided vaccination until there was an
epidemic.
The introduction of Jenner’s vaccine was also countered by
the emergence of the first anti-​vaccine movement. The 1871
Vaccination Act in Britain, which required poor individuals to
be vaccinated or risk fines or property loss, gave rise to the
National Anti-​Vaccination League, which opposed compul-
sory vaccination based on concerns that centered on vaccine
safety and effectiveness.
In the United States, an organized anti-​vaccine movement
took longer to develop. Many individuals were wary of com-
pulsory vaccination programs, and local anti-​ vaccination
societies emerged without much widespread organization
or membership. It was not until 1906 when John Pitcairn, a
self-​
made millionaire and Swedenborgian (a 19th-​ century
Christian denomination that believed vaccination represented
contamination of the soul), founded the Anti-​ Vaccination
League of Pennsylvania, the first anti-​vaccination organization
 A Brief History of Vaccines 23

with significant financial resources and organization. Pitcairn’s

activism was spurred by anger over compulsory laws that
required vaccination for everyone, even those who opposed it
due to their religious beliefs. (Note that at the time of Pitcairn’s
efforts, a less severe strain of smallpox had become more prev-
alent in many communities. Therefore, there was less fear of
smallpox, which made compulsory vaccination seem less nec-
essary and more objectionable to some individuals.)
Pitcairn’s efforts to block compulsory laws in Pennsylvania
were not successful, and he went on to help establish the Anti-​
Vaccination League of America in 1908, an organization whose
main goal was to “promote universal acceptance of the prin-
ciple that health is nature’s greatest safeguard against disease
and that therefore no State has the right to demand of anyone
the impairment of his or her health.” The Anti-​Vaccination
League of America attracted some vocal activists and focused
its efforts on blocking compulsory vaccination laws. Many
of the beliefs that fueled the group’s arguments still resonate
today. Some in the organization rejected the idea that diseases
were caused by specific germs that needed to be prevented,
arguing instead that diseases were a symptom of uncleanliness
or poor health. Others considered vaccination to be ineffective
and unsanitary, and they emphasized the importance of hav-
ing control over one’s own body. Vaccination was also consid-
ered an example of public health and medicine overstepping
its bounds: “Be your own doctor” is a statement from one
1911 League advertisement. Pitcairn and the group’s leader-
ship lobbied state legislatures and engaged in public debates
about vaccination. These efforts led to the defeat of manda-
tory vaccination legislation in some states in the 1910s, but the
group began to lose momentum by the 1920s as vaccination
and other public health prevention measures successfully pre-
vented diseases such as tuberculosis, diphtheria, and tetanus.
Vaccine technology had also begun to improve, which in turn
increased confidence in vaccine safety.
24 Vaccines

How did the public health community

make early vaccines safer?
Smallpox vaccines were born of an imperfect science that
reflected the limited knowledge of their era. The flaws of this
first class of vaccines came to a head during the 1901–​1904
smallpox epidemic that affected cities and states throughout
the United States. After widespread compulsory immuniza-
tion campaigns were initiated to stop disease transmission,
an outbreak of tetanus deaths among vaccinated patients in
Philadelphia, Camden, Cleveland, and Atlantic City quickly
followed—​all related to vaccines produced by one manufac-
turer. This highlighted the lack of oversight on vaccine pro-
duction and stirred a public distrust for the safety of vaccine
science. An ensuing investigation led by physician Joseph
McFarland found that contamination may have been due to
inadequate use of glycerin, which was added to vaccines dur-
ing that time to kill potentially contaminating bacteria. In July
1902, Congress passed the US Biologics Control Act, which
regulated vaccines that moved across state lines; ensuing reg-
ulations required testing for tetanus and other bacteria. These
laws were not easy to enforce, but more stringent requirements
led to fewer (and better) licensed vaccine manufacturers. In
1906, Congress followed with the Pure Food and Drug Act of
1906, which laid the groundwork for the US Food and Drug
Administration.
As the regulatory infrastructure for vaccines came on line in
the United States, the modern vaccine movement began amid
a flurry of scientific advancements. Louis Pasteur’s germ the-
ory, which is founded on principles that infectious diseases
are caused by microorganisms such as bacteria and viruses,
became widely accepted. Pasteur also showed that germs did
not appear spontaneously, as was the widespread belief at
the time, but rather that they are in the environment and air.
Pasteur also found that if he boiled liquid to kill any germs (a
process that became known as pasteurization) and sealed the
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the Malouines. stormy weather and high seas: we were obliged to
try under our main-sail on the 16th, having suffered some damage.
Since the 17th in the afternoon, when we came into soundings, the
weather was very foggy. The 19th, not seeing the land, though the
horizon was clear, and I was east of the Sebald’s isles by my
reckoning, I was afraid I had gone beyond the Malouines, and
therefore resolved to sail westward; the wind, which is a rare
circumstance, favoured my resolution. I proceeded very fast in
twenty-four hours, and having then found the soundings off the coast
of Patagonia, I was sure as to my position, and so proceeded again
very confidently to the eastward. Indeed, the 21st, at four o’clock in
the afternoon, we discovered the Sebald’s isles, remaining in N. E.
by E. eight or ten leagues distant, and soon after we saw the coast
of the Malouines. I could have spared myself all the Fault
trouble I had been in, if I had in time sailed close- committed in
hauled, in order to approach the coast of America, the direction of
this course.
and so find the islands by their latitude.
