September 7, 2023 • 26 mins
What can we learn from the centuries-long quest to eradicate smallpox, once the scourge of humanity? And how did it set the stage for all vaccines to come? First we meet Edward Jenner, a doctor in 18th century Britain who learned about the folk practice of “variolation” and found a safer way to inoculate people against smallpox. Then, Donald Hopkins of the Carter Center takes us back to the 1960s in Sierra Leone, where he discovered that successfully eradicating smallpox could be a feasible goal worldwide.
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Speaker 1 (00:03):
We heard a lot about coronaviruses over the past few years,
really a lot, maybe too much, definitely more than we
ever expected to hear, But we heard a lot less
about other viruses. And viruses are amazing. Viruses are older
than animals, they're older than plants. Some scientists think viruses
(00:28):
may be the origin of all life on Earth. Viruses
have been infecting humans, sometimes invisibly, sometimes with terrible consequences,
for as long as there have been humans. The story
of viruses is the story of humanity survival as a species,
and we're going to tell some of those viral stories
on this podcast. I'm Jacob Goldstein, and this is Incubation,
(00:52):
a show about the other viruses. It's about science and
about culture. It's about how viruses attack people and how
people fight back. On each episode of Incubation, we're going
to tell the story of one virus, and we're starting
off with one of the deadliest viruses in history, smallpox.
Smallpox stalked humanity for thousands of years. It gave people
(01:16):
rashes and blisters all over their bodies, and often it
killed them. Smallpox killed hundreds of millions of people, but
we humans fought back in profound and brilliant ways. Our
episode today starts with the story of Edward Jenner, a
doctor in the British countryside, and it ends centuries later
(01:39):
with thousands of people working together to wipe smallpox from
the face of the earth. My first guest today is
Gareth Williams. He's the author of Angel of Death, the
Story of Smallpox, and Gareth he knows a lot about
Edward Jenner.
Speaker 2 (01:56):
He was a great fields naturalist, and he also worked
out something about the migration of birds, which was completely
unknown before that. People thought that swallows went off and
hid in mud under riverbanks and things like this.
Speaker 1 (02:11):
I read that he built a hydrogen balloon that flew
twelve miles, That he played the violin, that he wrote poetry.
Speaker 2 (02:18):
He did all the above. He played the flute I
think rather bet, and he played the fiddle. He sang.
He had a good singing voice. I can recite one
of his poems if you'd like it.
Speaker 1 (02:26):
Of course, give it to me, okay.
Speaker 2 (02:29):
That he wrote it when a man called doctor Weight
died and doctor Weight had made medicinal gingerbread biscuits gingerbread nuts,
which not only tasted good but actually killed intestinal worms,
talking about tapeworms and things that around to twenty feet
or more. So here's a put on the death of
doctor Weight. It begins with the Latin names of the
worms Ascarides, Tearies, Lumbricki, and all he Kyle sucking insects
(02:55):
that tremblingly crawl. No more be afraid You're quite safe
in our gun, for Dr Waite has finished making his
gingerbread nuts.
Speaker 1 (03:05):
So in addition to writing poems about nuts, non trivially,
Jenner also invented the first vaccine in human history. Let's
talk about that. That's really what we're here to talk
about today. He's born in seventeen forty nine. He's growing
up in England in the you know, second half of
the seventeen hundreds. What would his experience of smallpox have.
Speaker 2 (03:26):
Been in Jenner's day? If you got smallpox and you
had roughly a one in three chants of getting it
during your lifetime, then you had about a one in
four chance of being killed by it. He went to
boarding school when he was eight. Both his parents had
died by then, and he had to be protected against
smallpox which had broken out nearby.
Speaker 1 (03:47):
And this thing happens to him where somebody, if I
understand right, cuts open his arm and puts dried out
pus from a smallpox patient into the cut on Jenner's arm.
What's going on there?
Speaker 2 (04:00):
This was what was called variolation. And variola is the
Latin word for speckled or spotted. It's the old name
for small pox, and it's the name of the virus
that causes small pox, of Variola virus. And in brief,
varilation was giving healthy people, usually children, the real thing
in the hope that the artificial infection wouldn't kill them
(04:23):
and that it would somehow leave them protected against future
attacks of naturally acquired small pox. It was about a
one in fifty mortality, so very very much lower. You
got a little bit of small pox pus from one
of those revolting blisters that covered people in the tens
and thousands, and you would scratch a little bit of
(04:44):
that revolting fluid into the skin on the arm of
a healthy child.
Speaker 1 (04:48):
Does it work?
Speaker 2 (04:49):
It's mad, bad, crazy, dangerous, sounds completely counterintuitive. The amazing
thing is it did work, very much so. And the
other thing is that if you were variolated, even if
you survived while you had your artificial dose of smallpox.
You have the real thing. So even though you might
get over it in two or three weeks, you could
(05:09):
spread it to other non immune people, you know, people
going back into the community, causing little mini outbreaks of
smallpox and killing lots of other people bi collateral damage.
Speaker 1 (05:21):
Wow. So okay, So this is the world. Jenner is
born into the world where you can either get smallpox
and a good chance of dying from it if you
get it, or if you're sort of lucky in a
weird way, you can get variolated and have a non
trivial chance of getting and dying of smallpox and maybe
(05:43):
spreading it to other people. That was it. Those were
the options.
Speaker 2 (05:45):
Absolutely.
Speaker 1 (05:46):
How does he go from being an eight year old
boy getting very related to inventing the first vaccine in
the world.
Speaker 2 (05:52):
Okay, if you want the conventional story, yeah.
Speaker 1 (05:56):
I feel like you're gonna give me two stories. One
is it Jenner classic, So give me Jenner clas.
