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Public Health—Stealth Health: Part One

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Burden S. Lundgren
January 3, 2022

We now have a COVID epidemic of the unvaccinated. Why, when there is a widely available vaccine that could prevent most of this misery, are there so many people who are unvaccinated? I believe much of the explanation lies in two areas: lack of appreciation of past experience and a fundamental misunderstanding as to what public health is. Today I want to concentrate on the former reason—I will save the latter for my next column.

The past experience most often cited as to public expectations of the vaccine is the polio vaccine. Parents rushed their children to be vaccinated even after the infamous “Cutter” incident which resulted in deaths. But polio is an outlier. In the latter part of the 20th century, the anti-vaccine movement started smoldering and was set on fire by the 1998 Lancet article stating that the MMR vaccine caused autism. Although the article was later proved to be fraudulent, anti-vaccine proponents continued to cite it. Celebrities endorsed it. The media, and later social media, spread the anti-vaccine gospel everywhere.

If you are reading this column, you have probably never worried about getting smallpox. This places you in a small minority of humans who have walked the earth. Smallpox is arguably the most lethal disease we have ever known. Untold millions have died from it. During the 18th century, 400,000 Europeans died from it each year. The disease was also well-known in Asia, the Middle East and Africa. It’s introduction to virgin populations in the New World proved genocidal. The mortality rate can be as high as 60% —80% in children and 90% in virgin populations—with many survivors left blind and/or disfigured. In the 1960s, with vaccines widely available, the disease claimed 2 million lives.  

There were anti-vaxxers even before there were vaccines. The initial effort to prevent death from smallpox was inoculation. First used in Asia and Africa, it involved inserting or rubbing material from the scabs or pustules of a patient into the skin. The hope was to provoke a mild infection which would then confer immunity. It was a very dangerous, but highly effective procedure. Onesimus, an enslaved person from West Africa owned by the Reverend Cotton Mather, introduced inoculation to this country. Mather’s promotion of the method during a 1771-2 smallpox epidemic in Boston brought fierce blowback from local physicians and others. A bomb was thrown through his window. The arguments against inoculation sound familiar. The first was that the technique was new and unproven—it was neither. The second was made on the grounds that it violated divine will. Another familiar process was the collection of data. By the epidemic’s end, 2% of those inoculated had died of the disease. Among the infected, non-inoculated population, the death rate was 15%. With spreading knowledge of its success, inoculation became more popular and smallpox deaths declined.

During the Revolutionary War, inoculation may have increased the new country’s odds of winning. Knowing that the British army mandated smallpox inoculation, General George Washington ordered mass inoculation of all American troops. Smallpox struck again during the War with devastating effects on the non-military personnel—Native Americans and African Americans—who were fighting with Washington’s troops. Cases among the inoculated regulars were only sporadic.  

Inoculation was a method to give the inoculated the disease in a milder form. Vaccines are designed to produce an immune reaction to a disease without producing the actual disease. And the very first vaccine on earth was that for smallpox. In 1796, Edward Jenner, an English physician, noticed that dairy workers who contracted cowpox—a mild disease—were unlikely to fall victim to smallpox. Famously, Jenner injected material from a cowpox lesion into a young boy, and then exposed the boy to smallpox several times. The boy did not catch the disease. Jenner continued his ethically outrageous experiments and published his findings which became widely accepted and adopted.

By the mid-20th century, the disease was well-suppressed by mandatory vaccination in the developed world, but endemic in over 30 countries. Suppression came at a cost. The vaccine was not overly safe, and requirements were stringent. In the United States, infant vaccination was universally required, and Americans needed proof of recent vaccination to re-enter the country when they traveled abroad.       

At the about same time, the World Health Organization (WHO) initiated efforts to eradicate the disease. Vaccination teams were sent out to South America, Asia and Africa. Inevitably, they encountered vaccine resistance—which was met in many instances by violent enforcement. A member of WHO’s vaccination team in Bangladesh recalls an “almost military style attack on infected villages” with people, including children, being chased from their homes and vaccinated. In India, there were reports of vaccinators breaking through doors in the middle of the night, dragging out, overpowering and vaccinating the occupants.      

This is public health at its most exposed, its most brutal, its most disrespectful of individual autonomy and its most successful. No one has died from smallpox since the late 1970s. WHO declared it eradicated in 1980. And no one reading this need worry about it.      


Author: Burden S Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care. After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA. She has served as a consultant to a number of non-profit groups. Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected].

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