The First Vaccine – Part 2

Depiction of Edward Jenner administering the first smallpox vaccination

Edward Jenner and Cowpox

The solution to safer smallpox inoculations came from English physician Edward Jenner. And surprisingly, he got help from a cow.

Edward Jenner was born into a big family (he was one of nine children) in 1749 in Berkeley, Gloucestershire. Because his father was a clergyman, young Edward and his siblings got a good basic education. But getting variolated as a teenager had an even greater impact on his life.

Jenner was grateful that he avoided smallpox by getting variolated at a young age. But he was also aware of the risks of the procedure. As he grew older he studied both zoology and human biology. That’s how he learned of a possible link between an animal disease and the dreaded smallpox that could be the key to safer inoculations.

The disease was cowpox. And it’s no wonder it attracted attention. Cowpox was a much milder disease than smallpox, and it didn’t cause as much scarring and death in the humans who contracted it. In fact, cowpox fatalities were less than one percent.

By the time Jenner began his career in the 1770s, there was growing evidence through observations by other doctors and even farmers that getting cowpox could be a way to avoid getting smallpox.  

But these observations lacked solid proof. So when Jenner noted that dairymaids who worked with infected cows rarely got smallpox, he began to study the phenomenon in a disciplined and scientific way. He hypothesized that not only did contracting cowpox result in immunity to smallpox, but also that a method could be developed to transmit this immunity. 

To test his hypothesis, he found a cowpox-stricken dairymaid and used her infected blisters to vaccinate 8-year-old James Phipps. Phipps fell briefly ill but recovered. And when Jenner then exposed Phipps to smallpox and the boy didn’t contract the disease, Jenner concluded his experiment worked. 

The Inquiry

Jenner tested his vaccine on many people, including his own son, before publishing his findings. When he did self-publish his Inquiry in 1798 (its full title is An Inquiry into the Causes and Effects of the Variolae Vaccinae, a Disease Discovered in Some of the Western Counties of England, Particularly Gloucestershire, and Known by the name of the Cow Pox) it was an immediate hit and he quickly became famous. Other scientists validated his observations, and by 1799 more than a thousand people had been vaccinated.

Such was his fame that even Jane Austen knew about Jenner. In a letter to her sister Cassandra, she describes a dinner party where guests took turns reading from “Dr. Jenner’s pamphlet.”

Napoleon was another fan. Despite waging war against the British, Napoleon had Jenner vaccinate his troops and awarded him a medal, calling him one of the “greatest benefactors of mankind.” 

And in 1821 Jenner was named “physician extraordinary” to the newly crowned King George IV, the monarch better known as the Prince Regent or Prinny.

Jenner’s Dream

Jenner’s dream, which he expressed in 1801, was that his vaccine would one day eliminate smallpox entirely. And despite problems that still had to be resolved regarding stability and distribution, the vaccine was soon on its way around the world.

In 1803, Dr. Francisco Javier de Balmis took Jenner’s vaccine on a 3-year expedition, traveling throughout the Americas and Asia, where he vaccinated thousands of people, saving countless lives.

Meanwhile, variolation fell out of favor during the early 19th century. The practice was finally banned in England in 1840 and the government instead provided free vaccinations with Jenner’s cowpox vaccine.

Opposition

Just as there are anti-vaxxers today, there were those in Jenner’s time who strongly opposed vaccination. Some people thought the vaccine would make cow-like parts erupt all over their bodies. And there were religious leaders who objected to the new vaccine on the grounds that by preventing the disease the vaccine went against God’s will.

1802 caricature by James Gillray illustrating people’s fears concerning Jenner’s cowpox vaccine

But while scientists labored and people argued the disease continued to rage. There were at least two more smallpox pandemics in Europe before 1840. And the Franco-Prussian War (1870-71) was the cause of yet another pandemic that killed half a million people.

Success at Last

Jenner’s development of a vaccine in the 1790s was only the beginning, not the end of the story of the fight against smallpox. It took the work of many other scientists to test and create a smallpox vaccine that was uncontaminated, stable and could be safely transported to countries around the world.

In 1853 Parliament made smallpox vaccinations mandatory for infants in Great Britain. By the 1860s two-thirds of all British babies had been vaccinated and there was a resulting drop in the number of infant deaths caused by the disease.  

However, vaccination remained controversial and anti-vaccination leagues formed in Britain and the United States. Fortunately, vaccinations continued and the disease’s grip on mankind weakened.

Following a series of global vaccination campaigns in the 19th and 20th centuries, success came at last.

In 1979, the World Health Organization declared smallpox officially eradicated. Smallpox is still the only human disease that’s been exterminated by vaccination.

It took 180 years, but Jenner’s dream of wiping smallpox off the face of the earth finally came true.