Speaker 2 (06:00):
The Jena classic is he is a medical apprentice in
his early teens and he meets a milkmaid small pox
has reappeared nearby, and she allegedly says to him, look, Gov,
you don't need to worry about me having that, because
I've had cowpox and that means that I can never
ever catch smallpox. And this was complete news to January,
(06:22):
never come across it. But it was also complete news
to all his teachers. It simply wasn't part of conventional
medical knowledge. It was common knowledge in the farming community.
Speaker 1 (06:31):
It was folk knowledge that had not sort of crossed
over to kind of high brow medical knowledge.
Speaker 2 (06:37):
A lot of people didn't want to believe it because
it had come up from the peasantry.
Speaker 1 (06:41):
Interesting, so you're saying, that's kind of the classic tale.
Do you think it's true.
Speaker 2 (06:46):
I'd like to believe it's true. The alternative story is
that one of Jenna's medical colleagues in Thornbury was actually
a variolator, very successful one, and he noted, apparently independently,
that some people that he valulated the varulation didn't take.
In otherwords, there was no sign that they'd caught this
artificial dose of smallpox. And this man is called John Fuster.
(07:11):
And story B if you like, is that it was
actually Feusta who made the original observation. Jenna was a
close friend of his, and Jenna may have decided to
pick up on it. Feusa didn't want to pursue it
because he was making so much money as a valulator.
He didn't see the need for any particular improvement.
Speaker 1 (07:29):
Okay, so Jenner has this idea, whether it's from the
milkmaid or from his colleague, this idea that cow pox,
which we should say is not a deadly disease in humans, right,
can protect humans against a smallpox. What does he do
with this idea.
Speaker 2 (07:50):
Well, he doesn't do anything with it for over thirty years.
He goes off he finishes his medical studies in London.
In seventeen ninety six, he gets the idea of collecting
cases of people who've had cowpox and look to see
if they appeared to be protected against smallpox. And he
collects a number of cases and the story appears to
(08:11):
be true. And then he moves beyond that to actually
test the hypothesis that giving somebody an artificial dose of
cowpox will protect them against smallpox. The killer and his
first guinea pig is his gardener's son, James Phipps. And
the ethics might be regarded as a bit dodgy, because
(08:32):
back then, if you were the gardener's son, then you
were effectively the property of the Lord of the manor
III Jenna, and he introduced cowpox into the arm of
James Phipps, who was eight years old. And what Jenna
did was to find a case of cowpox with a
lovely juicy cowpox blister on the back of her hand.
(08:52):
He stuck a lancid in that collected the juice and
scratched the cowpox juice into the arm of James Phipps,
and that all went well. The lad got a bit
of a local reaction, he got a bit of a fever.
Two weeks later he was back to normal. So Jenna
now has to test his hypothesis to see if the
lad is protected against smallpox. The killer gave him a
(09:13):
small dose of smallpox and it didn't take So that,
if you like, was the Eureka moment.
Speaker 1 (09:19):
So he just invented the first vaccine in the history
of the world, a vaccine against maybe the most deadly
infectious disease. Truly one of the great discoveries in the
history of medicine and the history of public health. What's
the first thing he does to try and tell the world.
Speaker 2 (09:34):
Well, he writes it all up as a paper and
he sends it off to the Royal Society, and amazingly,
the Royal Society reject the paper.
Speaker 1 (09:45):
They reject his paper, They reject the guy just invented vaccines.
Speaker 2 (09:49):
Well, they probably wouldn't have appreciated the full significance. But
you're right. It is one of the great pinnacle publications
in the history of medicine and science.
Speaker 1 (09:57):
But he doesn't give up. What's he doing next?
Speaker 2 (10:00):
He writes it up as a pamphlet. It's always known
as The Inquiry, okay, and it was published by private
printer in Soho came out in September seventeen ninety eight.
Jenna did not attempt to hide or make secret his invention.
He wanted everybody to know. He wanted everybody to do
it because he wanted to conquer smallpox.
Speaker 1 (10:20):
But you're saying he could also have not published it
and just tried to sell vaccination himself and be the
sort of soul purveyor of it.
Speaker 2 (10:29):
That's exactly it. His aim was to spread the word
as widely and as quickly as possible. It really takes
off and people recognize the value of vaccination immediately, and
within a few months it's on the continent of Europe,
it's widespread across England. It's making its appearance in North America.
Speaker 1 (10:47):
You said within months, within months, months, within This is
an era when there's obviously no electronic communication. They're going
to have to put the inquiry on a ship and
sail it across the ocean. But you're saying it spreads
basically a media in.
Speaker 2 (11:00):
That absolute absolutely.
Speaker 1 (11:03):
What do we know about how many people are being vaccinated?
How widespread it is, Like, tell me more about that.
Speaker 2 (11:10):
Well, it's still the preserve of the rich and wealthy
who could afford to pay for medical services, so it's
not widespread and philanthropic, but in terms of geographical reach
it is very impressive. Reaches Switzerland very quickly. The inquiry
reaches the King of Spain and he arranges for the
(11:31):
divine gift of vaccination to be sent out to all
the Spanish colonies and the Caribbean, South America around the
back of the world.
Speaker 1 (11:39):
So this is all happening in his lifetime, right, He's
seeing this happen.
Speaker 2 (11:43):
Well, Jenna works very hard actually trying to spread the word.
He is always one of the great saints of medicine.
But he wasn't a perfect man. In any sense. And
one of the things that he got wrong quite early
was to be able to connon himself into thinking the
vaccination was absolutely per effect, whereas in fact it did
have side effects. For example, you could get a farmyard
(12:05):
infection from kyle pox having get scratched into your arm.
