Covid-19, smallpox, and the anti-vaxxers

The tennis star Novak Djokovic just announced his entry into the company of anti-vaxxers. During a Facebook live interaction on 19 April, he said, contemplating a future SARS-CoV-2 vaccine, “Personally I am opposed to vaccination and I wouldn’t want to be forced by someone to take a vaccine in order to be able to travel."

The notion that vaccines are dangerous is the most pernicious contemporary healthcare myth. The HIV conspiracy theory about which I wrote in my previous column has done far more damage but the balance could change if millions of conscientious objectors refuse a future coronavirus vaccine. Vaccines depend on creating community immunity, a threshold of uptake beyond which it becomes impossible for a virus to spread. Community immunity shields individuals allergic to vaccines and those too young or too weak to take them. To get vaccinated is to protect not just oneself but society at large.

There are cases of vaccines causing severe side effects and it is conceivable that the covid-19 pandemic could create a rush to market without adequate safeguards. Caution regarding a new treatment, however, is not the same as blanket condemnation. The anti-vaxxer movement uses isolated missteps from the past to reject a class of preparations that has tamed the most ferocious contagions known to humankind.

The movement’s origins lie in an act of fraud. Andrew Wakefield, a gastroenterologist based in London at the time, published a paper in the prestigious medical journal The Lancet in 1998, claiming a link between the Measles, Mumps and Rubella (MMR) vaccine and autism. Questions about the quality of his research erupted when follow-up studies failed to replicate the results. Soon, a motive was found for Wakefield’s faulty methods: He had been funded by lawyers seeking to sue vaccine manufacturers.

The British General Medical Council censured him and The Lancet revoked his paper after finding he had falsified data. Wakefield’s deception ought to have left him unemployable but a faction of mostly well-educated individuals came to believe he was a victim of a conspiracy rather than the hatcher of one. Since then, hundreds of thousands of parents who believe vaccines cause autism have refused to let their children be protected, causing outbreaks of preventable diseases in the US and Europe.

In a sense, vaccines are victims of their own success. Even the world’s least privileged people are today protected from previously common infections thanks to the universal propagation of vaccines by governments. The best exemplar is the deadliest disease of all, smallpox.

The smallpox virus was a unique mix of high infectiousness and deadly outcome. It killed three out of every 10 persons it infected, and left the rest badly scarred or blinded. There was no effective treatment, nor any preventive intervention, until Chinese and Indian physicians, possibly independently, invented variolation. The procedure involved taking scabs or pus from individuals with mild smallpox and infecting healthy individuals with it, thus immunizing them from the more dangerous form of the disease.

Variolation was first described clearly in the 16th century. Its development proves that there is no such thing as “Western medicine" that can be opposed to traditional systems. Many parts of the world have contributed to the development of evidence-based treatments and continue to do so. Equally, it demonstrates that valuable knowledge was produced in India throughout history rather than in some mythic golden age thousands of years ago.

Variolation, which spread from Asia to Europe by the 18th century, had significant drawbacks. Not only did the procedure suffer a high failure rate, variolated subjects could themselves transmit full-blown smallpox. Since variolation was reserved mainly for the rich, it is possible that it increased the overall occurrence of infection, with affluent variolated subjects passing on the disease to large numbers of poorer vulnerable individuals.

Whatever the method’s defects, its underlying principle of creating immunity by inducing a mild infection was revolutionary and inspired the development of the first vaccine. An English physician named Edward Jenner, having noticed that humans infected with cowpox developed immunity to smallpox, replaced the smallpox scabs used in variolation with pus from cowpox blisters. The procedure came to be called vaccination, from vacca, Latin for cow. Jenner began his experiments in 1796 and was so successful that vaccination replaced variolation completely across Europe within decades.

Even as the prevention of smallpox, involving Europe’s relationship with the East, took important strides between the 16th and 19th centuries, a tragedy was playing out in lands conquered by European nations on the other side of the world. Unlike Asia, Europe and Africa, which had lived with smallpox for thousands of years, natives of the Americas were free of the disease and had no immunity to it as a consequence. The Aztecs, Incas and Mayans might have fended off the army of the foe from across the ocean had they not been felled in vast numbers by the brutal disease which covered victims in painful sores. They had experienced nothing like it and it sapped survivors of their will to fight or even live.

Just as variolation had been a preserve of the rich, vaccination remained for a long time a privilege rather than a right. That is why, despite the availability of an effective vaccine, smallpox killed approximately 300 million people in the 20th century alone. A decisive change occurred in 1967, when the World Health Organization (WHO) began focusing on the breathtakingly ambitious project of eradicating the disease.

In 1975, the last known case of variola major was detected in a two-year old Bangladeshi girl. In 1977, the last infection by its milder sibling, variola minor, was discovered in Somalia. In 1978, the virus claimed its final victim after escaping from a Birmingham laboratory.

On 8 May 1980, WHO officially announced an “unprecedented achievement in the history of public health", calling the eradication of smallpox to the attention of all nations, “which by their collective action have freed mankind of this ancient scourge and, in so doing, have demonstrated how nations working together in a common cause may further human progress".

I hope nations will find the will to work together with equal energy in the present crisis and that a safe vaccine, when it arrives, will not only be provided to the widest range of individuals but find acceptance among them all, from the humblest farmer to the world’s best tennis player.

Girish Shahane writes on politics, history and art.