Vaccines have been so successful that we have already forgotten what the world was like before them and that is a huge problem.

“One case came up and then another. The count started to go up. The city closed the pools and we all stayed at home, locked inside, avoiding other children“As Richard Rhodes explained in his memoirs, during the 1940s and 1950s, the great plague, the one that terrorized parents and closed entire cities, was not not plague, not cholera, not coronavirus: it was polio.

When you read books and reports that describe the era of the polio epidemic, it is surprising that all that, all that fear, all that anguish, all that helplessness, will leave such a tenuous residue on our memory as a society. In the collective imagination, polio appears as a holdover from worse times that are gone and cannot return. We have become accustomed to the fact that there is no reason to fear that those tenths of a fever that our 10-year-old nephew has actually hide paralysis, muscle atrophy and irretrievable deformities.

Vaccines have been so successful that we have already forgotten what the world was like before them and that is a huge problem

And we have done it with astonishing speed. Perhaps that is why, now that the World Health Organization has just declared the African continent free of polio, many are surprised and even unable to imagine a world like that; a world that survived until a few months ago only 4,000 kilometers away.

George Santayana said that “those who forget their past are condemned to repeat it” and, unfortunately, the coronavirus crisis offers us many examples that confirm this. But when we look at history in perspective and reflect on diseases like polio, it seems inevitable to wonder if just that, just remembering, is enough. Memories are useless if we do not really understand that past, if we cannot put ourselves in the shoes of those who suffered, died and fought against diseases. Can we really chastise ourselves from times past or are we doomed to have to learn all of this over and over again?

Vaccines have been so successful that we have already forgotten what the world was like before them and that is a huge problem

The consequences of a world without monsters

The last autochthonous case of polio in Spain occurred in 1988 and is not an isolated case. In the last 50 years, the coordinated effort of health workers, citizens and administrations have managed to banish of the country, of the whole developed world, dozens of diseases.

Examples are not lacking. Before the death in 2015 of a child in Olot, the last case of diphtheria had been in 1984; malaria was eradicated in 1964; The last outbreaks of cholera occurred in the 1970s and, for half a decade, Spain has been a country free from endemic transmission of rubella (since 2015) and measles (2016). Even non-infectious diseases like rickets they had become in the country “a medical curiosity rather than a clinical reality

Vaccines have been so successful that we have already forgotten what the world was like before them and that is a huge problem

This is a wonderful thing in every way. And yet there was something we hadn’t thought about. How millions of citizens who have not lived with eradicated diseases, who do not see the effects of vaccines in a direct and tangible way, were going to relate in a completely new way with the disease and with the risks of combating it. Day by day, In polio-endemic areas of Nigeria talking about the (comparatively insignificant) risks of the vaccine makes no sense; in Europe, which officially eradicated the disease in 2002, these speeches are gaining followers.

It may seem paradoxical, but “the reality – said Rino Rappuoli in an interview for El Confidencial a few years ago – is that people can afford to be anti-vaccines because vaccines have been very successful. A century ago life expectancy in Europe was 47 years. People died of diphtheria, tetanus, smallpox, and cholera“And the worst thing is that repeating it is of little use because the inability to see the past clearly is something that is deeply ingrained in our human nature and, by extension, in our cultures and societies.

Vaccines have been so successful that we have already forgotten what the world was like before them and that is a huge problem

How is it possible that someone worries so much about the risks of vaccine risks that they forget about the risks of not having them?

To understand it, it is good that we think about how we evaluate present, past and future risks. It’s more, It is good that we realize that it is very difficult for us to look at the past with other eyes than those of the present. And it is that, as the Romans already said, “memoria praeteritorum bonorum”, “the past is always well remembered.” Better, in any case, than it was.

Although it seems like a simple saying, they hide a great truth: a what explains how the horror stories of the pre-vaccination world are softened until they seem oversized anecdotes. In 1994, Mitchell and Thompson decided to study why people had this tendency to see the past rosy and they discovered that this bias played a fundamental role in people’s psychological well-being and self-esteem.

Along with “forward-looking optimism” (trusting that things will get better in the future) and “cushioning” (perceiving current experiences as worse than they are), the “softening of the past” appeared as a strategy that helped individuals to reinterpret (or even alter) their memories to better address – psychologically speaking – the problems that arose at the time.

Vaccines have been so successful that we have already forgotten what the world was like before them and that is a huge problem

However, it does not remain in a simple individual or psychological question. We have an important consensus that indicates that these “three biases against the present” also have positive effects at the social level because allow communities to dedicate resources to current problems imbued by that “prospective optimism” which, in its cultural formulation, we have used to call ‘progress’ (and which now, in the face of problems such as climate change, takes the form of “it is not yet too late”). In this framework, the popular idea that “the world is getting worse” can also be understood: as an elaboration of a dark vision of the present.

When vaccines died of success

We talk about the ‘positive effects’ because yes, these added psychosocial biases in cultural tendencies are an extremely important tool to align incentives with problems. But, of course, it can also have negative effects. “Prospective optimism” can backfire in the face of a catastrophe in the same way as the “softening of the past” can make us underestimate risks for the simple fact that they do not occur in the present.

This is the case of anti-vaccine movements. If we think about it coldly, In a world where the major infectious diseases of the past have been eradicated, side effects of vaccines are, in fact, a big problem. And this is so common sense that the first to agree, in fact, are the researchers working to improve them.

Vaccines have been so successful that we have already forgotten what the world was like before them and that is a huge problem

What is problematic comes when, beset by this “current danger” and unable to contrast our experience with those of other past circumstances, we underestimate the dangers of the past and trust that whatever we do “everything will be fine”. That is, when we discard a tool that, despite its problems, does infinitely more good than harm. Ultimately, what is problematic happens when we indulge in our biases and forget that, as Hannah Arendt said, it is sometimes very difficult to differentiate a trap from a burrow.

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