And the other thing was that it needed to be topped.
Speaker 1 (12:11):
Up, meaning like a booster, you needed what.
Speaker 2 (12:15):
Absolutely so other countries were giving boosters in the early
teenage years. And again if smallpox broke out again, say
in Germany, then people nearby would be revaccinated again. So
that was one of the things that he got tragically wrong.
Speaker 1 (12:30):
What's the end of his story.
Speaker 2 (12:32):
He gets gifts and accolades from all over the world.
He gets diamond ring from the Empress of Russia. He
spent his declining years, if you like, after his wife died,
being the vaccine clerk to the world. That's the way
he described himself. He was sitting in his office writing
letters back to all the fan mail that poured in
(12:53):
from across the world. He was able to look around
the world and see a world that was already changed.
Speaker 1 (13:01):
By the way, how does it come up with the
name vaccine?
Speaker 2 (13:04):
Well, the name was actually coined by somebody else. It's
from the Latin vaca, meaning cow, and Louis pasteur. When
he invented his rabies vaccine and various other vaccines, he
suggested that all such immanising or protective preparations should be
called vaccines in honor of Jenna. So that's why we
(13:25):
call them all vaccines today.
Speaker 1 (13:29):
Thank you for your time. Was a delight to talk
with you.
Speaker 2 (13:31):
Pleasure. Thank you for yours.
Speaker 1 (13:34):
Edward Jenner died in eighteen twenty three. In the twentieth century,
his vaccine would serve as the inspiration for one of
the most ambitious public health projects in the history of
the world, to wipe out every single case of smallpox forever.
We'll be right back. In the first half of the
(13:59):
twentieth century, Edward Jenner's vaccine continued to spread, but huge
swaths of the population remained unvaccinated, and hundreds of millions
of people continued to die of smallpox. The world had
become smaller and more connected. Air travel was taking off,
and smallpox was happy to hitch a ride. Even countries
that thought they'd eliminated smallpox found out that they could
(14:20):
only keep it at Bay for so long. A smallpox
scare grips Great Britain. In the wake of five deaths
attributed to the disease that was all but wiped out
in Western nations, tens of thousands throughout the nation line
up at health centers to be inoculated.
Speaker 2 (14:37):
The outbreak of a bad.
Speaker 3 (14:38):
Disease is checked by modern medical science.
Speaker 1 (14:45):
In the middle of the twentieth century, leaders around the
world cooked up an audacious plan to drive the smallpox
virus to extinction, to eradicate it from the face of
the earth. Donald Hopkins directed the smallpox eradication campaign in
Sierra Leone in the late nineteen sixties, just as the
global eradication project was getting started. When he arrived in
(15:06):
Sierra Leone, the West African nation had the highest smallpox
rate in the world. You get to this country, what
do you see on the ground?
Speaker 4 (15:16):
Well, I see, first of all a beautiful country, and
then I'm introduced to the health workers that I'm going
to be working with and find that they are very capable,
very enthusiastic. I'm young and very optimistic as well. Yes,
people were dying, but the upshot of that was that
(15:37):
people were eager. Most people were eager to get vaccinated,
and so we did not have a problem of trying
to persuade people to cooperate with the program, and that
made things a lot easier.
Speaker 1 (15:52):
Yeah, easier, but this is still a country where there
are a lot of places that are just hard to
get to, right. I mean, are there any particular instances
you remember that were that were especially challenging.
Speaker 4 (16:03):
So in the summer of nineteen sixty eight, it's the
rainy season in sily On, we get a message that
there's an outbreak in this area southeast of the capital
area called Moyamba. So I went there with a driver
and a couple of the Sierra Leone and public health workers.
(16:24):
And the village where that we were summoned to visit,
in fact, was about a forty five minute trek from
the nearest road. I'm afraid of snakes, and this was
a This was a trek through the forest.
Speaker 1 (16:42):
You're like Indiana Jones, You're wearing a hot.
Speaker 4 (16:48):
No hat I had. I had a full head of
hair then, so I didn't I didn't have to wear
a hat. But to we get into this get into
this village, and there are lots of people with smallpox,
including most notably a newborn infant only a few days old,
that was lying on a mat between its mother and
(17:10):
the mother's co wife.
Speaker 1 (17:12):
When you say co wife, what does that mean?
Speaker 4 (17:15):
That means that they were both married to the same man. Okay,
and the child had not been vaccinated. But both of
these two women were in the full throes of smallpox infections,
and so that infant had been exposed. Fortunately, I had
vaccine with me. I was able to vaccinate the infant,
(17:36):
and later about ten days later, when I came back,
I saw that the vaccination was taken and that baby
was saved.
Speaker 1 (17:44):
And just to just because you know, I've never seen smallpox, thankfully.
When you say that two women were in the throes
of infection, what did they look like?
Speaker 4 (17:55):
Well, it's hard to see people suffering so much, because
it's not only that people their bodies are swollen. They're
covered in all of these pustules. But it's very painful.
People describe it as feeling as if your skin was
on fire. Smallpox caused a generalized rash over most of
the body. It was most intense over the face, the hands,
(18:20):
and the feet. But in this instance you could see
these raised pimples first you get little bumps that turn
into blisters that then fill with puffs, which then these
blisters break, and if you're lucky and survive the broken
(18:44):
blisters and puffs, that all dries up, and gradually, over
the course of two three weeks the scabs drop off.
But all of that is infectious, and people when they're
just even before the rash starts, when they start feeling
headache fever, they're already breathing out smallpox virus onto other people.
(19:05):
And so the challenge is the situation like that, to
vaccinate as many people who do not yet have smallpox
as quickly as you can.
