The Untold Stories About Smallpox Vaccines

In the rich tapestry of medical science, vaccines stand out as monumental achievements lauded for their role in controlling, and sometimes eradicating, some of humanity's deadliest diseases. Yet, the story of vaccines is not just a straightforward account of scientific triumph. It is a complex narrative, woven with evolving methodologies, diverse perspectives, and debates over efficacy and safety.

The story of vaccines—particularly the smallpox vaccine—is more than a chapter in medical history; it's a reflection of the human journey, marked by groundbreaking discoveries, societal impacts, and ongoing learning. Smallpox, once a formidable scourge, was the first disease to be eradicated through vaccination. However, the path to this success was not linear. It was punctuated with challenges and controversies.

In this series, “Revisiting the Historical Vaccines,” we will explore the multifaceted history of vaccines, examine historical data, and seek a nuanced understanding of vaccine efficacy and safety.

This journey begins with the smallpox vaccine—a starting point that opened doors to modern immunization but also raised questions that resonate to this day. Our critical evaluation is to offer a well-rounded perspective, grounded in scientific data and enriched by historical context. Join us as we delve into the past to understand the present and shape our thoughts for the future of public health and medical science.

(Illustration by The Epoch Times, Shutterstock, Getty Images)

In general, smallpox vaccines can be roughly differentiated into three stages. The first stage began with the invention of the vaccine by Dr. Edward Jenner in 1796. The second stage involved the different versions of smallpox vaccines propagated and used by people during the 18th and 19th centuries. Finally, the third stage includes modern smallpox vaccines used in the late 20th and 21st centuries.

The Most Fearful Disease in History

The story of vaccines begins with a narrative of groundbreaking triumphs in public health. One of the earliest successes was the development of the smallpox vaccine by Dr. Edward Jenner (1749 to 1823) in the late 18th century, a pivotal moment that demonstrated the potential of the vaccine.

Smallpox, caused by the variola virus, was once one of the world's most feared diseases. Characterized by fever, malaise, telltale pustules on the skin, disfiguring scars, and blindness in many survivors, it has a storied history that intersects with the evolution of human civilization.

According to the World Health Organization (WHO), smallpox has two forms: variola minor, with a 1 percent mortality rate, and the more severe variola major, with a 30 percent mortality rate. About 65 to 80 percent of survivors bear deep, pitted facial scars called “pockmarks.”

Smallpox was responsible for an estimated 300 to 500 million deaths worldwide with an average of 5 million deaths a year. During the 18th century, it resulted in an estimated 400,000 deaths annually in Europe alone, leaving a third of the survivors blind.

Edward Jenner's 1796 Invention

The smallpox vaccine was introduced by Dr. Edward Jenner in 1796. The story of this first vaccine started with a belief among milkmaids that cowpox infection could prevent smallpox.

Inspired by this belief, Dr. Jenner experimented on an 8-year-old boy, James Phipps. Dr. Jenner used material from a dairymaid's cowpox lesions and scratched it onto James. When James didn't develop smallpox after exposure, Dr. Jenner concluded that the cowpox vaccination was effective.

This process was later termed “vaccination,” derived from the Latin word “vacca,” for cow; and “vaccinia,” for cowpox. Dr. Jenner's 1798 paper claimed lifelong immunity from smallpox through this method.

This single-person study evolved into the modern narrative being told in our textbooks for hundreds of years that "inspired by milkmaids, Dr. Jenner invented the smallpox vaccine consisting of the so-called cowpox virus, conferring cross-protection against smallpox."

Furthermore, lesser-known details in this story spread for more than 200 years. There are at least two points that are not true about this narrative. 

The first one, unfortunately, is that the story of the milkmaid was a lie invented by John Baron, Dr. Jenner's friend and first biographer. In his book, "The Life of Edward Jenner MD," Mr. Baron states that Dr. Jenner himself never claimed to have discovered the value of cowpox, nor did he ever say, despite a huge volume of correspondence, how he first came across the idea. The myths of the milkmaids are just that, myths.

The second point is that the virus contained in Dr. Jenner's original smallpox vaccine is supposed to be a type of cowpox virus. However, is this true? The answer is relatively obscure. Rather than the cowpox virus, evidence supports that Dr. Jenner might have used the vaccinia or the horsepox virus, which stands as the biggest mystery in Jenner’s vaccine story. 

