Community Health Forum: The development of the smallpox vaccine

Posted: February 25, 2013

Special to The Winchester Star

Welcome back to the continuing story of the world’s greatest disease eradication success and the role it played in the emergence of community health practices in these United States.

For those of you who missed part one about the smallpox vaccine, see the Feb. 18 edition of The Winchester Star.

We once more thank the College of Physicians of Philadelphia for permission to reproduce information from “Timelines — History of Vaccines,” a fascinating website that can be accessed at: historyofvaccines.org/content/timelines/all.

THE POX, Part Two:  From Revolutionary times to the close  of the 20th century

British commanders sent to subdue the rebellious Continental Army had a silent but extremely deadly ally: smallpox.

George Washington, who survived smallpox in Barbados in 1751, faced British troops who had already been variolated or exposed to smallpox. American troops were still vulnerable, a huge disadvantage during the siege of Boston.

It is believed that the British, in an early example of biological warfare, sent infected civilians into the American camps during the 1776 Quebec campaign, felling 5,000 of 10,000 troops, including the commander, and forcing a pitiful retreat.

By 1777, mandatory inoculation was required in the Continental Army, mostly administered as recruits passed through Alexandria. Andrew Jackson survived smallpox as a prisoner of war, although his brother and fellow prisoner died in 1781.

In 1792, as the new nation reorganized, Virginia revised and consolidated regulations for the administration of smallpox inoculation, with fines for unlicensed administration or the willful spreading of smallpox.

Meanwhile, in England, in 1796, Edward Jenner used cowpox vaccine to induce immunity to smallpox. This safer immunization was first given to U.S. children by Harvard University professor Benjamin Waterhouse who, receiving no reply from President John Adams regarding the possibility of exterminating smallpox, wrote then Vice President Thomas Jefferson in 1800. Jefferson, who had reviewed the scientific literature, responded from Monticello with enthusiasm: “Medicine has never before produced any single improvement of such utility.”

Waterhouse sent Jefferson some of the vaccine and Jefferson vaccinated family and neighbors. In 1813, Congress passed and President James Madison signed into law “An Act to Encourage Vaccination,” which included foundation of a National Vaccine Agency, appointment of the first National Vaccine agent (a Baltimore physician).

It also required the U.S. Post Office to carry mail weighing up to 0.5 oz. at no charge if it contained smallpox vaccine. Variolation was gradually abandoned in favor of the safer cowpox (or “vaccinia”) based vaccine. Outbreaks of smallpox still followed when vaccination practices slackened.

Abraham Lincoln developed smallpox shortly after delivering the Gettysburg Address.

States exercised their jurisdictions. The Virginia General Assembly authorized the governor to supply commonwealth citizens with free doses of smallpox vaccine and directions for use in 1832, and in 1855 Massachusetts was the first state to mandate vaccine for school-age children.

Antivaccination societies, first in England and then in the U.S., sprang up and caused confusion by contending that “filth” and not contagion caused smallpox.

Following an outbreak in 1902, Cambridge, Mass., as authorized by Massachusetts law, ordered all inhabitants of the city to be vaccinated.

Henning Jacobson refused, was judged guilty and continued appeals all the way to the U.S. Supreme Court.

The landmark 1905 ruling upheld the “police power” of states to protect public health and welfare as consistent with the U.S. Constitution.

Courts in some states, however, allowed a liberal interpretation of waiver exemptions. States such as Pennsylvania stepped up their regulation of vaccine suppliers, glycerin was introduced into the vaccine mixture and vaccine supplies became generally safer.

Contamination incidents involving other vaccine types led to the first federal legislation regulating the quality of drugs, known as the “Biologics Control Act,” which established the U.S. Public Health Service Hygenic Laboratory (later known as the National Institutes of Health).

Although antivaccine activity was sometimes militant, such as the forcible ejection in 1926 by a mob and city councilman of health officers attempting to vaccinate townspeople in Georgetown, Del., the final outbreak of smallpox in New York City in 1947 was met by swift collaborative action. Over 6.3 million residents (80 percent) were vaccinated and only 12 cases erupted among the unvaccinated.

In 1959, the Twelfth World Assembly adopted worldwide smallpox eradication as a goal. Dr. Benjamin Rubin’s invention of a bifurcated vaccine needle in 1965, allowing use of one-quarter of the original amount of vaccine, helped pave the way to treatment of the last case of wild type smallpox in the Horn of Africa in 1977.

The routine administration of smallpox vaccine in the U.S. ceased in 1972. The last known deaths related to smallpox occurred in Great Britain in 1978, due to contamination from a research lab one floor below.

A young darkroom worker died, her mother developed smallpox but survived, and her father died of a heart attack after learning of her condition.

Henry Bedson, the microbiology department chairman who had previously been informed that the causative microbiology lab did not meet WHO standards, committed suicide shortly thereafter.

Join the conversation! Please write, care of this newspaper, or email cedavis@jhsph.edu with ideas, interests or concerns about community health issues. We depend on you, readers, to choose our next direction of inquiry.