Speaker 1 (19:15):
So, okay, So you get to this village. You see
these two women and the baby. The women are clearly sick.
You vaccinate the baby because the smallpox vaccine can actually
help people who are in the early stages of an infection.
What do you do next? What else is happening in
this village?
Speaker 4 (19:32):
In this sensance, we learned very quickly that two weeks before,
a very prominent man in that village who was head
of a secret society, had gotten smallpox and had died.
Because he was so prominent, people came from other villages
to visit him when he was ill, and people came
(19:55):
for his funeral.
Speaker 1 (19:57):
This is a giant alarm bell. It's very bad news
for you. In nineteen sixty.
Speaker 4 (20:02):
Eight, very very bad news, because we also began learning
when I was there. What we were seeing was that
many people had come from other villages as well surrounding
this village, and so this was a much bigger outbreak
than what we were expecting.
Speaker 1 (20:20):
So tell me about what containment meant at this time
in this context.
Speaker 4 (20:24):
Yes, when we first began working in the smallpox program,
the strategy was to mass vaccinate eighty percent or more
of the population. The containment surveillance strategy was developed where
the strategy became find out where the current cases of
smallpox are go there, give priority to vaccinating people in
(20:50):
those households and that village and nearby villages, so called
ring vaccination, because if you could do that, you could
stop the virus from spreading to other people. That was
a much more efficient way of getting after the virus
to stop transmission. Because now you're looking to vaccinate three
(21:13):
four five percent of the population rather than eighty percent
of the population.
Speaker 1 (21:17):
It's like you draw a circle, a big circle around
the village where the infection is and you vaccinate everybody
inside that circle. So it's like you're surrounding the virus
with immune people.
Speaker 4 (21:29):
That's exactly what you're doing. And the radius of that
circle was at least five miles.
Speaker 1 (21:35):
Okay, so you have your information right, you have your
epidemiological surveillance, you have your your ring on a map.
What do you do?
Speaker 4 (21:44):
We then come back with several other vaccinators and have
a plan to assign different groups to go to each
of these villages and make sure that everyone there is vaccinated.
Speaker 1 (21:58):
And you just show up in a village where if
your briefcase full of a vaccine and say here we are,
come line up.
Speaker 4 (22:06):
The villagers had had warning, and in fact, we discussed
with the village chief and the senior people in the
village to agree on a mutual time when was most
convenient for them for us to come back and make
sure everybody was vaccinated. It had to give them notice
in advance, because otherwise, if you just show up, people
(22:27):
are out on their farms, which could be two or
three miles away in many different directions, et cetera.
Speaker 1 (22:33):
So how long does it take you to with your
team go to all of the villages inside this ring
and vaccinate everybody.
Speaker 4 (22:41):
That took a matter of a few days fast, so
each team only had to go to one or two villages,
and so we were able to get there in a
few days and get them vaccinated, and we were able
to stop that particular outbreak in only three or four
weeks max. Wow.
Speaker 1 (22:58):
So it worked.
Speaker 4 (22:59):
It worked. Not only worked in Sierra Leone, but when
we sent a telegram back to CDC headquarters to let
them know what had happened, they were ecstatic. And of
course this was one of the first big demonstrations of
the power of this new ring vaccination strategy, and so
(23:20):
it electrified the entire global smallpox eradication program to see
that this worked so well in Sierra Leone, which had
so much smallpox.
Speaker 1 (23:34):
So we have the good news. What did you do next?
How long were you in Siri Leone? What happened next?
Speaker 4 (23:39):
Ord? I was in Siri Leone for a total of
two years.
Speaker 2 (23:41):
That was.
Speaker 4 (23:42):
I left sierri Leone in August of nineteen sixty nine.
Smallpox was gone from Sierra Leone by April May of
nineteen sixty nine.
Speaker 1 (23:52):
So by the time you left, you and your team
had eradicated smallpox from one of the worst affected countries
in the world.
Speaker 4 (24:00):
And that was a big exclamation point. I was then
forever optimistic that smallpox was gonna go. It was then
to me just a matter of time.
Speaker 1 (24:14):
It's really striking to me that we or you, you
and your colleagues eradicated smallpox more than forty years ago now,
and we humanity haven't succeeded in eradicating anything else yet.
I know we're getting close on polio, but we've been
close on polio for a while, and yes, it's not
(24:36):
gone yet. Was smallpox unanomaly?
Speaker 4 (24:41):
Yes, smallpox is anominally Unfortunately, nothing else is like smallpox.
Eradication means you have to get to whatever disease you're
targeting everywhere wherever it exists. And it's going to exist
in some places where it's a big problem, people care
(25:01):
about it, they are motivated to work against it. But
it's also going to exist in some areas where it's
a trivial problem, where people have much bigger things to
worry about than that targeted disease. But you're going to
have to get them on board as well, because as
long as it exists, anywhere. It's unsafe for people everywhere.
Speaker 1 (25:23):
Doctor, it was a real delight to talk to you.
Let me say thank you for your work. I'm very
grateful to live in a world with no smallpox.
Speaker 4 (25:32):
Well, thank you, I am too.
Speaker 1 (25:35):
Donald Hopkins is currently the Special Advisor for guinea worm
Eradication at the Carter Center. Thanks to my guest today
Gareth Williams and Donald Hopkins. Next week we'll tell the
story of the race for the polio vaccine, and we'll
try to figure out why polio and other viruses have
turned out to be so much harder to eradicate than smallpox.
Speaker 3 (25:56):
We need to ensure that we have we have a
full momentum for this last push, the final push to
reach that last child in that last village of these areas.
