What would a world without vaccines look like?

They are among the most important health policy interventions of the past hundred years and are still in short supply in the fight against SARS-CoV-2 in many parts of the world: vaccines. OeAW experts from the fields of infectious diseases and the history of medicine explain what we owe them historically and why widespread vaccinations are essential to defeat a pandemic.

Without a vaccine, combating the corona pandemic would hardly be possible. © Shutterstock

Can you imagine a world without vaccines?

The outbreak of SARS-CoV-2 showed us for months what it feels like to be at the mercy of a pandemic without an appropriate antidote. But what if the world had no vaccines against infectious diseases at all? It is a thought experiment into another world, a world without vaccination, in which we could probably only live half of our lives. Many of us would die of preventable infectious diseases in childhood.

Savior of children's lives

"Vaccinations are one of the most effective ways to ensure survival in childhood. It is assumed that vaccinations have saved more children's lives than any other medical intervention," says medical historian Daniela Angetter from the Austrian Center for Digital Humanities and Cultural Heritage of the Austrian Academy of Sciences (OeAW). In the past 30 years, vaccinations have halved child mortality and continuously increased life expectancy. The average age at the end of the 19th century, when there was still no widespread vaccination (and no antibiotic research either), was forty years in this country.

Smallpox, polio, tetanus, diphtheria, and measles – described as the five most dangerous diseases in the last century – are now almost eradicated in our latitudes. "Without vaccines and appropriate drugs, we would probably be overwhelmed by viruses and bacteria," Angetter says. The fact that our immune system can now deal with most viruses relatively well is also due to vaccinations, according to the OeAW researcher.

Unparalleled success story

It all started with the English country doctor Edward Jenner, who administered the first vaccination against smallpox, one of the worst infectious diseases of all time, at the end of the 18th century. Around 170 years later, in an unprecedented global vaccination campaign, the World Health Organization (WHO) succeeded in eradicating the disease. These widespread vaccinations have shown what vaccines can achieve.

"With vaccination programs you can clearly demonstrate how certain preventable diseases have decreased in their incidence," says Heinz Burgmann, infectious disease specialist and Professor of Internal Medicine at the Medical University of Vienna. "With the Spanish flu, when there was no vaccine available, we saw the effects of an epidemic attacking mankind without a vaccine."

Risk of vaccination fatigue

Before the outbreak of the current COVID-19 pandemic, deaths from classic diseases such as diphtheria or measles were extremely rare. However, wherever there is a low vaccination rate, for example because there is no access to vaccination in poorer countries or because there is a degree of vaccination fatigue, cases of polio, diphtheria and measles reappear. Take measles, for example: the infectious disease had long disappeared from the focus of attention because of vaccination programs. But then the motivation to get vaccinated sank in the West and measles experienced a comeback.

"Vaccines are a victim of their own success," Burgmann says. One of the reasons why some people are no longer aware of their importance is that vaccines are given to healthy people for immunization. The paradoxical consequence: "The successes are not immediately noticeable if someone does not get any infection," Burgmann says.

The fact that the dangers posed by infectious diseases have been increasingly forgotten is also due to their successful treatment with antibiotics. "The previous century was the golden age of antibiotics, ushered in with the discovery of penicillin in the 1930s," Burgmann says. "All modern medicine is based on the control of infections – through vaccinations and antibiotics." The specialist, however, warns of another, creeping, pandemic: increasing antibiotic resistance. For this reason, research is currently being carried out on vaccines against multi-resistant bacteria.

Vaccination opponents and herd immunity

Fear of the syringe and its contents is as old as vaccination itself. "As early as 1800, opponents of vaccinations feared that children who received the cowpox vaccine invented by Jenner would develop cow-like traits," medical historian Angetter says.

There is currently a lot of talk about the herd immunity required to defeat a pandemic. It is often said that those who have been vaccinated also protect those who oppose the vaccination. That is right, says Angetter. But: "You also have to consider that there are many people who cannot be vaccinated because they are allergic to a component of the vaccine, because they have previous illnesses, or because they are of an age for which a vaccine is not yet available." For Angetter, it is therefore a social obligation to get vaccinated as soon as one has the chance. "Everyone can help to eradicate a disease."

Burgmann sees it similarly. “We don't have that many vaccines,” he says. "Effective vaccines are not yet available for many diseases, but we should use those that already exist."



Daniela Angetter is a historian and literary scholar. She works as a research associate at the Austrian Center for Digital Humanities and Cultural Heritage of the Austrian Academy of Sciences (OeAW). She is also a member of the Working Group for the History of Medicine at the OeAW Commission for the History and Philosophy of Sciences and Humanities.

Heinz Burgmann is an infectious disease specialist, Professor of Internal Medicine and head of the Division of Infectious Diseases and Tropical Medicine at the Medical University of Vienna. He is one of the experts at the OeAW who can provide information on various aspects of the COVID-19 pandemic.