The 23d the evening we entered and anchored in the great bay,
where the two Spanish frigates likewise came to an anchor on the
24th. They had suffered greatly during their course; the storm on the
16th having obliged them to bear away; and the commodore-ship,
having shipped a sea, which carried away her quarter-badges, broke
through the windows of the great cabbin, and poured a great quantity
of water into her. Almost all the cattle they took on board at
Montevideo for the colony, died through the badness of the weather.
The twenty-fifth the three vessels came into port, and moored.
The Spaniards April. The first of April I delivered our
take settlement to the Spaniards, who took possession of
possession of it, by planting the Spanish colours, which were
our settlement
at the
saluted at sun-rising and sun-setting from the shore
Malouines. and from the ships. I read the king’s letter to the
French inhabitants of this infant colony, by which his
majesty permits their remaining under the government of his most
catholic majesty. Some families profited of this permission; the rest,
with the garrison, embarked on board the Spanish frigates, which
sailed for Montevideo the 27th in the morning[16].
Historical Some historical remarks concerning these isles,
details will, I hope, not be deemed unnecessary.
concerning the Americo It appears to me, that the first
Malouines. Vespucci discovery of them may be attributed
discovers them. to the celebrated Americo Vespucci,
who, in the third voyage for the discovery of America, sailed along
the northern coasts of them in 1502. It is true, he did not know
whether it belonged to an isle, or whether it was part of the continent;
but it is easy to conclude, from the course he took, from the latitudes
he came to, and from the very description he gives of the coasts,
that it is that of the Malouines. I shall assert with French and
equal right, that Beauchesne Gouin, returning from English
the South Seas in 1700, anchored on the east side navigators visit
them after him.
of the Malouines, thinking he was at the Sebald’s
isles.
His account says, that after discovering the isle to which he gave
his own name, he anchored on the east side of the most easterly of
Sebald’s isles. I must first of all observe, that the Malouines, being in
the middle between the Sebald’s isles and the isle of Beauchesne,
have a considerable extent, and that he must have necessarily fallen
in with the coast of the Malouines, as is impossible not to see them,
when at anchor eastward of the Sebald’s isles. Besides,
Beauchesne saw a single isle of an immense extent; and it was not
till after he had cleared it, that he perceived two other little ones: he
passed through a moist country, filled with marshes and fresh-water
lakes, covered with wild-geese, teals, ducks, and snipes; he saw no
woods there; all this agrees prodigiously well with the Malouines.
Sebald’s isles, on the contrary, are four little rocky isles, where
William Dampier, in 1683, attempted in vain to water, and could not
find a good anchoring-ground.
Be this as it will, the Malouines have been but little known before
our days—Most of the relations report them as isles covered with
woods. Richard Hawkins, who came near the northern coast of
them, which he called Hawkins’s Maiden-land, and who pretty well
described them, asserts that they were inhabited, and pretends to
have seen fires there. At the beginning of this century, the St. Louis,
a ship from St. Malo, anchored on the south-east side, in a bad bay,
under the shelter of some little isles, called the isles of Anican, after
the name of the privateer; but he only stayed to water there, and
continued his course, without caring to survey them.
The French However, their happy position, to serve as a place
settle there. of refreshment or shelter to ships going to the
South-Seas, struck the navigators of all nations. In the beginning of
the year 1763, the court of France resolved to form a settlement in
these isles. I proposed to government, that I would establish it at my
own expence, assisted by Messrs. de Nerville and d’Arboulin, one
my cousin-german, the other my uncle. I immediately got the Eagle
of twenty guns, and the Sphinx of twelve, constructed and furnished
with proper necessaries for such an expedition, by the care of M.
Duclos Guyot, now my second. I embarked several Acadian families,
a laborious intelligent set of people, who ought to be dear to France,
on account of the inviolable attachment they have shewn, as honest
but unfortunate citizens.
The 15th of September I sailed from St. Malo. M. de Nerville was
on board the Eagle with me. After touching twice, once at the isle of
St. Catharine, on the coast of the Brasils, and once at Montevideo,
where we took in many horses and horned cattle, we made the land
of Sebald’s isles the 31st of January, 1764. I sailed into a great bay,
formed by the coast of the Malouines, between its N. W. point, and
Sebald’s isles; but not finding a good anchoring ground, sailed along
the north coast; and, coming to the eastern extremity of these isles, I
entered a great bay on the third of February, which seemed very
convenient to me, for forming the first settlement.
Account of the The same illusion which made Hawkins, Woods,
manner in Rogers, and others, believe that these isles were
which it was covered with wood, acted likewise upon my fellow
made.
voyagers. We were surprised, when we landed, to
see that what we took for woods as we sailed along the coast, was
nothing but bushes of a tall rush, standing very close together. The
bottom of its stalks being dried, got the colour of a dead leaf to the
height of about five feet; and from thence springs a tuft of rushes,
which crown this stalk; so that at a distance these stalks together
have the appearance of a wood of middling height. These rushes
only grow near the sea side, and on little isles; the mountains on the
main land are, in some parts, covered all over with heath, which are
easily mistaken for bushes.
