Public Health has never been the most glamorous area of medicine despite most of us agreeing that it is potentially one of the most important. As a medical student many years ago, I can’t remember any particularly formal instruction or indeed any nod to the advances in human health care derived from the pioneers of preventative medicine.

In previous blogs I have touched upon the contributions of early vaccinators such as Jenner leading to the eradication of smallpox. Another huge success for public health was the polio vaccine programme. It’s strange to think that it was within living memory that polio was one of the most feared of childhood diseases, infecting up to 8,000 people a year in the UK. Many of these died or were left permanently paralysed, the so-called infantile paralysis.

In 1952 in the United States there were 58,000 cases of polio, with over 3,000 deaths. However, in March of the following year the development in the United States of an effective polio vaccine by Dr Jonas Salk was announced on American radio. This announcement led to a mass vaccination programme around the world using this vaccine. Its adoption so rapidly and successfully was due in no small part to Salk’s decision not to seek to patent the vaccine, ensuring rapid global access. It was estimated by Forbes that, if patented, the vaccine would have been worth seven billion dollars. The subsequent development of an oral polio vaccine by Albert Sabin accelerated the vaccination programme globally to the extent that the disease was almost totally eliminated, culminating in Africa being declared polio free in 2020. According to estimates from the World Health Organisation, these two vaccines have prevented over 20 million cases of infantile paralysis. As a foot note, Albert Sabin, like Salk, refused to patent his vaccine ensuring that the resultant lower price would ensure the more extensive spread of the vaccine. Interestingly, Salk campaigned for mandatory vaccination throughout his life, calling the universal vaccination of children against disease a "moral commitment".

The importance of public health measures in combatting disease is strikingly illustrated by the polio programme but there is little room for complacency with vaccination rates for polio falling to levels where herd immunity is threatened. Recent reports of a wild polio outbreak from Malawi were due to the same strain of virus as that found in Pakistan, but we have no idea how it travelled there. Another and possibly bigger problem is that the oral vaccine, whist cheap and easy to administer is still a live vaccine and works by causing an intestinal infection and thus can be spread in human faeces. This was one reason why in the UK we have used the injected vaccine for the last 20 years. Recent reports of finding of vaccine derived polio virus in the London sewer system caused alarm, although the overall risks are still very low, but a public health driven programme is identifying those children in London not fully vaccinated and urging them to complete their courses.

Possibly more worrying than this is the rise in cases of measles with a minor epidemic of measles in the Birmingham area. Measles is highly infectious and is no minor childhood illness with the potential to be fatal or cause significant long term health issues. We have seen how misinformation over the MMR vaccine and autism in the 1990s had a major impact on vaccine take up and this, coupled with complacency in a population which had little experience of epidemic infectious disease, shows how vulnerable we are, and the need for major public health initiatives to bolster vaccination against these potentially deadly threats.

As we know, surveillance of clinical trials and marketed drugs contributes to improved drug safety and overall patient outcomes. Therefore, just like the pioneers of preventative medicine, pharmacovigilance has its own role to play in improving public health, particularly when it comes to education. Drug monitoring allows us to obtain accurate data, context, and perspective; It provides a wealth of knowledge that when appropriately communicated, has the potential to counteract misinformation and the harm that can be caused by it. When clinical data is successfully made available to the public, it results in informed decision making, enhancing trust and adherence to guidance – a key factor in the effectiveness of public health and potentially one of the causes of the rise in possibly preventable cases such as the Measles.

Just as an afterthought to this, the 31st January saw the 277th anniversary of the first clinic in England for the treatment of venereal disease at the London Lock Hospital. It is ironic that in the same month we have announced that sexual health services are said by the Local Government Association to be at breaking point with a report from the UK Health Security Agency showing record levels of sexually transmitted disease: gonorrhoea showing a 50.3% increase from 2021 and syphilis up 15.2% in the same period. Again, experts say that lack of funding prevents adequate health information strategies in the control of infectious diseases. Remember, those who fail to learn the lessons of history will be forced to relive them, so let’s all lobby for better health education throughout the population.