Speaker 1 (26:11):
Incubation is a co production of Pushkin Industries and Ruby
Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz,
and Amy Gaines McQuaid. Our editors are Julia Barton and
Karen Schakerjie Mastering by Anne Pope, fact checking by Joseph Fridman.
Our executive producers are Katherine Gerardeau and Matt Romano. I'm
Jacob Goldstein. Thanks for listening.
We heard a lot about coronaviruses over the past few years,
really a lot, maybe too much, definitely more than we
ever expected to hear, But we heard a lot less
about other viruses. And viruses are amazing. Viruses are older
than animals, they're older than plants. Some scientists think viruses
(00:28):
may be the origin of all life on Earth. Viruses
have been infecting humans, sometimes invisibly, sometimes with terrible consequences,
for as long as there have been humans. The story
of viruses is the story of humanity survival as a species,
and we're going to tell some of those viral stories
on this podcast. I'm Jacob Goldstein, and this is Incubation,
(00:52):
a show about the other viruses. It's about science and
about culture. It's about how viruses attack people and how
people fight back. On each episode of Incubation, we're going
to tell the story of one virus, and we're starting
off with one of the deadliest viruses in history, smallpox.
Smallpox stalked humanity for thousands of years. It gave people
(01:16):
rashes and blisters all over their bodies, and often it
killed them. Smallpox killed hundreds of millions of people, but
we humans fought back in profound and brilliant ways. Our
episode today starts with the story of Edward Jenner, a
doctor in the British countryside, and it ends centuries later
(01:39):
with thousands of people working together to wipe smallpox from
the face of the earth. My first guest today is
Gareth Williams. He's the author of Angel of Death, the
Story of Smallpox, and Gareth he knows a lot about
Edward Jenner.
Speaker 2 (01:56):
He was a great fields naturalist, and he also worked
out something about the migration of birds, which was completely
unknown before that. People thought that swallows went off and
hid in mud under riverbanks and things like this.
Speaker 1 (02:11):
I read that he built a hydrogen balloon that flew
twelve miles, That he played the violin, that he wrote poetry.
Speaker 2 (02:18):
He did all the above. He played the flute I
think rather bet, and he played the fiddle. He sang.
He had a good singing voice. I can recite one
of his poems if you'd like it.
Speaker 1 (02:26):
Of course, give it to me, okay.
Speaker 2 (02:29):
That he wrote it when a man called doctor Weight
died and doctor Weight had made medicinal gingerbread biscuits gingerbread nuts,
which not only tasted good but actually killed intestinal worms,
talking about tapeworms and things that around to twenty feet
or more. So here's a put on the death of
doctor Weight. It begins with the Latin names of the
worms Ascarides, Tearies, Lumbricki, and all he Kyle sucking insects
(02:55):
that tremblingly crawl. No more be afraid You're quite safe
in our gun, for Dr Waite has finished making his
gingerbread nuts.
Speaker 1 (03:05):
So in addition to writing poems about nuts, non trivially,
Jenner also invented the first vaccine in human history. Let's
talk about that. That's really what we're here to talk
about today. He's born in seventeen forty nine. He's growing
up in England in the you know, second half of
the seventeen hundreds. What would his experience of smallpox have.
Speaker 2 (03:26):
Been in Jenner's day? If you got smallpox and you
had roughly a one in three chants of getting it
during your lifetime, then you had about a one in
four chance of being killed by it. He went to
boarding school when he was eight. Both his parents had
died by then, and he had to be protected against
smallpox which had broken out nearby.
Speaker 1 (03:47):
And this thing happens to him where somebody, if I
understand right, cuts open his arm and puts dried out
pus from a smallpox patient into the cut on Jenner's arm.
What's going on there?
Speaker 2 (04:00):
This was what was called variolation. And variola is the
Latin word for speckled or spotted. It's the old name
for small pox, and it's the name of the virus
that causes small pox, of Variola virus. And in brief,
varilation was giving healthy people, usually children, the real thing
in the hope that the artificial infection wouldn't kill them
(04:23):
and that it would somehow leave them protected against future
attacks of naturally acquired small pox. It was about a
one in fifty mortality, so very very much lower. You
got a little bit of small pox pus from one
of those revolting blisters that covered people in the tens
and thousands, and you would scratch a little bit of
(04:44):
that revolting fluid into the skin on the arm of
a healthy child.
Speaker 1 (04:48):
Does it work?
Speaker 2 (04:49):
It's mad, bad, crazy, dangerous, sounds completely counterintuitive. The amazing
thing is it did work, very much so. And the
other thing is that if you were variolated, even if
you survived while you had your artificial dose of smallpox.
You have the real thing. So even though you might
get over it in two or three weeks, you could
(05:09):
spread it to other non immune people, you know, people
going back into the community, causing little mini outbreaks of
smallpox and killing lots of other people bi collateral damage.
Speaker 1 (05:21):
Wow. So okay, So this is the world. Jenner is
born into the world where you can either get smallpox
and a good chance of dying from it if you
get it, or if you're sort of lucky in a
weird way, you can get variolated and have a non
trivial chance of getting and dying of smallpox and maybe
(05:43):
spreading it to other people. That was it. Those were
the options.
Speaker 2 (05:45):
Absolutely.
Speaker 1 (05:46):
How does he go from being an eight year old
boy getting very related to inventing the first vaccine in
the world.
Speaker 2 (05:52):
Okay, if you want the conventional story, yeah.
Speaker 1 (05:56):
I feel like you're gonna give me two stories. One
is it Jenner classic, So give me Jenner clas.
Speaker 2 (06:00):
The Jena classic is he is a medical apprentice in
his early teens and he meets a milkmaid small pox
has reappeared nearby, and she allegedly says to him, look, Gov,
you don't need to worry about me having that, because
I've had cowpox and that means that I can never
ever catch smallpox. And this was complete news to January,
(06:22):
never come across it. But it was also complete news
to all his teachers. It simply wasn't part of conventional
medical knowledge. It was common knowledge in the farming community.
