J.R. Johnson

My little brother just got his first shot. I can’t tell you how happy I am that he and his wife are one step closer to full protection.

As discussed in many venues in recent months,* the path to the Covid-19 vaccines has been convoluted. And not only does our health and safety rest on the shoulders of scientists who spent most of their careers in under-rewarded obscurity** but the history of vaccines is even more complicated than it may at first seem.

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The past year has been a nightmare, but I am incredibly grateful that we haven’t had to deal with a disease like, say, smallpox. Wildly contagious with a fatality rate of about thirty percent, for most of human history this disease was unstoppable. It spread within communities and also, devastatingly, between locations (like 17th century Europe and North America).

Thanks to a concerted international effort and global vaccination campaign, by 1980 smallpox was eventually eradicated. Thank you, science! And now we’re tackling our own pandemic with the power of vaccination. How did we get here?

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The history of vaccination usually starts something like this:

One of the first methods for controlling smallpox was variolation, a process named after the virus that causes smallpox (variola virus)… The basis for vaccination began in 1796 when the English doctor Edward Jenner noticed that milkmaids who had gotten cowpox were protected from smallpox. Jenner also knew about variolation and guessed that exposure to cowpox could be used to protect against smallpox.

— History of Smallpox | CDC

What caught my eye about this bit in particular was “variolation.” Who, I wondered, was behind the initial work? I’m always interested in the beginnings of things. Who worked out how to eat a poisonous plant like cassava, for example? In this case, where did the idea of inoculation come from? What of the giants on whose shoulders we stand?

Practitioners in Asia worked out the method, and by the 1700s it had spread to Africa, India and the Ottoman Empire. Next stop, North America, by way of the slave trade.*** Here’s a version of that story in graphic form:

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At the same time, a smallpox epidemic devastated England. An English Lady (yep, capital L), Lady Mary Wortley Montagu, brought information about inoculation back with her from the Ottoman Empire, where female medical professionals practiced a variation of the technique:

An Old Effort To Stop The Smallpox Virus Has Lessons For COVID-19 Today

Unfortunately, “European doctors were aware of what the Ottomans and others were doing but they refused to believe it worked. At the time, “Europe was pretty isolated and it was fairly xenophobic”…”

Lady Mary’s efforts came up against (stop me if you’ve heard this one) prejudice, xenophobia, and the perverse financial incentives of the medical profession.

“I am patriot enough to take the pains to bring this useful invention into fashion in England.” But in the next breath, she expressed contempt for British doctors, who she believed were too preoccupied with making money: “I should not fail to write to some of our doctors very particularly about it, if I knew any one of them that I thought had virtue enough to destroy such a considerable branch of their revenue, for the good of mankind.”

— Lady Mary Wortley Montagu

Even so, she had a positive impact, not least on one particular individual:

…the technique she’d borrowed from Ottoman women did take hold in England. Many thousands were inoculated, including a young boy named Edward Jenner. He went on to develop the first vaccine, also against smallpox.

— An Old Effort To Stop The Smallpox Virus Has Lessons For COVID-19 Today

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So here’s to the unsung heroes who took the first steps into the unknown, the practitioners lost to history, and those who passed their knowledge down in the hopes that we would use it to build something better, like the slave who shared what he knew and the aristocrat who used her status for good. 

“One takeaway for everyone, whether it be scientists or nonscientists, is that we’re not nearly as smart as we think we are,” he says. “We have much we can learn from others.”

— An Old Effort To Stop The Smallpox Virus Has Lessons For COVID-19 Today

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* Here are a couple of articles if you’re interested in the background: How mRNA went from a scientific backwater to a pandemic crusher and How mRNA Technology Gave Us the First COVID-19 Vaccines.

** That really should change, and I hope the Nobel Prize Committee agrees with me. Katalin Karikó, Ugur Sahin and Ozlem Tureci in particular come to mind.

*** No, I’m not happy about this either, but I am very grateful that Onesimus was willing to share.

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