by Rebekah Edwards

“AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE. ”
– Ben Franklin, “On Protection of Towns from Fire,” The Philadelphia Gazette, February 4, 1735

While Ben Franklin’s famous insight about prevention was advocating for fire safety, it also applies to preventing disease and premature death. Here are some highlights in the advancement of prevention throughout history.

Vaccines and Treatments

1000

First attempts at smallpox inoculation documented in China and India.

1796

Edward Jenner

First-ever vaccine invented by Edward Jenner—for smallpox.

  • Prior to 1796, smallpox caused 7.7% (1 in 13) of all deaths.
  • 1980: Smallpox declared eradicated worldwide.

1918–1920

Global Influenza outbreak causes ~50 million deaths.

  • 1945: First influenza vaccine licensed in the U.S.
  • 2017–18: Flu shot prevents ~6.2 million cases and 5,700 flu-related deaths in U.S.

1952

Jonas Salk invents first effective vaccine for polio, a highly contagious virus that can cause paralysis and kill ~5% of children and ~30% of adults who are infected.

  • 1957: Albert Sabin develops vaccine for three types of polio virus.
  • 1994: Polio eliminated in the Americas. By 2018, polio is eliminated or interrupted in most of the world. Global cases reduced from 350,000 in 1988 to 29 in 2019.

1971

Measles, mumps, rubella vaccine licensed, inducing 94% to 96% immunity.

  • Before the vaccine, measles killed an estimated 2.6 million people each year. In 2018, measles killed 140,000 people globally.

1981

First official reporting in Los Angeles of acquired immunodeficiency syndrome (AIDS).

  • 1984: Scientists identify human immunodeficiency virus (HIV) as the cause of AIDS. The U.S. government announces goal of a vaccine within two years.
  • 1992: AIDS is No. 1 killer of U.S. men aged 25–44.
  • 1997: AIDS deaths decline by 47% from previous year due to a combination of drugs to suppress growth of HIV.
  • 2009: Clinical trials of HIV vaccine show modest preventive effect, but not enough for widespread vaccination.– Vaccine development continues due to HIV’s frequent mutations and the challenge of identifying an immune response effective at controlling the virus.
    • 2012: U.S. Food and Drug Administration (FDA) approves PrEP (pre-exposure prophylaxis), which reduces risk of contracting HIV if exposed. For the first time, the majority of people eligible for treatment are receiving it (54%).
PrEP (pre-exposure prophylaxis)
  • 2019: Annual HIV infections have decreased by more than 66% since the 1980s. Approximately 38 million people are infected with HIV globally, including 1.2 million in the U.S.

2006

FDA approves Gardasil, a vaccine that protects against human papillomavirus (HPV). Approximately 14 million Americans contract HPV annually, which can cause several types of cancer.

  • HPV causes ~35,000 cancer cases in the U.S. annually. HPV vaccine can prevent more than 90% of these cancers.
  • Since the vaccine was deployed, infections causing most HPV-related cancers have dropped 86% in teen girls. Among vaccinated women, cervical precancers caused by HPV have dropped 40%.
  • About 35,000 cancer cases linked to HPV develop in the U.S. annually. HPV vaccination can prevent more than 90% of these cancers.

2015

FDA approves an oral treatment for hepatitis C, which cures 90% of cases with few side effects.

  • In 2018, the CDC estimated 50,300 people contracted hepatitis C, with 15,713 deaths.

2019-2021

COVID-19, caused by SARS-CoV-2, declared a pandemic. As of December 18, of 51 vaccine candidates in development globally, FDA approved two for emergency use in U.S.

Quarantine

1347

The practices of quarantine and physical distancing used in Europe to curb plague epidemics.

1878

U.S. introduces federal quarantine legislation to quell an outbreak of yellow fever.

2020

14-day self-quarantine advised in many U.S. states for people who may have COVID-19 or travelled to infection hotspots.

  • A study by the University of Michigan Medical School and the U.S. Centers for Disease Control and Prevention (CDC) shows that during the 1918 flu pandemic, U.S. cities adopting early and sustained self-isolation measures had the greatest reductions in weekly death rates.

Hand Hygiene

1843–1847

Ignaz Philipp Semmelweis recommends handwashing for physicians in his maternity clinic, which decreased maternal mortality rates from 16% to 3%.

1854

Florence Nightingale

Florence Nightingale and other nurses implement handwashing and other hygiene practices at a British base hospital during the Crimean War, reducing death rates by 66%.

  • Despite proven benefits of handwashing, hand hygiene promotion stagnates until the 1980s.

2002

CDC establishes hand hygiene guidelines in use today.

Rise of Germ Theory and Masking

400 BCE

Greek physician Hippocrates proposes the miasma theory of disease, which claims “bad air” causes disease. This theory was widely accepted through the end of the 19th century.

1854

British physician John Snow connects London cholera outbreak to contaminated drinking water, challenging the miasma theory of disease.

1877

Louis Pasteur

French scientist Louis Pasteur proposes germ theory of disease, where most infectious diseases are caused by microbes.

1878

American physician A.J. Jessup recommends wearing cotton masks to reduce infection during epidemics. His idea was largely ignored.