Different Viruses, Different Diseases

Smallpox results from the variola virus, a DNA virus belonging to the Orthopoxvirus genus. This virus only infects humans. Unique to humans, who are its only known reservoir, it spreads primarily through inhaling respiratory droplets or through direct contact with infected material on mucous membranes. Importantly, it is not transmitted from cows.

Cowpox is caused by the cowpox virus, which mainly resides in wild mammals like cattle and cats without causing obvious symptoms. In humans, the infection is usually mild and self-limiting, characterized by fever, aches, and a red blister that evolves into a pus-filled lesion.

Moreover, the horsepox virus further complicated the story, as Dr. Jenner had also used lymph from horsepox lesions to prepare the smallpox vaccine in 1813 and 1817. Horsepox causes pustular lesions in horses and horse handlers.

The cowpox virus, horsepox virus, and smallpox virus are all different viruses. Even so, Dr. Jenner used various sources, including cows and horses, to create vaccine substances. This practice led to the development of multiple vaccine concoctions, often used without a full understanding of their composition.

2018 paper in The Lancet Infectious Diseases by Clarissa Damaso carefully revisited the complex and obscure history of smallpox vaccines and concluded that the virus strains used by Dr. Jenner remain a mystery (i.e., cowpox, horsepox, or vaccinia viruses).

In 1823 when Dr. Jenner died, there were already three distinct types of smallpox vaccines: cowpox, described as “pure lymph from the calf,” horse grease, described as “the true and genuine life-preserving fluid,” and horse grease variants.

The vaccines were commonly applied by scratching the arms or thighs, then using the material to vaccinate others, a method known as arm-to-arm vaccination. Dr. Jenner's vaccine lacked standardization and safety testing.

Despite the uncertainties, lack of quality standards, and inadequate investigation of ingredients, nobody knew exactly what was inside the cocktail derived from different sources—like a broth of hundreds of thousands of microbes. Nevertheless, Jenner's vaccination concept was widely adopted based on a superstition.

The idea that injecting a contaminated fluid or tissue into a human from a diseased animal to “prevent” another disease in humans, defies common sense and logic and creates scientific skepticism among contemporary physicians.

Medical Skepticism

Dr. Jenner's vaccines met early challenges.

British physician and medical author, Dr. Charles Creighton (1847 to 1927), was highly regarded for his scholarly writings on medical history. His book “History of Epidemics in Britain” (1891 to 1894) has been described as a “classic of unimpeachable accuracy.”

In his other book “Jenner and Vaccination: A Strange Chapter of Medical History,” Dr. Creighton critiques Dr. Jenner's vaccine theory as focusing on four main claims without scientific proof: It prevents smallpox; it isn't contagious; it doesn't cause outbreaks; and it is safe. Dr. Creighton emphasizes the need for more detailed research in pathology to truly understand vaccines.

Similarly, other prominent medical professionals of the time, including Sir Erasmus Wilson, often referred to as the “father of dermatologists,” Dr. John D. Hillis, Dr. Liveing, Sir Ranald Martin, Professor W.T. Gairdner, Dr. Tilbury Fox, and Dr. Gavin Milroy, have testified that the original smallpox vaccination was the vehicle for the dissemination of leprosy.

Dr. Robert Hall Bakewell, a physician who treated leprosy, and others have pointed out the risks associated with vaccination. They cited examples where vaccination was spreading diseases such as leprosy rather than preventing infection, challenging the notion of vaccination.

In 1799, shortly after Jenner published his paper on using cowpox to get lifelong protection from smallpox, Dr. Drake, a surgeon from England, conducted a vaccination experiment on three children with a vaccine obtained directly from Edward Jenner.

Unfortunately, when challenged with smallpox inoculation all three vaccinated children developed smallpox. The vaccine had failed.

“In three of them, a lad aged seventeen and two of the Colborne children (one four years, the other fifteen months), the cowpox vesicles came to early maturity and were scabbed under the usual time. The lad was inoculated with smallpox on the 20th December, being the eighth day from his vaccination, and the two children on the 21st, being again the eighth day. They all developed smallpox, both the local pustules and the general eruption with fever.”

Failures Since 1804

Over time, numerous instances of vaccination not working were reported. Despite initial promises of protection, people were still contracting smallpox after being vaccinated.

Dr. Baron, in his book, “The Life of Edward Jenner” said, “From 1804, reports of failures in vaccination had begun to multiply,” and Dr. John Birch, surgeon of St. Thomas's Hospital, says, in the same year, “Every post brings me accounts of the failures of vaccination.” 