Jenner’s Legacy

Edward Jenner died in 1823. A humble man, he was considered a hero in his lifetime and still is today. While he may not have been the first to realize that cowpox could lead to immunity against smallpox, his work made smallpox inoculations popular and laid the groundwork for the widespread vaccinations that eventually defeated the disease.

In addition, his scientific inquiries became the basis of the modern science of immunology. 

Jenner’s work put him ahead of his time – so much so that it was almost another century before French chemist Louis Pasteur developed the next vaccines, for rabies and anthrax, in the 1880s.

Vaccines today

But why is that we call all inoculations “vaccines”? Jenner’s name for his discovery came from the Latin word for cow, “vacca.” So, technically, it should apply only to his cowpox vaccine. 

But Pasteur wanted to pay homage to Jenner’s creation of the first vaccine by naming all inoculations, including the ones he developed, “vaccinations” even though cows had nothing to do with them.

Pasteur’s tribute to Jenner caught on and that’s why now we have “vaccines” for influenza, tetanus, shingles, pneumonia and many other potentially deadly diseases.

Hopefully soon there’ll be a vaccine for coronavirus, too. When that day comes, it will be yet another outcome of Jenner’s pioneering work over 200 years ago.

Additional information

For more information on this topic see this article, “Edward Jenner and the history of smallpox and vaccination,” available from the National Institutes of Health.

Also, read this article on smallpox vaccines by the World Health Organization. (It’s a relief to know that despite the disappearance of smallpox there are still stockpiles of vaccine in existence.)

The First Vaccine – Part 1

As I write this, much of the world is still in lockdown due to the coronavirus pandemic. As people across the globe struggle to protect themselves with face masks, social distancing and self-isolation, scientists are scrambling to develop an effective COVID-19 vaccine.

But this isn’t the first race to develop a vaccine. In the 18th century, Edward Jenner developed the first vaccine, to combat smallpox. It’s a story that’s still inspiring and relevant today.

The Scourge of Smallpox

You can’t overestimate the horror of smallpox. For centuries it was rightly feared for the way it killed, disabled and disfigured people on a massive scale.

Smallpox killed at least 20 percent of its victims. It was especially brutal to children. According to data collected in Glasgow, a city famed for its careful record-keeping, from about 1783 to 1800 approximately half all children born died before they reached the age of 10, and smallpox was responsible for 40 percent of those deaths.

Other statistics show that during the same time period the mortality rate among infants who contracted smallpox was nearly 80 percent in London and 98 percent in Berlin.

Imagine those figures – absolutely heart-breaking!

The disease did other damage, too. Survivors were usually left with disfiguring scars, especially on their faces. Plus, before the vaccination era, smallpox was the chief cause of blindness throughout Europe.

The First Inoculations

But by the 18th century it was widely believed that if you could survive smallpox you’d be immune to it. In fact, we know that as early as 436 B.C. (which shows you how long smallpox plagued mankind) smallpox survivors were the ones who took care of the sick.

Armed with this knowledge, people developed a way to combat smallpox by deliberately exposing themselves to it. They developed a process called variolation, from the Latin word variola that was used at the time for smallpox.

Variolation was done by piercing the skin of an arm or leg, usually with a sharp lancet dripping with fluid from an active smallpox blister. Another method involved rubbing a piece of fluid-soaked cloth over a scratch on the skin.

This practice was used widely in Asia and the Middle East, and while it sounded barbaric to Western ears it often worked – the rate and the severity of smallpox infections dropped significantly when variolation was performed.

Variolation Goes West

Variolation came to England in the early 18th century. It happened soon after Lady Mary Wortley Montagu, wife of the British Ambassador to the Ottoman Empire, saw the procedure performed in Istanbul.

If anyone had a reason to hate smallpox, it was Lady Mary. Not only had her brother died from it, but a bout with smallpox in 1715 left her, once a celebrated beauty, with a badly scarred face.

Lady Mary and her son

While living In Turkey, Lady Mary had her 5-year-old son variolated by embassy surgeon Charles Maitland. But when she got back home, she discovered English doctors opposed this foreign practice.

That didn’t stop her. When a smallpox epidemic loomed in 1721, she insisted her 4-year-old daughter be variolated. Once again Dr. Maitland performed the procedure, but this time Lady Mary made sure royal physicians saw him do it. When Maitland also successfully variolated two daughters of the Princess of Wales in 1722, variolation became acceptable in English society. 

But variolation had its downsides. The biggest drawback was the risk of the procedure going spectacularly wrong. If that happened, variolation could give someone smallpox or make them a carrier of the disease.

The concept of inoculating someone against smallpox by introducing a small amount of it into their bodies seemed to work. But how could this procedure not only be safer, but easier to administer to lots of people?

The answer to that question is in my next post, The First Vaccine, Part 2.