Speaker 1 (06:31):
It was folk knowledge that had not sort of crossed
over to kind of high brow medical knowledge.
Speaker 2 (06:37):
A lot of people didn't want to believe it because
it had come up from the peasantry.
Speaker 1 (06:41):
Interesting, so you're saying, that's kind of the classic tale.
Do you think it's true.
Speaker 2 (06:46):
I'd like to believe it's true. The alternative story is
that one of Jenna's medical colleagues in Thornbury was actually
a variolator, very successful one, and he noted, apparently independently,
that some people that he valulated the varulation didn't take.
In otherwords, there was no sign that they'd caught this
artificial dose of smallpox. And this man is called John Fuster.
(07:11):
And story B if you like, is that it was
actually Feusta who made the original observation. Jenna was a
close friend of his, and Jenna may have decided to
pick up on it. Feusa didn't want to pursue it
because he was making so much money as a valulator.
He didn't see the need for any particular improvement.
Speaker 1 (07:29):
Okay, so Jenner has this idea, whether it's from the
milkmaid or from his colleague, this idea that cow pox,
which we should say is not a deadly disease in humans, right,
can protect humans against a smallpox. What does he do
with this idea.
Speaker 2 (07:50):
Well, he doesn't do anything with it for over thirty years.
He goes off he finishes his medical studies in London.
In seventeen ninety six, he gets the idea of collecting
cases of people who've had cowpox and look to see
if they appeared to be protected against smallpox. And he
collects a number of cases and the story appears to
(08:11):
be true. And then he moves beyond that to actually
test the hypothesis that giving somebody an artificial dose of
cowpox will protect them against smallpox. The killer and his
first guinea pig is his gardener's son, James Phipps. And
the ethics might be regarded as a bit dodgy, because
(08:32):
back then, if you were the gardener's son, then you
were effectively the property of the Lord of the manor
III Jenna, and he introduced cowpox into the arm of
James Phipps, who was eight years old. And what Jenna
did was to find a case of cowpox with a
lovely juicy cowpox blister on the back of her hand.
(08:52):
He stuck a lancid in that collected the juice and
scratched the cowpox juice into the arm of James Phipps,
and that all went well. The lad got a bit
of a local reaction, he got a bit of a fever.
Two weeks later he was back to normal. So Jenna
now has to test his hypothesis to see if the
lad is protected against smallpox. The killer gave him a
(09:13):
small dose of smallpox and it didn't take So that,
if you like, was the Eureka moment.
Speaker 1 (09:19):
So he just invented the first vaccine in the history
of the world, a vaccine against maybe the most deadly
infectious disease. Truly one of the great discoveries in the
history of medicine and the history of public health. What's
the first thing he does to try and tell the world.
Speaker 2 (09:34):
Well, he writes it all up as a paper and
he sends it off to the Royal Society, and amazingly,
the Royal Society reject the paper.
Speaker 1 (09:45):
They reject his paper, They reject the guy just invented vaccines.
Speaker 2 (09:49):
Well, they probably wouldn't have appreciated the full significance. But
you're right. It is one of the great pinnacle publications
in the history of medicine and science.
Speaker 1 (09:57):
But he doesn't give up. What's he doing next?
Speaker 2 (10:00):
He writes it up as a pamphlet. It's always known
as The Inquiry, okay, and it was published by private
printer in Soho came out in September seventeen ninety eight.
Jenna did not attempt to hide or make secret his invention.
He wanted everybody to know. He wanted everybody to do
it because he wanted to conquer smallpox.
Speaker 1 (10:20):
But you're saying he could also have not published it
and just tried to sell vaccination himself and be the
sort of soul purveyor of it.
Speaker 2 (10:29):
That's exactly it. His aim was to spread the word
as widely and as quickly as possible. It really takes
off and people recognize the value of vaccination immediately, and
within a few months it's on the continent of Europe,
it's widespread across England. It's making its appearance in North America.
Speaker 1 (10:47):
You said within months, within months, months, within This is
an era when there's obviously no electronic communication. They're going
to have to put the inquiry on a ship and
sail it across the ocean. But you're saying it spreads
basically a media in.
Speaker 2 (11:00):
That absolute absolutely.
Speaker 1 (11:03):
What do we know about how many people are being vaccinated?
How widespread it is, Like, tell me more about that.
Speaker 2 (11:10):
Well, it's still the preserve of the rich and wealthy
who could afford to pay for medical services, so it's
not widespread and philanthropic, but in terms of geographical reach
it is very impressive. Reaches Switzerland very quickly. The inquiry
reaches the King of Spain and he arranges for the
(11:31):
divine gift of vaccination to be sent out to all
the Spanish colonies and the Caribbean, South America around the
back of the world.
Speaker 1 (11:39):
So this is all happening in his lifetime, right, He's
seeing this happen.
Speaker 2 (11:43):
Well, Jenna works very hard actually trying to spread the word.
He is always one of the great saints of medicine.
But he wasn't a perfect man. In any sense. And
one of the things that he got wrong quite early
was to be able to connon himself into thinking the
vaccination was absolutely per effect, whereas in fact it did
have side effects. For example, you could get a farmyard
(12:05):
infection from kyle pox having get scratched into your arm.
And the other thing was that it needed to be topped.
Speaker 1 (12:11):
Up, meaning like a booster, you needed what.
Speaker 2 (12:15):
Absolutely so other countries were giving boosters in the early
teenage years. And again if smallpox broke out again, say
in Germany, then people nearby would be revaccinated again. So
that was one of the things that he got tragically wrong.
