Tag Archives: vaccination

Eradicating smallpox: the global vaccination push that brought the world ‘arm-to-arm’

Edward Jenner vaccinating his son, held by Mrs Jenner; a maid rolls up her sleeve, a man stands outside holding a cow. Coloured engraving by C. Manigaud after E Hamman. The Wellcome Collection.

Michael Bennett, University of TasmaniaAs the roll-out of COVID vaccines proceeds, it’s worth looking back on the challenges and successes of the early global spread of smallpox vaccination.

Smallpox (also known by its scientific name, variola) was a horrible, highly infectious disease, with a case fatality-rate of 30%. In 1798, Edward Jenner, an English country doctor, published data on cowpox (or “vaccine”, a term derived from the Latin for cow and increasingly preferred by Jenner; modern scientific name vaccinia). His data suggested this pustular disease found on dairy cows protected people from smallpox.

He detailed experiments in which he inoculated children with cowpox (usually by nicking the arm and inserting cowpox pus under the skin), and presented the inoculation of cowpox as a safe and effective way to prevent smallpox.

Jenner’s claims were initially met with scepticism. Even in Britain, vaccination was not taken up on any scale until 1800. By this time, though, cowpox samples were being dispatched overseas and attracting great interest as a way to protect people against smallpox. By 1805, at the height of the Napoleonic Wars, people were already being vaccinated all around the world. By 1815, several million people, half of them outside Europe, had been vaccinated.

Sadly, however, the global eradication of smallpox was not achieved until the late 1970s.

Read more:
Four of the most lethal infectious diseases of our time and how we’re overcoming them

The wonder of cowpox

Smallpox was universally feared but people had learned to live with it. It was easy enough to recognise; victims became visibly ill before they became infectious. Crucially, people knew that if they survived the attack, they could be confident of lifelong immunity.

Learning to live with smallpox sometimes involved deliberately exposing children to the disease in the hope of a mild outcome. In Britain, it was found smallpox inoculation — that is, making a light cut in the arm and applying smallpox pus to the wound — resulted in far fewer deaths than in cases of naturally acquired smallpox.

It was as a practitioner of smallpox inoculation (which was also known as variolation) that Jenner found evidence people who had been casually infected with cowpox appeared to be immune to smallpox infection.

He put the theory to the test by inoculating a boy with cowpox lymph — taken not from the cow but from a vesicle or blister on a milkmaid’s hand — and demonstrating his resistance to smallpox by variolation.

Jenner’s presentation of cowpox as a safe and effective substitute for smallpox found corroboration in trials in London in 1799. It wasn’t easy to allay doubts among parents. Still, people were even more scared of smallpox, and recognised smallpox inoculation involved significant risk to the patient and the community. Cowpox was a game-changer.

More diaspora than roll-out

Although hailed as a boon, the new approach got off to a shaky start. Cowpox was rare, appearing only sporadically in dairy farms. The supply of vaccine depended from the outset on its propagation on human bodies. If the vaccine “took” on the child’s arm then, nine or ten days later, the ripe pustule was pricked to provide fresh vaccine.

Children of the poor were immunised at no charge and, on returning to clinics for examination, were put arm-to-arm with the next batch of children. Some vaccine was dried, often on cotton threads, as a future supply. Quality control was a major problem. In 1800, a cowpox institute was set up in London to propagate and distribute vaccine and in 1803 the Royal Jenner Society was established to promote the practice.

Cowpox was a rare disease, appearing only sporadically in dairy farms.
J. Pass, Public domain, via Wikimedia Commons

The spread of the first vaccine was more diaspora than roll-out. Samples of cowpox on cotton threads were sent in the post, in Britain and overseas, rather in the manner of plant seeds.

Many samples proved useless on arrival, but by sending them in some profusion, it proved relatively simple to seed the practice in Europe and North America. Improvements in packaging even made it possible to send vaccine from Vienna to Baghdad, where it was propagated for onward transmission to India in 1802. Viable vaccine was even delivered, after a 154-day voyage, to Sydney in 1804.