In the various excursions, which I immediately ordered, and partly
made in the island myself, we did not find any kind of wood; nor
could we discover that these parts had been frequented by any
nation.
I only found, and in great quantity too, an exceeding good turf,
which might supply the defect of wood, both for fuel, and for the
forge; and I passed through immense plains, every where
intersected by little rivulets, with very good water. Nature offered no
other subsistence for men than fish and several sorts of land and
water fowl. It was very singular, on our arrival, to see all the animals,
which had hitherto been the only inhabitants of the island, come near
us without fear, and shew no other emotions than those which
curiosity inspires at the sight of an unknown object. The birds
suffered themselves to be taken with the hand, and some would
come and settle upon people that stood still; so true it is, that man
does not bear a characteristic mark of ferocity, which mere instinct is
capable of pointing out to these weak animals, the being that lives
upon their blood. This confidence was not of long duration with them;
for they soon learnt to mistrust their most cruel enemies.
First year. The 17th of March, I fixed upon the place of the
new colony, which at first was only composed of twenty-seven
persons, among whom were five women, and three children. We set
to work immediately to build them huts covered with rushes, to
construct a magazine, and a little fort, in the middle of which a small
obelisk was erected. The king’s effigy adorned one of its sides, and
under its foundations we buried some coins, together with a medal,
on one side of which was graved the date of the undertaking, and on
the other the figure of the king, with these words for the exergue,
“Tibi serviat ultima Thule.”[17]
However, to encourage the colonists, and encrease their reliance
on speedy assistance, which I promised them, M. de Nerville
consented to remain at their head, and to share the risks to which
this weak settlement was exposed, at the extremity of the globe,
where it was at that time the only one in such a high southern
latitude. The fifth of April, 1764, I solemnly took possession of the
isles in the king’s name, and the eighth I sailed for France.
Second year. The fifth of January, 1765, I saw my colonists
again, and found them healthy and content. After landing what I had
brought to their assistance, I went into the straits of Magalhaens, to
get a cargo of timber, palisadoes and young trees, and I began a
navigation, which is become necessary to the colony. Then I found
the ships of commodore Byron, who, after surveying the Malouines
for the first time, passed the straits, in order to get into the South-
seas. When I left the Malouines the 27th of April following, the colony
consisted of twenty-four persons, including the officers.
In 1765 we sent back the Eagle to the Malouines, and the king
sent the Etoile, one of his store ships, with her. These two vessels,
after landing the provisions and new colonists, sailed together to
take in wood in the straits of Magalhaens. The settlement now began
to get a kind of form. The governor and the ordonnateur[18] lodged in
very convenient houses built of stone, and the other inhabitants lived
in houses of which the walls were made of sods. There were three
magazines, both for the public stores and those of private persons.
The wood out of the straits had served to build several vessels, and
to construct schooners for the purpose of surveying the coast. The
Eagle returned to France from this last voyage, with a cargo of train
oil and seals-skins, tanned in the island. Several, trials had been
made towards cultivation, which gave no reason to despair of
success, as the greatest part of the corn brought from Europe was
easily naturalized to the country. The encrease of the cattle could be
depended upon, and the number of inhabitants amounted then to
about one hundred and fifty.
However, as I have just mentioned, commodore Byron came in
January, 1765, to survey the Malouines. He touched to the westward
of our settlement, in a port which we had already named Port de la
Croisade, and he took possession of these islands for the crown of
England, without leaving a single inhabitant there. It was not before
1766, that the English sent a colony to settle in Port de la Croisade,
which they had named Port Egmont; and captain Macbride, of the
Jason frigate, came to our settlement the same year, in the
beginning of December. He pretended that these parts belonged to
his Britannic majesty, threatened to land by force, if he should be any
longer refused that liberty, visited the governor, and sailed away
again the same day.
Such was the state of the Malouines, when we put them into the
hands of the Spaniards, whose prior right was thus inforced by that
which we possessed by making the first settlement[19]. The account
of the productions of these isles, and the animals which are to be
found there, will furnish matter for the following chapter, and are the
result of the observations of M. de Nerville, during a residence of
three years. I believed it was so much more proper to enter upon this
detail, as M. de Commerçon has not been at the Malouines, and as
their natural history is in some regards important[20].
 CHAP. IV.
Detail of the natural history of the Isles Malouines.

A Country which has been but lately inhabited always offers

interesting objects, even to those who are little versed in natural
history; and though their remarks may not be looked upon as
authorities, yet they may satisfy, in part, the curiosity of the
investigators of the system of nature.
