Smallpox vaccine: ahead of its time

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Abstract
From its introduction in 1798, smallpox vaccination was always the subject of fierce controversy, particularly in England, where waning immunity from the first vaccinations coincided with government attempts to enforce compulsory vaccination. Unfortunately some supporters of vaccination tended to exaggerate its safety and benefits, while opponents equally played up the dangers and failures. Although some critics had legitimate concerns about safety and the duration of immunity, others denied that vaccination had any value at all, and claimed that its only effects were dangerous. This story has been told many times as a battle between government interference and growing demands for freedom of the individual from an increasingly articulate public – an early manifestation of the 'nanny state' and reaction against it. This collision is important, but so is the scientific climate in which the controversy took place. In this paper the arguments are assessed from two previously neglected viewpoints. First, vaccination was introduced many years before laboratory methods had been developed to assess its effects objectively, which allowed claims and counterclaims to be made without supporting evidence. Then, when laboratory studies began, the initial results were far from clear cut. Although early bacteriological studies clarified the dangers caused by contamination of the vaccine by bacterial pathogens, other results were less certain: in particular, opponents were encouraged by inevitable but honest disagreements among and between bacteriologists and protozoologists about the nature of and relation between smallpox virus and vaccine. Second, smallpox vaccine was introduced long before Pasteur developed the second generation of vaccines in the 1880s. Here again, the initial results were sufficiently promising to encourage supporters, but also caused enough problems to hearten opponents. Although this account concentrates on nineteenth century developments, sufficient information is provided on more recent work to show how earlier and persistent problems caused confusion and have since been clarified.

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