The world arm-to-arm

Another approach to conquering the tyranny of distance was to move patients under vaccination. Early in 1802, Tsar Alexander approved an expedition to establish vaccination through Russia in which children vaccinated in one province were escorted to go “arm-to-arm” with children in the next. In 1803, King Carlos of Spain launched an even grander expedition that, by vaccinating a succession of children, delivered live vaccine to Spanish America and then across the Pacific to Manila and Macao.

Vaccination literally brought the world arm-to-arm. The rapid global spread of the vaccine itself owed a lot to the universal dread of smallpox but also to humanitarian enthusiasm and international collaboration.

A range of measures were used to embed the practice. In Berlin, children were given trinkets and medals. Poor mothers in Mexico and India were bribed to have their children vaccinated. In Austria, mothers whose children died of smallpox were named and shamed.

Some states moved rapidly along the road to compulsion. In France, where Napoleon was a great advocate of the practice, vaccination was urged as a civic duty but not made mandatory. In Denmark, a vaccination certificate was rapidly made a requisite for schooling, public employment and even marriage.

Complacency and lack of resolve

Aware of vaccine’s global success, Jenner and his colleagues deplored the loss of momentum in Britain itself. In London, the practice was under challenge from a noisy anti-vaccination lobby led by old-style inoculators.

A smallpox epidemic in 1805, while showing the value of vaccination, disclosed some failures arising from poor early practice. In claiming vaccination was for life, Jenner had set the bar too high. To the end of his life in 1823, he was reluctant to concede the need for periodic re-vaccination.

The major problem in Britain and elsewhere was complacency. The early success in suppressing smallpox, and indeed eliminating it in some places, led parents to neglect vaccination.

Outbreaks in the 1830s were a major shock and pushed the British government to fund vaccination in 1840 and to make it mandatory in 1853. Victoria — though not New South Wales — followed this lead. Although it was controversial and fuelled anti-vaccination sentiment, compulsory vaccination, with some provision for conscientious objection, played a vital role making the practice routine. This kept smallpox at bay, prompted improvements, and helped inspire the development of new vaccines.

From the outset, vaccination was seen as a means of eradicating smallpox. It saved countless lives, kept communities safe for as long as vaccination was maintained, and limited the severity of outbreaks.

The permanent elimination of smallpox required governments to provide the infrastructure and resources, and show the political will to incentivise if not mandate vaccination.

Although the disease was largely brought under control in the West, millions were still dying from smallpox elsewhere in the middle of the twentieth century when the World Health Organization committed itself to the global eradication of smallpox.

Read more:
Four of the most lethal infectious diseases of our time and how we’re overcoming them

The Conversation

Michael Bennett, Professor in School of History and Classics, University of Tasmania

This article is republished from The Conversation under a Creative Commons license. Read the original article.

From cow pox to mumps: people have always had a problem with vaccination

© Wellcome Collection, CC BY-SA

Sally Frampton, University of Oxford

A recent surge in mumps among young adults in the UK has been linked to the 1998 MMR vaccine scare, when a now-discredited medical paper authored by Andrew Wakefield suggested a connection between the vaccine and the development of autism. The publication of the paper led many parents to refuse the vaccine for their child.

The effect of Wakefield’s paper is still deeply felt. Indeed, every week seems to bring news of an unfolding controversy about vaccination. In the UK an alarming decline in childhood vaccination rates has been recorded. Vaccine scepticism seems to be increasing – a fitting testament to these troubling times, when distrust of science and expertise permeate.

Social media is often pinpointed as part of the problem. The ease with which ideas and information about vaccination are spread on Twitter, Facebook and other platforms is causing concern. As one medical journalist observed in 2019: “Lies spread through social media have helped demonise one of the safest and most effective interventions in the history of medicine.”

Social media has undoubtedly changed the way information about vaccination is engaged with. But the media-driven nature of the debate isn’t actually that new. When vaccination began at the end of the 18th century, it quickly became fodder for commentators.