Speaker 1 (12:30):
What's the end of his story.
Speaker 2 (12:32):
He gets gifts and accolades from all over the world.
He gets diamond ring from the Empress of Russia. He
spent his declining years, if you like, after his wife died,
being the vaccine clerk to the world. That's the way
he described himself. He was sitting in his office writing
letters back to all the fan mail that poured in
(12:53):
from across the world. He was able to look around
the world and see a world that was already changed.
Speaker 1 (13:01):
By the way, how does it come up with the
name vaccine?
Speaker 2 (13:04):
Well, the name was actually coined by somebody else. It's
from the Latin vaca, meaning cow, and Louis pasteur. When
he invented his rabies vaccine and various other vaccines, he
suggested that all such immanising or protective preparations should be
called vaccines in honor of Jenna. So that's why we
(13:25):
call them all vaccines today.
Speaker 1 (13:29):
Thank you for your time. Was a delight to talk
with you.
Speaker 2 (13:31):
Pleasure. Thank you for yours.
Speaker 1 (13:34):
Edward Jenner died in eighteen twenty three. In the twentieth century,
his vaccine would serve as the inspiration for one of
the most ambitious public health projects in the history of
the world, to wipe out every single case of smallpox forever.
We'll be right back. In the first half of the
(13:59):
twentieth century, Edward Jenner's vaccine continued to spread, but huge
swaths of the population remained unvaccinated, and hundreds of millions
of people continued to die of smallpox. The world had
become smaller and more connected. Air travel was taking off,
and smallpox was happy to hitch a ride. Even countries
that thought they'd eliminated smallpox found out that they could
(14:20):
only keep it at Bay for so long. A smallpox
scare grips Great Britain. In the wake of five deaths
attributed to the disease that was all but wiped out
in Western nations, tens of thousands throughout the nation line
up at health centers to be inoculated.
Speaker 2 (14:37):
The outbreak of a bad.
Speaker 3 (14:38):
Disease is checked by modern medical science.
Speaker 1 (14:45):
In the middle of the twentieth century, leaders around the
world cooked up an audacious plan to drive the smallpox
virus to extinction, to eradicate it from the face of
the earth. Donald Hopkins directed the smallpox eradication campaign in
Sierra Leone in the late nineteen sixties, just as the
global eradication project was getting started. When he arrived in
(15:06):
Sierra Leone, the West African nation had the highest smallpox
rate in the world. You get to this country, what
do you see on the ground?
Speaker 4 (15:16):
Well, I see, first of all a beautiful country, and
then I'm introduced to the health workers that I'm going
to be working with and find that they are very capable,
very enthusiastic. I'm young and very optimistic as well. Yes,
people were dying, but the upshot of that was that
(15:37):
people were eager. Most people were eager to get vaccinated,
and so we did not have a problem of trying
to persuade people to cooperate with the program, and that
made things a lot easier.
Speaker 1 (15:52):
Yeah, easier, but this is still a country where there
are a lot of places that are just hard to
get to, right. I mean, are there any particular instances
you remember that were that were especially challenging.
Speaker 4 (16:03):
So in the summer of nineteen sixty eight, it's the
rainy season in sily On, we get a message that
there's an outbreak in this area southeast of the capital
area called Moyamba. So I went there with a driver
and a couple of the Sierra Leone and public health workers.
(16:24):
And the village where that we were summoned to visit,
in fact, was about a forty five minute trek from
the nearest road. I'm afraid of snakes, and this was
a This was a trek through the forest.
Speaker 1 (16:42):
You're like Indiana Jones, You're wearing a hot.
Speaker 4 (16:48):
No hat I had. I had a full head of
hair then, so I didn't I didn't have to wear
a hat. But to we get into this get into
this village, and there are lots of people with smallpox,
including most notably a newborn infant only a few days old,
that was lying on a mat between its mother and
(17:10):
the mother's co wife.
Speaker 1 (17:12):
When you say co wife, what does that mean?
Speaker 4 (17:15):
That means that they were both married to the same man. Okay,
and the child had not been vaccinated. But both of
these two women were in the full throes of smallpox infections,
and so that infant had been exposed. Fortunately, I had
vaccine with me. I was able to vaccinate the infant,
(17:36):
and later about ten days later, when I came back,
I saw that the vaccination was taken and that baby
was saved.
Speaker 1 (17:44):
And just to just because you know, I've never seen smallpox, thankfully.
When you say that two women were in the throes
of infection, what did they look like?
Speaker 4 (17:55):
Well, it's hard to see people suffering so much, because
it's not only that people their bodies are swollen. They're
covered in all of these pustules. But it's very painful.
People describe it as feeling as if your skin was
on fire. Smallpox caused a generalized rash over most of
the body. It was most intense over the face, the hands,
(18:20):
and the feet. But in this instance you could see
these raised pimples first you get little bumps that turn
into blisters that then fill with puffs, which then these
blisters break, and if you're lucky and survive the broken
(18:44):
blisters and puffs, that all dries up, and gradually, over
the course of two three weeks the scabs drop off.
But all of that is infectious, and people when they're
just even before the rash starts, when they start feeling
headache fever, they're already breathing out smallpox virus onto other people.
(19:05):
And so the challenge is the situation like that, to
vaccinate as many people who do not yet have smallpox
as quickly as you can.
Speaker 1 (19:15):
So, okay, So you get to this village. You see
these two women and the baby. The women are clearly sick.
You vaccinate the baby because the smallpox vaccine can actually
help people who are in the early stages of an infection.
What do you do next? What else is happening in
this village?
