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hypodermic-needleIf you are age 70 or older, you may remember getting vaccinated for smallpox when you were a child. This disease that used to kill about a third of the people who contracted it and left scars on the rest is now only a faint memory, thanks to Dr. Edward Jenner from England, who developed the first vaccine back in 1796. It took, however, almost 200 years and a number of intense vaccination programs on every continent to finally declare the world free of smallpox.

Why did it take so long? A closer look at what happened in the United States will shed some light on the development of medicine in general during that time and its relationship with government.

Early attempts to control this very infectious disease involved a procedure called variolation. In this process a small amount of the pus from a person with an active case of smallpox was scratched into the arm of a well person. The well person sometimes developed similar symptoms of fever and rash but did not die from the disease. In contrast Jenner’s vaccine was created using the pus from a similar disease in cows, called cowpox.

Manufacturing this more effective vaccine in the United States finally took off in the 1870s. All a person needed was a heifer, a seed virus from a case of cowpox, the passing on of the virus to subsequent calves, and some ivory points to transfer the vaccine to humans. Although this vaccine was easy to manufacture, it was also difficult to regulate its purity. It took about 20 more years for the manufacturers to finally add glycerin to the vaccine to rid it of harmful bacteria. But by then the general public had developed a mistrust of the whole process–and a healthy dislike of government interference.

In the 1890s, control of infectious diseases was still in the hands of local and state officials. Public health programs were starting to gain popularity in many communities, but according to Michael Willrich in Pox: An American History, “No public health measure inspired more ill will than compulsory vaccination” (91). And vaccination programs targeting school children were particularly unsuccessful in regions that still had no laws mandating school attendance.

Another difficulty lay with local doctors who often had limited formal medical training and sometimes misdiagnosed the skin rash of smallpox as measles or some similar disease, thereby allowing one or two isolated cases to explode into an epidemic that would ravage entire communities.

It took the power of the federal government to finally regulate the quality of the smallpox vaccine. Under the Biologics Control Act of 1902, manufacturers of the vaccine were now required to have a federal license and to agree to unannounced inspections of their facilities.

But even with a more reliable vaccine, programs of mandated vaccination of school children, especially during threatened outbreaks of the disease, still met with fierce opposition from parents and even some school officials. The first decade of the 20th century was a time of great change in American  society. With government assuming more and more power, some citizens saw their personal liberty draining away. Even J.W. Hodge, a homeopathic doctor, declared, “Compulsory vaccination ranks with human slavery and religious persecution as one of the most flagrant outrages upon the rights of the human race” (Willrich 254).

As smallpox epidemics continued to decimate whole communities, not only in the United States but around the world, a series of intense vaccination campaigns waged by the World Health Organization finally stopped the disease in its tracks. By 1952 North America had eradicated the disease, and the other continents followed. Finally, on May 8, 1980, the World Health Assembly officially declared the world free of smallpox.

There may be no more smallpox, but the controversy over mandatory vaccinations is far from over. Questions still remain: Who has the power to make medical decisions for children? And when is the freedom of the individual to be limited for the good of all?

References consulted: (1) “History of Smallpox.” Centers for Disease Control and Prevention, 30 Aug. 2016, http://www.cdc.gov/smallpox/history/history.html. (2) Michael Willrich. Pox: An American History. The Penguin Press, 2011.