First aspect The first time we landed upon these isles, no
they bear. inviting objects came in sight, and, excepting the
beauty of the port in which we lay, we knew not what could prevail
upon us to stay on this apparently barren ground: the horizon
terminated by bald mountains, the land lacerated by the sea, which
seems to claim the empire over it; the fields bearing a dead aspect,
for want of inhabitants; no woods to comfort those who intended to
be the first settlers; a vast silence, now and then interrupted by the
howls of marine monsters; and, lastly, the sad uniformity which
reigned throughout; all these were discouraging objects, which
seemed that in such dreary places nature would refuse assistance to
the efforts of man. But time and experience taught us, that labour
and constancy would not be without success even there. The
resources with which nature presented us, were immense bays,
sheltered from the violence of the winds by mountains, which poured
forth cascades and rivulets; meadows covered with rich pastures,
proper for the food of numerous flocks; lakes and pools to water
them; no contests concerning the property of the place; no fierce, or
poisonous, or importune animals to be dreaded; an innumerable
quantity of the most useful amphibia; birds and fish of the best taste;
a combustible substance to supply the defect of wood; plants known
to be specifics against the diseases common to sea-faring men; a
healthy and continually temperate climate, much more fit to make
men healthy and robust, than those enchant-countries, where
abundance itself becomes noxious, and heat causes a total
inactivity. These advantages soon expunged the impressions which
the first appearance had made, and justified the attempt.
To this we may add, that the English in their relation of Port-
Egmont, have not scrupled to say, that the countries adjacent
furnished every thing necessary for a good settlement. Their taste for
natural history will, without doubt, engage them to make and to
publish enquiries which will rectify these.
Geographical The Malouines are situated between 51° and 52°
position of the 30′ S. lat. and 65° 30′ W. long. from Paris; and
Malouines. between 80 and 90 leagues distant from the coast of
America or Patagonia, and from the entrance of the straits of
Magalhaens.
The map which we give of these islands, has certainly not a
geographical accuracy, which must have been the work of many
years. It may, however, serve to indicate nearly the extent of these
isles from east to west, and from north to south; the position of the
coasts, along which our ships have sailed; the figure and depth of
the great bays, and the direction of the principal mountains[21].
Of the The harbours, which we have examined, are both
harbours. extensive and secure; a tough ground, and islands
happily situated to break the fury of the waves, contribute to make
them safe and easily defensible; they have little creeks, in which the
smallest vessels can retire. The rivulets come down into the sea; so
that nothing can be more easy, than to take in the provision of fresh
water.
Tides. The tides are subject to all the emotions of the
sea, which surrounds the isles, and have never risen at settled
periods, which could have been calculated. It has only been
observed, that, just before high-water, they have three determinate
variations; the sea, at that time, in less than a quarter of an hour,
rises and falls thrice, as if shaken up and down; and this motion is
more violent during the solstices, the equinoxes, and the full moons.
Winds. The winds are generally variable; but still those
between north and west, and between south and west, are more
prevalent than the others. In winter, when the winds are between
north and west, the weather is foggy and rainy; if between west and
south, they bring snow, hail, and hoar frost; if from between south
and east, they are less attended with mists, but violent, though not
quite so much as the summer winds, which blow between south-
west and north-west: these latter, which clear the sky and dry the
soil, do not begin to blow till the sun appears above the horizon; they
encrease as that luminary rises; are at the greatest height when he
crosses the meridian; and lose their force when he goes to
disappear behind the mountains. Besides being regulated by the
sun’s motion, they are likewise subject to be governed by the tides,
which encrease their force, and sometimes alter their direction.
Almost all the nights throughout the year are calm, fair, and star-light,
especially in summer. The snow, which is brought by the south-west
winds in winter, is inconsiderable; it lies about two months upon the
tops of the highest mountains; and a day or two, at most, upon the
surface of the other grounds. The rivers do not freeze, and the ice of
lakes and pools has not been able to bear men upwards of twenty-
four hours together. The hoar-frosts in spring and autumn do no
damage to the plants, and at sun-rising are converted into dew. In
summer, thunder is seldom heard; and, upon the whole, we felt
neither great cold, nor great heat; and the distinction of seasons
appeared almost insensible. In such a climate, where the revolutions
of the seasons affect by no means the constitution, it is natural that
men should be strong and healthy; and this has been experienced
during a stay of three years.
Water. The few mineral substances found at the
Malouines, are a proof of the goodness of the water, which is every
where conveniently situated; no noxious plants infect the places
where it runs through; its bed is generally gravel or sand, and
sometimes turf, which give it a little yellowish hue, without
diminishing its goodness and lightness.
Soil. All the plains have much more depth of soil than
is necessary for the plough to go in. The soil is so much interwoven
with roots of plants, to the depth of near twelve inches, that it was
necessary, before it was possible to proceed to cultivation, to take off
this crust or layer; and to cut it, that it might be dried and burnt. It is
known, that this process is excellent to make the ground better, and
we made use of it. Below this first layer, is a black mould, never less
than eight or ten inches deep, and frequently much deeper; the next
is the yellow, or original virgin-soil, whose depth is undeterminate. It
rests upon strata of slate and stones; among which no calcareous
ones have ever been found; as the trial has been made with
aquafortis. It seems, that the isles are without stones of this kind.
