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The history of immunisation

Explainers · Health protection | April 24, 2023

Vaccines are vital in the prevention and control of infectious disease outbreaks, preventing between 3.5 – 5 million deaths each year. There are currently vaccines for over 20 life-threatening diseases, such as tetanus, influenza, measles and diphtheria[1] and they are one of the most cost-effective health protection measures, critical in the maintenance and extension of global health and responsible for the eradication of smallpox.

Vaccines have a history dating back to at least the 15th century when variolation, the exposure of healthy people to material from smallpox sores to immunise individuals against smallpox, was practiced globally.

Lady Mary Wortley Montagu introduced variolation to Western medicine, advocating for its use and inoculating her son as one of the first in England to undergo the procedure. Developing this technique, in 1774 Benjamin Jesty successfully tested his hypothesis that infection with cowpox would protect a person from smallpox. Then, in 1796, Edward Jenner built on Jesty’s discovery. After being inoculated with cowpox matter collected from the infected sore of a milkmaid, a child made a fully recovery after suffering a local reaction and feeling unwell. When the child was reinoculated a few months later, he remained in perfect health. This became the first instance of modern vaccination, and the term vaccine was coined, taken from the Latin word for cow – Vacca[2].

Where cowpox led, other diseases followed, and a range of vaccines were developed. An outbreak of the Spanish Flu during World War 1, which killed one in 67 soldiers, made the development of a flu vaccine a priority for the US military. However, despite two million doses being administered by the US Army Medical School in 1918, it wasn’t until 1945 that the first influenza vaccine was approved for military use (and later in 1946 for civilian use). During this period, vaccines were also developed for yellow fever and whooping cough (pertussis).

Vaccine technology has also been developed. The attenuation of live organisms, as first demonstrated by Louis Pasteur in 1870[3], was the basis of one of two modern vaccine technologies, the other being the inactivation of an organism for the injection of immunogenic components. In the 1970’s, the discovery of DNA sequencing introduced genetic engineering and led to the development of the first recombinant vaccine, meaning that no live or infectious agents needed to be injected into the recipient[4]. The most common Covid-19 vaccines all use genetic engineering techniques as the basis of their development[5].

Vaccine efficacy is most successful as a health intervention tool if uptake amongst the population is high, and vaccine hesitancy has long existed with questions of safety and risk-benefit being consistently raised. However, as a result of campaigning and public health messaging carried out by public health professionals, attitudes have shifted towards acceptance as understanding of the importance and efficacy of vaccines have increased.[6]

An example of the successes of mass vaccination is Smallpox. In 1967 the World Health Organisation (WHO) announced the Intensified Smallpox Eradication Programme, which aimed to eradicate smallpox in more than 30 countries through surveillance and vaccination. By 1980, the World Health Assembly announced its eradication – a major, global public health success story.[7]

Although they have no formal role in vaccine delivery, as local leaders of the nation’s health, Directors of Public Health (DsPH) work in partnership with local organisations and communities beyond the NHS to listen to concerns and build trust. Thanks to their collaborative approach across a wide range of public health issues, DsPH are able to work with people in places that we don’t reach as well as we should, promoting culturally sensitive messages to encourage vaccine uptake. In fact, research has found that health professionals are the top trusted sources for information on vaccines, although this was lower for non-White British participants[8].

DsPH play an important role in reducing inequalities in access to and uptake of vaccines in population groups with known low uptake rates, including people from minority ethnic backgrounds, people with physical or learning disabilities and new migrants and asylum seekers.[9] DsPH’s knowledge of the local population can help to identify vulnerable populations and improve how vaccination campaigns are communicated. Tailoring immunisation strategies, engaging community-based approaches, dispelling digital misinformation and including the experience of vulnerable or disadvantaged populations in campaigns are all strategies which can be implemented.[10]

The importance of this role was perhaps best demonstrated during the rollout of the Covid-19 vaccine. As the representative body for DsPH, we identified two main challenges faced by DsPH: the exacerbation of inequalities and vaccine hesitancy.[11] By supporting the sharing of best practice, DsPH were able to address these challenges, through targeted and locally led communications strategies, using local insights and interventions to engage vulnerable groups, and limiting physical barriers to access[12].

We will continue to support DsPH in their health protection role, as we work to close the gap in health equity and strive to protect everyone from disease.


[1] Vaccines and Immunisation, The World Health Organisation, Available Online at:, Accessed January 2023.

[2] A Brief History of Vaccination, The World Health Organisation, Available Online at:, Accessed January 2023.

[3] Historical vaccine development and introduction of routine vaccine programmes in the UK, Available online at:, Accessed January 2023

[4] Advances in Vaccine Technology and Their Impact on Managed Care, J A McCullers and J D Dunn, Available Online at: Accessed January 2023.

[5] Different types of COVID-19 vaccines: How they work, Mayo Clinic, Available Online at:, Accessed January 2023.

[6] Vaccinating Britain, London School of Hygiene and Tropical Medicine, Available online at:, Accessed January 2023.

[7] History of Smallpox, Centers for Disease Control and Prevention, Available online at:, Accessed April 2023

[8] Targeted messaging required to tackle vaccine hesitancy, University of Sterling, Available online at, Accessed January 2023.

[9] Vaccine uptake in the general population,

[10] International Horizon Scanning and Learning Report, Communication campaigns for vaccine acceptance, Public Health Wales, Available online at:, Accessed April 2023

[11] Directors of public health and the Covid-19 pandemic ‘A year like no other’, The King’s Fund, Available Online, Accessed January 2023.

[12] Explainer: Covid-19 Vaccination, The Association of Directors of Public Health, Available online at:, Accessed January 2023.

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