The Smallpox Vaccine

Although it has now been eradicated, smallpox, named for the pus-filled blisters that often rendered the disease-ridden individual unrecognizable, left a devastating and indelible mark on the New World. In a particularly graphic and poignant anecdote, the Cakchiquel Mayan people lamented the helplessness and inevitability of their situation, bestowed upon them by European invasions. Although this particular chronicle does not reference smallpox directly, the sentiment is representative of the ever-present vulnerability that plagued the Native populations for centuries to come:

“Great was the stench of the dead. After our fathers and grandfathers succumbed, half of the people fled to the fields. The dogs and vultures devoured the bodies. The mortality was terrible. Your grandfathers died, and with them died the son of the king and his brothers and kinsmen. So it was that we became orphans, oh, my sons! So we became when we were young. All of us were thus. We were born to die!”

This defenselessness, while pervasive, was coupled with a fiery tenacity to uplift society with scientific experimentation and humanitarianism. An excellent personification of this phenomenon is exhibited through the work of Guatemalan physician José Flores. Named the head of the Protomedicato in 1793 by the Audiencia of Guatemala, Flores possessed an impressive knowledge of the epidemiology of the smallpox virus, as well as a unique perspective of the demographics and sociocultural climate of Guatemala itself. Understanding that all populations are distinctive, Flores created a ‘local method’ of inoculation, using cantharides, or beetles capable of irritating skin and raising blisters, instead of the more intimidating lancet and scalpel tools. After the blister appeared on the body, Flores, and those following his instructions, placed a cotton string soaked in the pus of a mature smallpox vesicle in the sore, which he left for up to two days. Finally, he replaced the cotton with a desiccant, waiting for the inoculated individual to exhibit symptoms of a mild form of smallpox. The infected population, mainly children, were then escorted by city officials to a dwelling on the outskirts of town, often provoking an emotional response from the parents and elders of the area. In addition to the vaccination efforts, Flores, and the Protomedicato of 1794, implemented a three-point plan, in order to mitigate the spread of the deadly virus. Firstly, they decided to block the three major roads from Guatemala to Chiapas, Mexico, limiting the spread of travel. Secondly, they began inoculating the population immediately, targeting those not alive during the previous outbreak. Thirdly, the committee distributed an inoculation handbook, written by Dr. Flores, in order to streamline the process for those not accustomed to basic medical procedures, but required to administer the vaccine. This comprehensive manual included specific medical practices, such as the aforementioned “local technique”, and also detailed the importance of priests in the inoculation program, with Flores insisting they should act with “charity and with persuasion, speaking to the Indians in their own language, with love and fondness”. Eventually, Flores would even advocate for refashioning the vaccination process into a Catholic religious ceremony, reinforcing the hierarchical relationship of the colonizer and the colonized, and further neglecting indigenous responses and medical customs.

Despite his coercive processes of the late eighteenth century, the success of Flores’s inoculation campaign led to Spain’s Consejo de Indias desire for his medical recommendations, in order to formulate a robust empire-wide vaccination program, going into the nineteenth century. This Royal Maritime Vaccination Expedition capitalized on the newly developed Jenner vaccine, striving to implement a global humanitarian initiative. The technology of the Jenner vaccine was nothing short of revolutionary, as the mortality rate for smallpox was staggering, with estimates ranging from thirty to sixty percent in New Spain. The massive distribution effort, guided by economic potential, an Enlightened interest in science, and a genuine humanitarianism, permanently altered the global landscape of medical practices. The latter phenomenon, often touted as the most important objective, is best shown through the following quote, spoken by Dr. Flores:

“This ... is the crowning moment of my glory; because it provides me the most happy opportunity to promote an easy and safe method to eradicate smallpox, and forever liberate the inhabitants of those lands from the most frightening contagions. I ask you then to listen indulgently [to] the first fruits of a medical physician who burns for love for his homeland [patria], all of America, [and] all of humanity.”

Altruistism was also present in the mind of Edward Jenner, evidenced by his resounding hope that the “practice of producing cowpox in human beings will spread over the world”. This custom, while seemingly unconventional, was tested by Jenner on May 14, 1796. Noticing the absence of smallpox amongst milkmaids, Jenner theorized that their frequent exposure to cowpox protected them from the far more serious disease. He then tested this theory on eight-year-old James Phillips, vaccinating him with cowpox, and six weeks later, inoculating him with matter from a smallpox vesicle. When the smallpox virus did not develop, Jenner’s theory was proven correct, and the demand for cowpox grew exponentially, as the news of the groundbreaking discovery spread and enthusiasm soared. The majority of the world was astonished by his breakthrough, but Jenner was not without his critics. The noble intentions throughout the creation and distribution of the vaccine, were met with both ethical and logistical difficulties.