Journeys have been undertaken to the very tops of the mountains, in
order to find some; but they have never procured any other than a
kind of quartz, and a sandstone, not friable; which produced sparks,
and even a kind of phosphorescent light, accompanied with a smell
of brimstone. Stones proper for building are not wanting; for most of
the coasts are formed of them. There are strata of a very hard and
small grained stone; and likewise other strata, more or less sloping,
which consist of slates; and of a kind of stone containing particles of
talc. There are likewise stones, which divide into shivers; and on
them we observed impressions of a kind of fossil shells, unknown in
these seas; we made grind-stones of it to sharpen our tools. The
stone taken out of the quarries was yellowish, and not yet come to a
sufficient degree of hardness, as it could be cut with a knife; but it
hardened in the air. Clay, sand, and earth, fit for making potters-ware
and bricks, were easily found.
Turf and its The turf, which is generally to be met with above
qualities. the clay, goes up a great way in the country. From,
whatever point one sets out, one could not go a league without
meeting with considerable strata of it, always easy to be
distinguished by the inequalities in the ground, by which some of its
sides were discovered. It continually is formed from the remains of
roots and plants in marshy places; which are always known by a
sharp-pointed kind of rushes. This turf being taken in a bay, near our
habitation, where it shews a surface of twelve feet high to the open
air, gets a sufficient degree of dryness there. This was what we
made use of; its smell was not disagreeable; it burnt well, and its
cinders, or embers, were superior to those of sea-coals; because, by
blowing them, it was as easy to light a candle as with burning coals;
it was sufficient for all the works of the forge, excepting the joining of
great pieces.
Plants. All the sea-shores, and the inner parts of the isles
are covered with a kind of gladiolus, or rather a species of gramen. It
is of an excellent green, and is above six feet high, and serves for a
retreat to seals and sea-lions: on our journies it sheltered us, as it did
them. By its assistance we could take up our quarters in a moment.
Its bent and united stalks, formed a thatch or roof, and its dry leaves
a pretty good bed. It was likewise with this plant that we covered our
houses; its stalk is sweet, nourishing, and preferred to all other food
by the cattle.
Next to this great plant, the heath, the shrubs, and the gum-plant
were the only objects that appeared in the fields. The other parts are
covered by small plants, which, in moist ground, are more green and
more substantial. The shrubs were of great use to us as fuel, and
they were afterwards kept for heating the ovens, together with the
heath; the red fruit of the latter attracted a great quantity of game in
the season.
Resinous gum- The gum-plant, which is new and unknown in
plant. Europe, deserves a more ample description. It is of
a bright green, and has nothing of the figure of a plant; one would
sooner take it to be an excrescence of the earth of this colour; for it
has neither stalk, branches, nor leaves—Its surface, which is
convex, is of so close a texture, that nothing can be introduced
between it, without tearing it. The first thing we did, was to sit down
or stand upon it; it is not above a foot and a half high. It would bear
us up as safely as a stone, without yielding under our weight. Its
breadth is very disproportionate to its height; and I have seen some
of more than six feet in diameter, without being any higher than
common. Its circumference is regular only in the smaller plants,
which are generally hemispherical; but when they are grown up, they
are terminated by humps and cavities, without any regularity. In
several parts of its surface, are drops of the size of pease, of a tough
yellowish matter; which was at first called gum; but as it could not be
dissolved, except by spirituous solvents, it was named a rosin. Its
smell is strong, aromatic, and like that of turpentine. In order to know
the inside of this plant, we cut it close to the ground, and turned it
down. As we broke it, we saw that it comes from a stalk, whence an
infinite number of concentric shoots arise, consisting of leaves like
stars, enchased one within the other, by means of an axis common
to all.
 These shoots are white within, except at a little distance of the
surface, where the air colours them green. When they are broken, a
milky juice comes out in great abundance; which is more viscid than
that of spurge[22]. The stalk abounds with the juice, as do the roots,
which extend horizontally; and often at some distance send forth
new shoots, so that you never find one of these plants alone. It
seems to like the sides of hills; and it thrives well in any exposure. It
was not before the third year that we endeavoured to know its flower
and seeds, both of which are very small, because we had been
disappointed in our attempts to bring it over to Europe. At last,
however, some seeds were brought, in order to endeavour to get
possession of so singular and new a plant, which might even prove
useful in physic; as its rosin had already been successfully applied to
slight wounds by several sailors. One thing deserves to be observed,
namely, that this plant loses its rosin by the air alone, and the
washing of the rains. How can we make this agree with its quality of
dissolving in spirits alone? In this state it was amazingly light, and
would burn like straw.
Beer-plant. After this extraordinary plant, we met with one of
approved utility; it forms a little shrub, and sometimes creeps under
the plants, and along the coast. We accidentally tasted it, and found
it had a spruce taste, which put us in mind of trying to make beer of
it; we had brought a quantity of melasses and malt with us; the trials
we made, answered beyond expectation; and the settlers being once
instructed in the process, never were in want of this liquor
afterwards, which was anti-scorbutic, by the nature of the plant; it
was with good success employed in baths, which were made for sick
persons, who came from the sea. Its leaves are small and dentated,
and of a bright green. When it is crushed between the fingers, it is
reduced into a kind of meal, which is somewhat glutinous, and has
an aromatic smell.
A kind of celery or wild parsley, in great quantities; abundance of
sorrel, water-cresses, and a kind of maiden-hair[23], with undated
leaves, furnished as much as could be required against the scurvy,
together with the above plant.