In the 1790s, the surgeon Edward Jenner had confirmed through a number of experimental procedures on patients that exposure to cowpox pustules – symptoms of a disease of cows’ udders which in humans resembles mild smallpox – could confer immunity to smallpox. Following the publication of his results in 1798, vaccination came into widespread use.

With it came immediate unease and distrust. Satirists like James Gillray capitalised upon rumours that inserting cowpox pustules into the skin might cause one to sprout cow horns, a fear which had its roots in religious and cultural stigma surrounding the pollution of blood with animal matter.

James Gillray: Edward Jenner vaccinating patients against smallpox.
Wellcome Collection, CC BY

Images like Gillray’s were an early indicator of the ability of vaccination to capture the public imagination in a way few other medical developments would over the ensuing decades. This only intensified in the mid-19th century, when the Compulsory Vaccination Act of 1853 decreed that all babies should be vaccinated. Compulsory vaccination aroused accusations that personal liberty was under threat. In its wake, resistance to vaccination ramped up considerably.

Victorian vaccination

Vaccine hesitancy was amplified by the tumultuous world of print which characterised the Victorian age.

Improved printing technologies and lower prices gave rise to a rapid increase in the number of periodicals and newspapers available. Information was democratised, as cheap papers and periodicals became accessible to women and the working classes. Medical and health issues were mined by journalists for their dramatic content, and tropes of the vaccination debate we see today were given shape by the information revolution of the late 19th century.

Indeed, it was during this time that the polarisation between “pro” and “anti” vaccination camps solidified. Use of the phrase “anti-vaccination” rocketed at the end of the 19th century. Pamphlets and magazines sprung up in opposition to its use, claiming that vaccination was a dangerous, toxic procedure that was being thrust upon society’s most vulnerable citizens: children.

The not so catchily named National Anti-Compulsory-Vaccination Reporter, a magazine which began in 1876, sold hundreds of copies every month. The paper revelled in its radicalism, its opening editorial announcing:

As sound-hearted and enlightened Anti-Vaccinators, it is our bounden duty, and should be our steady and constant aim, to work towards the complete destruction of Medical Despotism.

Meanwhile, humour publications such as Punch and Moonshine skewered organisations like the Anti-Vaccination League for their zealotry and irrationality. In an of age of self-professed scientific medicine, the movement’s association with radical religious beliefs and other non-conforming lifestyle choices, such as vegetarianism and abstinence from alcohol, made it a target for lampoonery.

An illustration in Punch, 1872. ‘A snobbish mother resistant to her daughter’s doctor using a vaccine from their neighbour’s child.’
Wellcome Collection, CC BY

A polarised debate

Anti-vaccination publications believed they were deliberately excluded from a press that was in the pocket of the state and who sought to suppress the true dangers of vaccination. Publications such as The Times had become the gatekeepers of public opinion – in 1887 the paper claimed to have suffered from “an epidemic of letters about vaccination”. But anti-vaccinators lambasted newspaper editors as “shamelessly unprincipled and venal” for refusing to publish that correspondence which was critical of vaccination.

This is an accusation that has its echoes in conspiracy theories that continue today. The prominent American anti-vaccine organisation Children’s Health Defense has denounced the mainstream media for being under the thumb of Big Pharma and ignoring the voices of those harmed by vaccines.

As this shows, there has always been a potency to the vaccination debate few other medical practices generate. The provocative issue of children’s health at the heart of it, and the tension vaccination evokes between notions of collective responsibility and the freedom to choose what we think best for our bodies has made it an emotive, highly polarised debate that has been brewing since the 19th century. This has always been galvanised by sustained media interest.

But there is a complexity to vaccination that polarisation does not properly unpack. What of, for example, the many people who would not identify as “anti-vax”, but instead form a loose group who are hesitant about vaccines and may delay or choose only some vaccinations?

Social media may amplify division between the two camps, but it builds upon a long history of media outlets constructing it.The Conversation

Sally Frampton, Humanities and Healthcare Fellow, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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