The History of Vaccines and the Importance of Vaccine Mandates
Part 1: Asia: The Earliest Inoculations
Since the arrival of the Covid-19 vaccines, and particularly mandates for them, school vaccine requirements have faced increasing hostility. In the past year, several states have considered legislation to loosen vaccine requirements by providing easier access to vaccine exemptions or adding new exemption categories. Some would even like to see school vaccine requirements abolished nationwide. This increased momentum has led to record highs in the use of exemptions to existing vaccine requirements. Further, presidential candidates Donald Trump and Robert F. Kennedy, Jr. have made comments criticizing vaccine requirements, particularly for the measles, mumps, and rubella (MMR) vaccine.
With this increased focus on school vaccine requirements, I am going to change the format of this newsletter for the next few weeks by writing a series of related posts about the history of vaccine development, the history of vaccine mandates, and why vaccine requirements are so important to enforce within schools. To begin, I ask: where and how did the first inoculations begin?
Variolation, the vaccine precursor
The history of modern vaccine development begins with a now extinct disease and a long distant practice called variolation that developed in Asia. Smallpox is one of vilest killers the world has ever known. The earliest evidence of smallpox traces to Egyptian mummies around the 15th century BCE. As a famous example, the mummified skull of Pharaoh Ramses V is riddled with what appear to be remnants of smallpox lesions and some have argued that it was his likely cause of death in 1145 BCE. Over its entire existence, smallpox may have killed billions of people. In just the last 100 years of its existence smallpox killed 500 million people worldwide. The use of the modern smallpox vaccine to eradicate this deadly disease is one of the great achievements of humanity. However, the roots of this modern vaccine begin in the distant past.
The earliest form of inoculation against smallpox occurred in China as early as the 11th century where it was “common practice to collect the scabs of smallpox lesions, grind them to a powder and blow this [powder into] the nose” of a child. While not 100-percent effective and there were some dangers, this procedure was found to offer protection from infection and provide immunity against severe illness from smallpox. Other ancient practices of inoculation against smallpox can be found in India.
A different, but similar, method was the first to make its way to the west. Smallpox pustules were lanced and a small amount of pus was placed into a non-infected person through a tiny incision or scratch with the same device. The practice made its way from India to the middle east as well as to northern Africa.
Arrival in Europe
The procedure of variolation made its way to England through Lady Mary Wortley Montague. Lady Mary had a long history with smallpox. Her brother died from an infection and she was infected herself in 1715 at the age of 26. While she recovered, she was left with a scarred and disfigured face for life. For the time, the experience of Lady Mary’s family wasn’t unusual. In 18th century Europe, smallpox infected over one million people each year and resulted in about 400,000 deaths in a population of 200 million people. Around one-third of those infected died and those who survived were often left with severe scars for life. A similar rate of infection and mortality in the present day United States would leave 660,000 people dead each year.
When Lady Mary’s husband was appointed ambassador to Constantinople she was introduced to the practice of variolation. She wrote to her friend Sarah Chiswell in April 1718:
“The smallpox, so fatal . . . amongst us, is here entirely harmless by the invention of engrafting. . . . They make parties for this purpose . . . the old woman comes with the best sort of smallpox, and asks which veins you please to have opened. She immediately . . . puts into the vein as much venom as can lie upon the head of a needle. The children or young patients play together all the rest of the day, and are in perfect health until the eighth [day]. Then the fever begins to seize them and they keep to their beds for two days, very seldom three . . . in eight days time they are as well as before their illness. . . . Every year thousands undergo this operation. . . . I intend to try it on my dear little son.”
Try it she did. She would inoculate her young son Edward while still living in Constantinople and would inoculate her daughter after returning to England. Soon the practice would spread widely, especially among members of the royal family in England. Others nobles throughout Europe followed suit including Catherine the Great and her family in Russia, along with royalty in Austria, France, and Prussia. Eventually the practice would trickle down to the masses.
Around the same time period variolation would arrive in North America by a different route, Africa. Here the procedure was met with more controversy. It would also play a pivotal role in the coming Revolutionary War. We pick up there in part 2 of this series.
Troy Tassier is a professor of economics at Fordham University and the author of The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us during Outbreaks.
Part 1: Asia: The Earliest Inoculations
Part 2: Inoculation in the North American colonies and Washington’s mandate
Part 3: A Safer Procedure and the Rise of New Vaccinations
Part 4: Vaccine Inequality and the Case of Polio
Part 5: Measles Vaccines and the Importance of School Mandates Today