Fruits. Two small fruits, one of which is unknown, and
looks like a mulberry, the other no bigger than a pea, and called
lucet, on account of the similarity it bears to that which is found in
North-America, were the only ones which were to be had in autumn.
Those which grew upon the bushes were good for nothing, excepting
for children, who will eat the worst of fruits, and for wild-fowl. The
plant on which the fruit, which we called mulberry, grew, is creeping;
its leaf resembles that of the hornbeam; its branches are long, and it
is propagated like the strawberry.
The lucet is likewise a creeping plant, bearing the fruit all along its
branches, which are beset with little shining round leaves, of the
colour of myrtle leaves; their fruits are white, and coloured red on
that side which is turned towards the sun; they have an aromatic
taste, and smell like orange-blossoms, as do the leaves, of which the
infusion drank with milk is very pleasant to the taste. This plant is
hidden among the grass, and prefers a wet soil: a prodigious
quantity of it grows in the neighbourhood of lakes.
Flowers. Among several other plants, which we found
superfluous to examine, there were many flowers, but all without
smell, one excepted, which is white, and has the smell of the
tuberose. We likewise found a true violet, as yellow as a jonquil. It is
worth notice that we have never found any bulbous-rooted plant.
Another singularity is, that in the southern part of the isle we
inhabited, beyond a chain of hills which divides it from east to west, it
appeared that there were hardly any of the resinous gum-plants, and
that in their stead we found abundance of another plant of the same
form, but of a different green, wanting the solidity of the other, and
not producing any rosin, but only fine yellow flowers in the proper
season. This plant, which was easily opened, consisted as the other,
of shoots which all spring from the same stalk, and terminate at its
surface. Coming back over the hills, we found a tall species of
maiden hair; its leaves are not waved, but in the form of sword
blades. From the plant arise two principal stalks, which bear their
seeds on the underside, like the other species of maiden hair. There
were likewise a great quantity of friable plants growing upon stones,
they seemed to partake of the nature of stone, and of vegetables;
they were thought to be species of lichen, but the ascertaining
whether they would be of use in dying, was put off to another time.
Sea plants.
 As to the submarine plants, they were more inconvenient than of
any use. The whole harbour is covered with sea weeds, especially
near the shore, by which means the boats found it difficult to land;
they are of no other service than to break the force of the waters
when the sea runs very high. We hoped to make a good use of them
by employing them for a manure. The tides brought us several
species of coralines, which were very much varied, and of the finest
colours; these, together with the spunges and shells, have deserved
places in the cabinets of the curious. All the spunges have the figure
of plants, and are branched in so many different ways, that we could
hardly believe them to be the work of marine insects. Their texture is
so compact, and their fibres so delicate, that it is inconceivable how
these animals can lodge in them.
The coasts of the Malouines have provided the collections in
Europe with several new shells; the most curious of which, is that
called la poulette. There are three sorts of this bivalve; and among
them the striated one had never before been seen, except in the
fossil state; this may prove the assertion, that the fossil-shells, found
much below the level of the sea, are not lusus naturæ, and
accidentally formed; but that they have really been inhabited by living
animals, at the time when the land was covered by the water. Along
with this shell, which is very common here, there are limpets[24];
esteemed on account of their fine colours; whelks[25], of several
kinds; scallops[26]; great striated and smooth muscle-shells[27], and
the finest mother of pearl.
Animals. There is only a single species of quadruped upon
these islands; it is a medium between the wolf and the fox. The land
and water-fowls are innumerable. The sea-lions and seals are the
only amphibia. All the coasts abound with fish, most of them little
known. The whales keep in the open sea; some of them happen now
and then to be stranded in the bays, and their remains are
sometimes seen there. Some other bones of an enormous size, a
good way up in the country, whither the force of the waves could
never carry them, prove that either the sea is diminished, or that the
soil is encreased.
The wolf-fox, (loup-renard) thus called, on account of its digging a
kennel under ground, and having a more bushy tail than a wolf, lives
upon the downs along the sea-shore. It attacks the wild fowls; and
makes its roads from one bay to another, with so much sagacity, that
they are always the shortest that can be devised; and, at our first
landing on the isle, we had almost no doubt of their being the paths
of inhabitants. It seems this animal fasts during a time of the year; for
it is then vastly lean. Its size and make is that of a common
shepherd’s dog; and it barks in the same manner, though not so
loud. In what manner can it have been transported to these
islands[28]?
The birds and fish have enemies, which endanger their tranquility.
These enemies of the birds are the above kind of wolf, which
destroys many of their eggs and young ones; the eagles, hawks,
falcons, and owls.
The fish are still worse used; without mentioning the whales, which
feeding, as is well known, upon fry only, destroy prodigious numbers;
they are likewise exposed to the amphibious creatures, and to birds;
some of which are always watching on the rocks, whilst others
constantly skim along the surface of the sea.
It would require a great deal of time, and the eyes of an able
naturalist, in order to describe the following animals well. I shall here
give the most essential observations, and extend them only to such
animals as were of some utility.
Web-footed Among the web-footed birds, the swan is the first
birds. in order; it only differs from the European one by its
neck; which is of a velvet black, and makes an admirable contrast
with the whiteness of the rest of its body; its feet are flesh-coloured.
