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Brief History of Vaccines in Turkey

Brief History of Vaccines in Turkey

     Turkey is a world pioneer in vaccines and vaccination.

The history of vaccines and vaccination in Turkey goes back to the days of the Ottoman Empire. Lady Mary Montagu (1689-1762), the wife of a British ambassador to the Sublime Porte, wrote with great astonishment to her friends in Britain between 1717-1721 about a procedure called “vaccination” (in fact, variolation) against smallpox, then in practice among the people of Istanbul. Lady Montagu had herself and her family members inoculated in this Ottoman method against smallpox, and campaigned upon her return to Britain to popularize the process there. Her Turkish Embassy Letters provide the oldest documentation of vaccines and vaccination in Turkey and Europe.

A century after Montagu’s testimony to the use of ancient style smallpox inoculation/vaccination in Turkey, Ottoman polymathic scholar and physician Şanizade Mehmed Ataullah Efendi (d. 1826), managed to derive and successfully use smallpox vaccination in the modern method of the world’s first vaccine Edward Jenner (1749-1823) invented around a decade ago. Şanizade proposed to the Ottoman Sultan, Mahmud II in 1811 -among other public health policies such as quarantines to prevent plague contagion- to institutionalize his work with a vaccine factory. However, his and the later mid-19th century efforts of Hekim İsmail Pasha (1807-1880) in trials for domestic smallpox vaccine production lacked continuous bureaucratic backing and eventually faltered in the vicissitudes and political upheavals of the 19th century Ottoman Empire. Lasting strides in vaccines and immunization in Turkey would have to wait until the last quarter of the 19th century when the state would take up these public health measures into its political program.

Louis Pasteur (1822-1895), a pioneer of vaccination and modern infectious diseases research, reached out to foreign heads of state in order to raise funds for the nascent Pasteur Institute. Among the petitioned rulers was the Ottoman Sultan Abdülhamid II (reign 1876-1909), who responded positively that the Ottoman Empire could help, provided that Pasteur continued his work in Istanbul. When Pasteur turned down this offer, the Sultan responded with a follow-up offer, which proposed Pasteur an award of the Order of the Medjidie and 10,000 gold francs. In return Pasteur Institute would offer a research and training fellowship for three specialists from the Ottoman Empire. Some sources give an alternative figure for the Ottoman financial assistance to Pasteur, 800 liras, which would equal the price of 180-200 houses in Istanbul at the time.

When the French side acceded, the Ottoman government sent in 1886 a team of researchers consisting of the delegation head Alexander Zoeros Pasha (1842-1917) -a professor from the      Mekteb-i Tıbbiye-i Şahane (Ottoman Imperial School of Medicine) Kaymakam (Lieutenant Colonel) Dr. Hüseyin Remzi Bey (1839-1896) and veterinarian Lt. Col. Hüseyin Hüsnü Bey (d. 1904). At the conclusion of their fellowship in Paris, the team of researchers returned to the Ottoman Empire with a bone marrow sample injected with the “rabies virus”, which served as the basis for further vaccine research and production in Istanbul. 

 


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Constantinople Imperial Bacteriology Institute (CIBI, Bakteriyolojihâne-i Şâhâne/Osmânî)


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Imperial Smallpox Vaccine Laboratory (Telkihhâne-i Şâhâne)

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In 1885, the Ottoman government issued a decree for the mandatory application of the smallpox vaccine, the first-ever state legislation for mandatory vaccination in world history.
In 1885, the first rabies vaccine was developed in France.
In January 1887, the rabies vaccine was brought to the Ottoman Empire. This was followed by the establishment of an institution dedicated to rabies and general bacteriology research called “Dâu’l-Kelb ve Bakteriyoloji Ameliyathanesi” (Rabies and Bacteriology Laboratory) -later called Rabies Treatment Center in Zoeros Pasha’s clinic at the Mekteb-i Tıbbiye-i Şahane (Ottoman Imperial School of Medicine). This institution was the third rabies center in the world, and the first such research institution in the entire East. This center later also succeeded in producing an anti-diphtheria serum.
In 1892, the Imperial Vaccine Laboratory (Telkihhâne-i Şâhâne) was established under the direction of -now Miralay (Colonel)- Hüseyin Remzi Bey for the production of the smallpox vaccine.
In 1893, the Constantinople Imperial Bacteriology Institute (CIBI, Bakteriyolojihâne-i Şâhâne/Osmânî) was established.
Veterinarian Mustafa Adil (1871-1904) successfully produced anti-diphtheria serum in 1896, anti-rinderpest serum in 1897 and anti-scarlet fever serum in 1903.
In 1911, typhoid vaccine and in 1913 cholera, dysentery and plague vaccines were domestically prepared and administered for the first time in Turkey.
Tuberculosis vaccine production began in 1927.
 
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The production of animal and human vaccines continued even under the difficult conditions imposed by World War I (1914-1918) and the Turkish War of Independence (1919-1923). When the Allies occupied Istanbul, the Imperial Vaccine Laboratory moved first to Eskişehir and then to Kırşehir in Anatolia. In the same period, smallpox vaccine production continued in Afyon. The serum laboratory in Erzurum was moved to Aleppo, Niğde, Sivas and Erzincan during the Russian occupation of East Anatolia. Kastamonu too was a center for vaccine production. Vaccine manufacturing carried on similarly in multiple loci after the foundation of the Republic of Turkey. 

In 1928, Central Institute for Hygiene (Hıfzıssıhha Enstitüsü) was established by the Minister of Health Dr. Refik Saydam, which contributed to the centralization of the vaccine production processes.
Tetanus and diphtheria vaccines were in domestic production from 1931 to 1996.
Anti-rabies serum production started in 1937.
Until the 1940s, mass production of typhoid, typhus, diphtheria, BCG, cholera, pertussis, tetanus, and rabies vaccines was accomplished.
In 1938, Turkey sent cholera vaccines to aid China against a cholera outbreak. 
In 1942, the production of typhus vaccines and anti-scorpion venom serum started.
In 1947, the Biological Control Laboratory was established.
In 1950, the Turkish Influenza Laboratory was recognized by the World Health Organization (WHO) as a Regional Influenza (flu) Center and influenza vaccine production started.
In 1968, a serum institute producing anti-tetanus, anti-gas gangrene, anti-diphtheria, anti-rabies, anti-anthrax, and anti-scorpion venom serums was established.
In 1976, experimental production of Dried BCG vaccines began. 
The vaccine production for typhus and smallpox was stopped in 1971 and 1980 respectively, thanks to the successful eradication of these diseases in Turkey. 
Dried BCG vaccine production started in 1983.
Vaccine production in Turkey ended with the termination of DTaP and rabies vaccine production in 1996 and BCG in 1997 respectively.
During the procurement program of the Five-in-One Combined Vaccine (DTaP-IPA-Hib) in 2009 and the Four-in-One Combined Vaccine (DTaP-IPA) in 2011, packaging and blow-fill-seal (BFS) technology were also gradually introduced in our country.
The application of the pneumonia vaccine (PCV-Pneumococcal conjugate vaccine) in 2010 enabled the introduction of formulation and BFS technologies to the country.
Scorpion and snake venom antisera are currently in production by a Turkish company.
Anti-snake venom, anti-scorpion venom, anti-tetanus and anti-diphtheria serum production is carried on by the General Directorate of Public Health (GDPH) of the Turkish Ministry of Health.
Production of the domestic Td vaccine commenced in 2020 while filling of Td vaccine had already been done domestically since 2018.