In 1809, Lord Henry Petty said in the House of Commons, “Unless Dr. Jenner was completely blinded by conceit, he must have recognized that the general faith in vaccination, exhibited in 1801, had been much shaken by the experience of the succeeding seven years.”

In the Committee of Supply on July 29, 1807, Mr. Shaw-Lefevre, speaking upon the motion for a public grant to Dr. Edward Jenner, referred to the report of a Commission of Inquiry, which stated that “the practice of vaccine inoculation was the infallible preventive of smallpox.” He emphatically denied the truth of this document and showed that in 56 cases of vaccine inoculation, smallpox had followed. “Here we have fifty-six cases of real failure,” said Mr. Shaw-Lefevre.

The Medical Observer for 1810 contains particulars of 535 cases of smallpox after vaccination, including 97 fatal cases and 150 cases of vaccine injuries. This data was supported by 10 medical professionals, including two anatomy professors who witnessed vaccination injuries within their own families.

An 1817 article entitled “Observations on Prevailing Diseases” in the London Medical Repository Monthly Journal and Review reported that many people who had been vaccinated were still getting smallpox.

1818: Scottish Surgeon's 1,200 Cases

In 1818, after vaccinating 1,200 healthy people, Dr. Thomas Brown, a Scottish surgeon with 30 years of clinical experience, found that many vaccinated people still contracted the virus and even died from smallpox.

Dr. Brown discussed the complications and failures associated with smallpox vaccination. He described situations where individuals, despite being vaccinated (as indicated by a properly formed areola around the vaccine puncture), still contracted smallpox. In some of these cases, the smallpox was severe (confluent) and even led to death. Notably, he mentions instances where smallpox pustules developed within the area of the vaccine puncture itself.

In the context of smallpox disease, “confluent” refers to a severe form of illness where the characteristic skin lesions known as pustules, merge and cover a significant portion of the body. Instead of discrete, separate pustules, the lesions become densely clustered, creating a continuous rash or eruption. This severe form of smallpox is often associated with a higher risk of complications and a more severe course of the disease.

Dr. Brown further emphasized that reports from around the world, wherever vaccination has been practiced, indicated a significant increase in vaccination failures.

He also mentioned that when those who have been vaccinated for more than six years come in contact with a strong and active smallpox infection, nearly all of them end up getting smallpox. This raises major concerns about whether the smallpox vaccine works well over a long period and if it actually protects against the disease.

“I must, however, Sir, first take the liberty of observing, that no one could feel more deeply the disappointment of vaccination being found inadequate to give perfect security against smallpox than I did,” he said. His conscience could no longer support vaccination.

In 1829, an English journalist, William Cobbett, highlighted the ineffectiveness of vaccination in preventing smallpox. In his book, “Advice to Young Men and (Incidentally) to Young Women,” he wrote, “In many cases, people vaccinated by Jenner himself have later contracted actual smallpox. Some of these people died from the disease, while others barely survived.”

1845: The Lancet Reports Surge After Vaccination

In 1845, Mr. Stanley, president of the Royal Medical and Chirurgical Society, published an article in The Lancet on a paper by Dr. George Gregory, a physician from the London Smallpox Hospital.

The hospital played a significant role in treating patients with smallpox and was crucial to the development of smallpox treatments and vaccination efforts in the 18th and 19th centuries.

Dr. Gregory wrote about how his hospital, after enjoying freedom from smallpox in the years 1842 and 1843, was hit with an epidemic in 1844 and a significant rise in weekly deaths from the disease. Here are the key points:

In 1844, there were 647 smallpox patients admitted to the Smallpox Hospital, marking one of the highest admission rates since the hospital's founding in 1746.

During the 1844 smallpox epidemic, 312 smallpox patients were vaccinated with the smallpox vaccine, accounting for 48 percent of admitted patients.

Among the 312 vaccinated patients, 100 experienced a milder form of the disease, and nearly two-thirds had moderate to severe disease. Of the 312 vaccinated patients, 24 died—a mortality rate of nearly 8 percent.

In summary, the 1845 Lancet article indicated that smallpox vaccination in the 19th century was not as effective as expected in preventing the spread or reducing the severity of smallpox, as evidenced by the significant number of cases and deaths during the 1844 epidemic.

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