This kind of swan is likewise to be found in Rio de la Plata, and in
the straits of Magalhaens.
Four species of wild-geese made part of our greatest riches. The
first only feeds on dry land; and has, improperly, been called
bustard[29]. Its high legs serve to elevate it above the tall grass, and
its long neck to observe any danger. It walks and flies with great
ease; and has not that disagreeable cackling cry, peculiar to the rest
of its kind. The plumage of the male is white, mixed with black and
ash-colour on the wings. The female is yellow; and its wings are
adorned with changing colours; it generally lays six eggs. Its flesh is
wholesome, nourishing, and palatable; it seldom happened that we
had any scarcity of this kind of geese; for, besides these which are
bred in the isle, they come in great flocks in autumn, with the east
wind, probably from some uninhabited country. The sportsmen easily
distinguish these new-comers, by the little fear they shew of men.
The other three species are not so much in request; for they feed on
fish, and get a trainy taste. Their figure is not so elegant as that of
the first species; one of these kinds seldom rises above the water,
and is very noisy. The colours of their feathers are chiefly white,
black, yellow, and ash-colour. All these species, and likewise the
swan, have a soft down under the feathers; which is white or grey,
and very thick.
Two kinds of ducks, and two of teals, frequent the ponds and
rivers. The former are but little different from those of our climate;
some of those which we killed, were quite black, and others quite
white. As to the teals, the one has a blue bill, and is of the size of the
ducks; the other is much less. Some of them had the feathers on the
belly of a flesh colour. These species are in great plenty, and of an
excellent taste.
Here are two kinds of Divers, of a small size. One of them has a
grey back, and white belly; the feathers on the belly are so silky,
shining, and close, that we imagined these were the birds, of whose
plumage the fine muffs are made: this species is here scarce[30]. The
other, which is more common, is quite brown, but somewhat paler on
the belly than on the back. The eyes of these creatures are like
rubies. Their surprising liveliness is heightened and set off still more
by the circle of white feathers that surrounds them; and has caused
the name of Diver with Spectacles to be given to the bird. They
breed two young ones at a time, which are probably too tender to
suffer the coldness of the water, whilst they have nothing but their
down; for then the mother conveys them on her back[31]. These two
species have not webbed feet, as the other water-fowl; but their toes
are separate, with a strong membrane on each side; in this manner,
each toe resembles a leaf, which is roundish towards the claw; and
the lines, which run from the toe to the circumference of the
membrane, together with its green-colour and thinness, increase the
resemblance.
 Two species of birds, which were called by our people saw-bills[32],
I know not for what reason, only differed from each other in size, and
sometimes because there were now and then some with brown
bellies; whereas, the general colour of that part, in other birds of the
kind, was white. The rest of the feathers are of a very dark blueish-
black; in consequence of their shape, and the close texture and
silkiness of their vent feathers, we must rank them with the divers,
though I cannot be positive in this respect. They have a pointed bill,
and the feet webbed without any separation between the toes; the
first toe, being the longest of the three, and the membrane which
joins them, ending in nothing at the third toe, gives a very
remarkable character. Their feet are flesh-coloured[33]. These birds
destroy numbers of fish; they place themselves upon the rocks, join
together by numerous families, and lay their eggs there. As their
flesh is very good to eat, we killed two or three hundred of them at a
time; and the abundance of their eggs offered another resource to
supply our wants. They were so little afraid of our sportsmen, that it
was sufficient to go against them with no better arms than sticks.
Their enemy is a bird of prey, with webbed feet; measuring near
seven feet from tip to tip, and having a long and strong bill,
distinguished by two tubes of the same substance as the bill itself,
which are hollow throughout. This is the bird which the Spaniards
call Quebrantahuessos[34].
A great quantity of mews, variously and prettily marked, of gulls
and of terns, almost all of them grey, and living in families, come
skimming along the water, and fall upon the fish with extraordinary
quickness; they were so far of use to us, that they shewed us the
proper season of catching pilchards; they held them suspended in
the air for a moment only, and then presently gave back entire, the
fish they had swallowed just before. At other seasons they feed upon
a little fish, called gradeau, and some other small fry. They lay their
eggs in great quantities round the marshes, on some green plants,
pretty like the water lily[35], and they were very wholesome food.
We found three species of penguins: the first of them is
remarkable on account of its shape, and the beauty of its plumage,
and does not live in families as the second species, which is the
same with that described in Lord Anson’s Voyage[36]. The penguin of
the first class is fond of solitude and retired places. It has a peculiar
noble and magnificent appearance, having an easy gait, a long neck
when singing or crying, a longer and more elegant bill than the
second sort, the back of a more blueish cast, the belly of a dazzling
white, and a kind of palatine or necklace of a bright yellow, which
comes down on both sides of the head, as a boundary between the
blue and the white, and joins on the belly[37]. We hoped to be able to
bring one of them over to Europe. It was easily tamed so far as to
follow and know the person that had the care of feeding it: flesh, fish,
and bread, were its food; but we perceived that this food was not
sufficient, and that it absorbed the fatness of the bird; accordingly,
when the bird was grown lean to a certain degree, it died. The third
sort of penguins live in great flocks or families like the second; they
inhabit the high cliffs, where we found the saw-bills (becs-scies), and
they lay their eggs there. Their distinguishing characters are, the
smallness of their size, their dark yellow colour, a tuft of gold-yellow
feathers, which are shorter than those of the egret[38], and which they
raise when provoked, and lastly, some other feathers of the same
colour, which stand in the place of eye-brows; our people called
them hopping penguins, because they chiefly advance by hopping
and flapping. This species carries greater air of liveliness in its
countenance than the two others[39].