Speaker 4 (19:32):
In this sensance, we learned very quickly that two weeks before,
a very prominent man in that village who was head
of a secret society, had gotten smallpox and had died.
Because he was so prominent, people came from other villages
to visit him when he was ill, and people came
(19:55):
for his funeral.
Speaker 1 (19:57):
This is a giant alarm bell. It's very bad news
for you. In nineteen sixty.
Speaker 4 (20:02):
Eight, very very bad news, because we also began learning
when I was there. What we were seeing was that
many people had come from other villages as well surrounding
this village, and so this was a much bigger outbreak
than what we were expecting.
Speaker 1 (20:20):
So tell me about what containment meant at this time
in this context.
Speaker 4 (20:24):
Yes, when we first began working in the smallpox program,
the strategy was to mass vaccinate eighty percent or more
of the population. The containment surveillance strategy was developed where
the strategy became find out where the current cases of
smallpox are go there, give priority to vaccinating people in
(20:50):
those households and that village and nearby villages, so called
ring vaccination, because if you could do that, you could
stop the virus from spreading to other people. That was
a much more efficient way of getting after the virus
to stop transmission. Because now you're looking to vaccinate three
(21:13):
four five percent of the population rather than eighty percent
of the population.
Speaker 1 (21:17):
It's like you draw a circle, a big circle around
the village where the infection is and you vaccinate everybody
inside that circle. So it's like you're surrounding the virus
with immune people.
Speaker 4 (21:29):
That's exactly what you're doing. And the radius of that
circle was at least five miles.
Speaker 1 (21:35):
Okay, so you have your information right, you have your
epidemiological surveillance, you have your your ring on a map.
What do you do?
Speaker 4 (21:44):
We then come back with several other vaccinators and have
a plan to assign different groups to go to each
of these villages and make sure that everyone there is vaccinated.
Speaker 1 (21:58):
And you just show up in a village where if
your briefcase full of a vaccine and say here we are,
come line up.
Speaker 4 (22:06):
The villagers had had warning, and in fact, we discussed
with the village chief and the senior people in the
village to agree on a mutual time when was most
convenient for them for us to come back and make
sure everybody was vaccinated. It had to give them notice
in advance, because otherwise, if you just show up, people
(22:27):
are out on their farms, which could be two or
three miles away in many different directions, et cetera.
Speaker 1 (22:33):
So how long does it take you to with your
team go to all of the villages inside this ring
and vaccinate everybody.
Speaker 4 (22:41):
That took a matter of a few days fast, so
each team only had to go to one or two villages,
and so we were able to get there in a
few days and get them vaccinated, and we were able
to stop that particular outbreak in only three or four
weeks max. Wow.
Speaker 1 (22:58):
So it worked.
Speaker 4 (22:59):
It worked. Not only worked in Sierra Leone, but when
we sent a telegram back to CDC headquarters to let
them know what had happened, they were ecstatic. And of
course this was one of the first big demonstrations of
the power of this new ring vaccination strategy, and so
(23:20):
it electrified the entire global smallpox eradication program to see
that this worked so well in Sierra Leone, which had
so much smallpox.
Speaker 1 (23:34):
So we have the good news. What did you do next?
How long were you in Siri Leone? What happened next?
Speaker 4 (23:39):
Ord? I was in Siri Leone for a total of
two years.
Speaker 2 (23:41):
That was.
Speaker 4 (23:42):
I left sierri Leone in August of nineteen sixty nine.
Smallpox was gone from Sierra Leone by April May of
nineteen sixty nine.
Speaker 1 (23:52):
So by the time you left, you and your team
had eradicated smallpox from one of the worst affected countries
in the world.
Speaker 4 (24:00):
And that was a big exclamation point. I was then
forever optimistic that smallpox was gonna go. It was then
to me just a matter of time.
Speaker 1 (24:14):
It's really striking to me that we or you, you
and your colleagues eradicated smallpox more than forty years ago now,
and we humanity haven't succeeded in eradicating anything else yet.
I know we're getting close on polio, but we've been
close on polio for a while, and yes, it's not
(24:36):
gone yet. Was smallpox unanomaly?
Speaker 4 (24:41):
Yes, smallpox is anominally Unfortunately, nothing else is like smallpox.
Eradication means you have to get to whatever disease you're
targeting everywhere wherever it exists. And it's going to exist
in some places where it's a big problem, people care
(25:01):
about it, they are motivated to work against it. But
it's also going to exist in some areas where it's
a trivial problem, where people have much bigger things to
worry about than that targeted disease. But you're going to
have to get them on board as well, because as
long as it exists, anywhere. It's unsafe for people everywhere.
Speaker 1 (25:23):
Doctor, it was a real delight to talk to you.
Let me say thank you for your work. I'm very
grateful to live in a world with no smallpox.
Speaker 4 (25:32):
Well, thank you, I am too.
Speaker 1 (25:35):
Donald Hopkins is currently the Special Advisor for guinea worm
Eradication at the Carter Center. Thanks to my guest today
Gareth Williams and Donald Hopkins. Next week we'll tell the
story of the race for the polio vaccine, and we'll
try to figure out why polio and other viruses have
turned out to be so much harder to eradicate than smallpox.
Speaker 3 (25:56):
We need to ensure that we have we have a
full momentum for this last push, the final push to
reach that last child in that last village of these areas.
Speaker 1 (26:11):
Incubation is a co production of Pushkin Industries and Ruby
Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz,
and Amy Gaines McQuaid. Our editors are Julia Barton and
Karen Schakerjie Mastering by Anne Pope, fact checking by Joseph Fridman.
Our executive producers are Katherine Gerardeau and Matt Romano. I'm
Jacob Goldstein. Thanks for listening.
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