1897

German scientist Carl Friedrich Flügge publishes research on the transmission of disease via respiratory droplets and suggests a mouth covering be worn during surgery. Surgical masks became standard practice in the 1930s.

1918–1920

To quell contagion during influenza pandemic, face masks encouraged, even mandatory in some cities.

2020

Universal masking promoted during the COVID-19 pandemic to reduce contagion.

Bacterial Infections and Antibiotics

1600s-2000s

Tuberculosis (TB) responsible for 25% of deaths in Europe and the U.S. The disease can be traced back 9,000 years in the Mediterranean.

Robert Koch
  • 1882: Robert Koch discovers bacterium that causes TB, for which he received the Nobel Prize in 1905. Prior to this, many believed TB was hereditary or caused by vampires. We now know it is an airborne infectious disease with chronic progression.
  • 1953: CDC first publishes TB data for U.S., citing 84,304 known cases.
  • 2019: CDC reports 8,916 TB cases in U.S., lowest number on record.

1928

Sir Alexander Fleming discovers penicillin, for which he and two others received the Nobel Prize in 1945.

1945

Antibiotic era begins with introduction of large-scale use of penicillin for treating bacterial infections.

  • Five antibiotics discovered between 1943 and 1966 are still used to commonly treat drug-susceptible TB. 80%–90% of TB cases can be cured with these drugs.
  • 1950s–1970s: More antibiotics are discovered, extending the average life expectancy from 47 to 78.8 years as a leading cause of death shifted from communicable to non-communicable diseases.
  • 2013: CDC declares beginning of post-antibiotic era due to overuse of antibiotics, the lack of new antibiotics, and the rise of antibiotic-resistant bacteria.
  • Drug-resistant, multidrug resistant, and extensively drug-resistant variants of TB are major global health concerns.

1923

Pap test developed to better understand menstrual cycles.

  • 1960s–present: Cervical cancer deaths reduced by 70% through screening with pap test.

1960s

Mammography develops as a screening test and is officially recommended in 1976.

  • Women 60–69 who receive mammograms have 33% lower risk of dying from breast cancer, and women 50–59 have 14% lower risk.

1969

First colonoscopy performed in New York.

  • 2012 study shows polyp removal by colonoscopies reduced colorectal cancer deaths by 53%.
  • Regular screenings, including colonoscopy, beginning at age 50 could prevent 60% of colorectal cancer deaths.

1970s

Low doses of aspirin can help prevent reoccurrence of heart attack and stroke in individuals who have already experienced an event, which is known as secondary prevention.

  • 1987: First statin approved by the FDA to treat high cholesterol and prevent coronary heart disease. An individual is 54% less likely to suffer a heart attack while taking a statin.
  • In 2019, CDC reported heart disease is No. 1 killer in nation, responsible for 25% of deaths in the U.S. About 80% of heart diseases are estimated to be preventable.
  • By 2035, 45% of the population is expected to live with heart disease.

2015–2018

U.S. Preventive Services Task Force recommends important preventive screenings, including cholesterol, blood pressure, diabetes, and skin cancer tests.

  • When routine blood pressure check reveals hypertension, risk of heart attack or stroke can be reduced by more than 20%.

2020

CDC estimates 60% of Americans live with at least one chronic disease, such as heart disease, cancer, lung disease, Alzheimer’s, or diabetes.

2020

American Cancer Society (ACS) estimates >1.8 million people will be diagnosed with cancer in the U.S. and more than 600,000 will die from it (not including some skin cancers, which are not required to be reported to cancer registries).

  • Cancer may become leading cause of death worldwide by 2099.
  • ACS researchers claim 42% of newly diagnosed cancers are avoidable, including 19% of cancers caused by smoking and 18% caused by obesity, alcohol consumption, poor nutrition, and/or physical inactivity.

Vehicles

1959

Three-point seatbelt invented.

  • 1966: All U.S. vehicles required to have seatbelts, which reduce risk of death by 45% in drivers and front-seat passengers.

1986

All states in the U.S. mandate use of child car seats.

  • When correctly used, child restraints reduce deaths among child passengers by 70%–80%.

1995

Road fatalities increase 3.2% after repeal of federal speed limits.

  • 2017: The Insurance Institute for Highway Safety estimates 36,760 more people were killed from 1993–2017 than if speed limits hadn’t risen, with 1,900 lives that would’ve been saved in 2017 alone.

1998

All automobiles required to have front airbags, which reduce 29% of driver fatalities and 32% of front-seat passenger fatalities.

Smoking

1964

Surgeon General issues first report on harms of smoking.

2009

30 states institute laws requiring 100% smoke-free workplaces, restaurants, and bars.

2014

Study shows preterm births and hospital admissions for asthma decreased 10% since public smoking bans.

2017

Though smoking-related deaths in U.S. decreased 55% since 1990, smoking remains the leading cause of preventable disease, disability, and premature death.

Sunscreen

1978

FDA establishes first regulations for sunscreen.

2019

Study shows daily use of SPF 15+ sunscreen reduces risk of developing skin cancer by 50%.

  • More people in the U.S. are diagnosed with skin cancer than all other cancers combined. Over 5 million skin cancer cases are diagnosed annually, and 1 in 5 Americans will develop skin cancer by age 70.