Three species of petrels, (alcyons) which appear but seldom, did
not forebode any tempests, as those do which are seen at sea. They
are however the same birds, as our sailors affirmed, and the least
species has all the characters of it. Though this may be the true
alcyons[40], yet so much is certain, that they build their nests on
shore, whence we have had their young ones covered only with
down, but perfectly like their parents in other respects. The second
sort only differs from them in size, being somewhat less than a
pigeon. These two species are black, with some white feathers on
the belly[41]. The third sort was at first called white-pigeon, on
account of its feathers being all of that colour, and its bill being red:
there is reason to suppose it is a true white alcyon, on account of its
conformity with the other species.
Birds with Three sorts of eagles, of which the strongest have
cloven feet. a dirty white, and the others a black plumage, with
yellow and white feet, attack the snipes and little birds; neither their
size nor the strength of their claws allowing them to fall upon others.
A number of sparrow hawks and falcons, together with some owls,
are the other enemies of the fowl. Their plumage is rich, and much
varied in colour.
The snipes are the same as the European ones; they do not fly
irregularly when they rise, and are easy to be shot. In the breeding
season they soar to a prodigious height; and after singing and
discovering their nest, which they form without precaution in the
midst of the fields, on spots where hardly any plants grow, they fall
down upon it from the height they had risen to before; at this season
they are poor; the best time for eating them is in autumn.
In summer we saw many curlews, which were not at all different
from ours.
Throughout the whole year we saw a bird pretty like a curlew on
the sea-side; it was called a sea-pie[42], on account of its black and
white plumage; its other characteristics are, a bill of the colour of red
coral, and white feet. It hardly ever leaves the rocks, which are dry at
low water, and lives upon little shrimps. It makes a whistling noise,
easy to be imitated, which proved useful to our sportsmen, and
pernicious to the bird.
Egrets are pretty common here; at first we took them for common
herons, not knowing the value of their plumes. These birds begin to
feed towards night; they have a harsh barking noise, which we often
took for the noise of the wolf we have mentioned before.
Two sorts of stares or thrushes came to us every autumn; a third
species remained here constantly, it was called the red bird[43]; its
belly is quite covered with feathers of a beautiful fiery red, especially
during winter; they might be collected, and would make very rich
tippets. One of the two remaining species is yellow, with black spots
on the belly, the other has the colour of our common thrushes. I shall
not give any particular account of an infinite number of little birds,
that are pretty like those seen in the maritime provinces of France.
Amphibious The sea-lions and seals are already known; these
creatures. animals occupy the sea-shore, and lodge, as I have
before mentioned, among the tall plants, called gladioli[44]. They go
up a league into the country in innumerable herds, in order to enjoy
the fresh herbs, and to bask in the sun. It seems the sea-lion
described in Lord Anson’s Voyage ought, on account of its snout, to
be looked upon as a kind of marine elephant, especially as he has
no mane; is of an amazing size, being sometimes twenty-two feet
long, and as there is another species much inferior in size, without
any snout, and having a mane of longer hairs than those on the rest
of the body, which therefore should be considered as the true sea-
lion[45]. The seal (loup marin) has neither mane nor snout; thus all the
three species are easily distinguished. Under the hair of all these
creatures, there is no such down as is found in those caught in North
America and Rio de la Plata. Their grease or train oil, and their skins,
might form a branch of commerce.
Fish. We have not found a great variety of species of
fish. That sort which we caught most frequently, we called mullet[46],
to which it bears some resemblance. Some of them were three feet
long, and our people dried them. The fish called gradeau is very
common, and sometimes found above a foot long. The sardine only
comes in the beginning of winter. The mullets being pursued by the
seals, dig holes in the slimy ground, on the banks of the rivulets,
where they take shelter, and we took them without difficulty, by taking
off the layer of mud that covered their retreats. Besides these
species, a number of other very small ones were taken with a hook
and line, and among them was one which was called a transparent
pike[47]. Its head is shaped like that of our pike, the body without
scales, and perfectly diaphanous. There are likewise some congers
on the rocks, and the white porpesse, called la taupe, or the mole,
appears in the bays during the fine season. If we had had time, and
men enough to spare, for the fishery at sea, we should have found
many other fish, and certainly some soals, of which a few have been
found, thrown upon the sands. Only a single sort of fresh water fish,
without scales, has been taken; it is of a green colour, and of the size
of a common trout[48]. It is true, we have made but few researches in
this particular, we had but little time; and other fish in abundance.
Crustaceous Here have been found only three small sorts of
fish. crustacea; viz. the cray-fish, which is red, even
before it is boiled, and is properly a prawn; the crab, with blue feet,
resembling pretty much that called tourelourou, and a minute