Changing interest among physicians toward pneumococcal vaccination throughout the twentieth century.

Interest in using pneumococcal vaccination among physicians has come full circle since the early twentieth century. Interest first arose during an epidemic among South African gold miners when a potential therapeutic agent, ethylhydrocupreine, caused significant toxicities. When a safe and effective vaccine became available in 1946, interest in using it paradoxically waned as its introduction coincided with the advent of penicillin. Physicians believed that this effective new antibiotic would change pneumonia from a dreaded infection to a casual, infrequent occurrence. The manufacturer was unable to promote vaccine use and withdrew it from the market. Enthusiasm for vaccination remained low long after limitations in antibiotic therapy of pneumococcal infections became clear in the 1960s and a new vaccine once again became available in 1978. Interest in vaccination was eventually renewed in the 1990s when the propagation of pneumococcal resistance to multiple agents diminished the complete confidence that physicians had in antibiotics and when populations at risk for infection were expanding. Scientific evidence of vaccine efficacy, demonstrated in 1944 and 1977, has not alone been sufficient to convince physicians to use vaccination. Rather, doctors have accepted the need to vaccinate for pneumococcus when they have recognized the shortcomings of therapeutic measures during epidemic periods.