From the very inception of the Jenner vaccine, ethical questions arose, often for two interconnected reasons. Various opponents of Jenner believed that the entire vaccination process was immoral and sacrilegious, stating that infecting healthy people with “repugnant and dirty material” from an animal was unacceptable. Additionally, even though the experiment was a success, it was morally problematic to conduct a medical study on a live human, without possessing a deep understanding of immunity, antibodies, and the disease itself. Furthermore, transporting and maintaining a steady supply of cowpox was a logistical nightmare, and many countries were forced to rely on the transmission of foreign lymph fluid. In his previously mentioned official report to the Spanish Empire, Dr. José Flores suggested a two-part expedition, with ships carrying both a “sufficient” number of young boys and cattle infected with cowpox, and a quantity of vaccine material sealed between glass slides. The leaders of the Royal Maritime Vaccination Expedition agreed with Dr. Flores’s strategy, and they instructed physicians to take non-immune boys from the Casa de Niños Expósitos in Madrid on the voyage, in order to maintain a live supply of the virus. The struggle to preserve cowpox lymph plagued Guatemalan society, and in the absence of naturally occurring cowpox, the Audiencia supported the introduction of human smallpox into animals, hoping the same anti-smallpox properties would occur. Ultimately, establishing a reliable domestic supply of cowpox would depend on keeping animals, such as cattle, ewes, horses, and mules sick, so that workers could continuously extract the infectious material. While this practice would certainly be unethical by twenty-first-century standards, medical officials of the time considered it a microcosm of scientific experimentation and advancement:

“This little can of smallpox will garner much interest, namely, that the [human] smallpox pus from Ciudad Real will be injected into ewes, thereby sowing the vaccine, because we have not had the good luck to locate [cowpox] among the cows or sheep in this vicinity, nor further away, no matter how much we rushed our efforts. Immediately we intend to conduct original experiments, found on so perfect an analogy, thus it seems success is guaranteed.”

The published material and correspondence of this era further proved the lack of ethical standards or misgivings amongst the scientific community, in regard to both the animal and human experimentation. After the formal introduction of the smallpox vaccine into Guatemalan society, the promotion of these trials became government sponsored, as well as propagandized in Gazeta de Guatemala. The end result, hoped to be the eradication of the destructive disease that decimated populations globally, justified the use of extraordinary means, including arm-to-arm transfer of vaccination, forced animal inoculation, and doctoral self-experimentation. Unfortunately, those with little power, such as foundlings, the poor, and racial minorities were the primary subject of testing and vaccine maintenance, as both violated ideas of bodily integrity.

Today, in the age of another global pandemic, those with little societal power are still experiencing unproportionate effects of the disease, albeit in different ways. The United Nations High Commissioner for Human Rights recently highlighted the “rising disparities in how COVID-19 is affecting communities, and the major disproportionate impact it is having on racial and ethnic minorities”. However, the humanitarian and enlightenment efforts of past centuries have persevered, as well. Specifically, the members of the NGO Wuqu’ Kawoq/Maya Health Alliance have created radio programs in twenty different Mayan languages, in order to inform the rural populations of Guatemala that are sheltered in place and separated from the world due to a lack of internet access. Additionally, scientists, still benefiting from Edward Jenner’s breakthrough, continue to use animals in the experimentation process, utilizing mice, hamsters, ferrets, and monkeys to test the safety of a potential vaccine. This effort, much like those of the eighteenth and nineteenth centuries, is credited with being the pinnacle of benevolence and scientific advancement. Yet, a rising number of critics point to animal testing as an archaic and unacceptable sacrifice. A German organization, Doctors Against Animal Experiments, has spoken out against animal testing in the midst of the COVID-19 era, stating that animal experiments have “poor predictivity for human medicine”, and that there are better methods, such as “organ-chips and lung organoids” available. Although these two approaches are underfunded and under researched, the comprehensive plan to phase out animal-based testing in the Netherlands shows the growing possibility of an innovative world, devoid of controversial and systematic animal exploitation. Ultimately, the science, ethics, and logistics of the Royal Maritime Vaccination Expedition continue to inform and influence society today, but we must continue to grow and mature in relation to these phenomena, leaving the following generations a more sustainable humanity than we received.