The adoption of the vaccine
Jenner’s first report of a successful vaccine against smallpox was met dismissively by the Royal Society. His paper was rejected in 1797 on the grounds that Jenner “ought not to risk his reputation by presenting to the learned body anything which appeared so much at variance with established knowledge, and withal so incredible”.
But when, the following year, Jenner published a private pamphlet outlining a series of further successful trials, the vaccine was accepted as a major breakthrough in the battle against disease.
The speed of its adoption across the world is astonishing (See module ‘The Vaccine Triuphant’).
(Right) The manuscript of Jenner’s “Inquiry”, 1797 © The Wellcome Library, London By 1801, more than 100,000 had been vaccinated in England, In France, over 1.7 million people had been vaccinated by 1811, and the emperor Napoleon vaccinated more than half his army. Between 1804 and 1814, 2 million were vaccinated in Russia. In the USA the practise was taken up with great enthusiasm by Dr Benjamin Waterhouse of Boston.
In India, its adoption went hand-in-hand with the spread of the British Empire. Officials of the East India Company introduced the vaccine into their Indian protectorates, and they were able to use the benefits of vaccination as an example of the ‘civilizing’ benefits of British imperialism, justifying further territorial expansion.
Resistance to Vaccination
From the start, vaccination had its critics (see module, “Mad Cows and Ox-faced Boys”).
Vaccination was statistically far safer than variolation, but side-effects did occur. One patient in fifty thousand suffered adverse reactions to the vaccine, and one in a million died.
Equally problematic was the chance that, during arm-to-arm vaccination, a patient might be infected unwittingly with another viral disease. The fear of compulsory vaccination resulting in the unwitting transfer of syphilis, say, from subject to subject proved a powerful argument against the proceedure.
(Right)The extremely rare side effects of vaccination: a one year old child with a case of erythema multiforme. © The Centre for Disease Control and Prevention Anti-vaccination campaigners played up these risks to persuade parents to resist the pressure for infant vaccination.
In time, improvements in vaccine technology diminished the risks. In 1898, arm-to-arm vaccination was abolished in Britain. Thereafter all vaccine stocks were harvested from calf lymph. (In the twentieth century, the vaccine was harvested by growing cultures on chicken eggs).
The persistence of smallpox
In part because of widespread resistance to vaccination, smallpox persisted, and in some places thrived, around the world. Three major European epidemics, in 1824-1829, 1837-1840, and 1870-1875, spread the disease throughout the continent. Russia suffered 100,000 smallpox deaths in 1856; France between 60,000 and 90,000 in 1870-1871; and Germany 162,000 in 1871-1872.(Right) Thorns used for vaccination during an outbreak of smallpox in Palestine in 1921. © The Science Museum, London In the twentieth century, smallpox remained a global scourge. It was endemic in 124 countries in 1920. In the USA (where anti-vaccination protest was strong), an outbreak of a mild strain of smallpox infected 130,000 people from 1901 to 1902, and 200,000 from 1920 to 1921. Some 64,000 Filipinos died of smallpox from 1918 to 1919; India reported 100,000 cases a year, and Nigeria suffered 22,000 cases, including 6,000 casualties, in 1930.
The decline of smallpox in the west
By the early 20th century, smallpox fatalities in the developed world were on the decline. Outbreaks were quickly contained, and as vaccination became increasingly common, the numbers of people lacking smallpox immunity diminished, lessening the chance of the disease taking hold.
Outbreaks still occurred, infrequently, but usually they were the consequence of the disease being brought in from some other part of the world. For instance, there were 14 deaths in Merseyside in 1946, and 10 deaths in Brighton in 1951; both these outbreaks were caused by soldiers returning from abroad. In 1945, an American soldier returning from Japan caused an outbreak of Smallpox in Seattle.
Western governments responded with health checks at ports and airports. In Britain, in-bound flights from Bangladesh and Pakistan were controlled, with all visitors expected to produce proof of vaccination.
Poster used in Latin America to encourage vaccinations against smallpox. Colour process print, c.1940. ©The Wellcome Library, London In time, the numbers of outbreaks dwindled, and it was deemed more dangerous to vaccinate people than not. So in 1971, for the first time, Britain stopped recommending routine vaccination for children.
A disease that had once infected humankind had become a disease of the poor. Less developed countries south of the equator continued to be devastated, whilst richer, more developed nations barricaded themselves against the worst effects of the virus.