Introduction

The Smallpox Myth is the foundational legend of vaccinology. As goes the story, Edward Jenner realised that cowpox, a disease of the cow’s teat, provided protection against smallpox infection. It came into mass use across the nineteenth century and was mandated in a large number of countries. However there are a number of questions that can be asked regarding this foundational myth, and evidence against the hypothesis that smallpox was eliminated by vaccination.

How Deadly Was Smallpox?

One of the fundamental claims of vaccinology is that smallpox was an extremely dangerous disease that ravaged the world before vaccination. In reality, while smallpox did kill a lot of people, there is more nuance to this discussion. There are two points to consider: was smallpox any more dangerous than any other kinds of zymotic disease (a term historically used to mean eruptive fevers, infectious diseases as a class) and to what degree, and did smallpox cause excess death in epidemic years?

Taking the first question, pro-vaccinationists take the death rate of smallpox to be very high. Jurin, a figure who could be considered an early statistician of sorts in the 18th century and pro-inoculator, argued that around 1 in 6 smallpox infections resulted in death. The accepted figure by the end of the 19th century became around 18%. This is a very high rate. Of course this assumes a smallpox infection occurs, when there were many people who died without ever being infected with smallpox – which means we need more evidence than case fatality rate.

Bills of mortality recorded in London offer some evidence on this score. They show varying death rates from smallpox, depending upon whether it was an epidemic year for smallpox.

However, London data is not extrapolatable to the rest of the country. This is because London was much less sanitary than rural areas and had much higher population density, both of which facilitated the spread of smallpox and a high death rate. This is one of the main problems with the pro-vaccinationist argument – they ignore the conditions in which smallpox existed. Death rates in areas where statistical recording was less fastidious are unknown.

Death Rates from Diseases: Did Smallpox cause Excess Death?

Zymotic diseases were a rampant cause of death in the 17th and 18th centuries in cities due to the terrible sanitation and poor quality diet present in those environments. Was smallpox any worse than any of these other eruptive fevers spreading in unsanitary filth? The key question here is whether smallpox epidemics caused excess deaths, that is deaths above and beyond the average, or whether these deaths were largely interchangeable between different diseases. In order to examine this, we can look at smallpox epidemic years and see whether the overall deaths were any worse than non smallpox epidemic years.

Charles Pearce, in his book Vaccination Its Tested Effects, produced tables to show that vaccination did not lower overall death rates and that other epidemics killed as many or more due to common factors such as poor sanitation and overcrowding. William White argues that Dr. Robert Watt had demonstrated that there was in interchangeable nature to diseases as early as 1813 in Glasgow. This is important since even if vaccination was highly effective if those living in poor conditions would simply die of another disease, vaccination cannot be said to have saved lives.

The Nature of ‘Vaccine Lymph’

One of the main theoretical problems in asserting that vaccination abolished smallpox is the nature of vaccine lymph. Although the simple version of history (and the name itself) tells us that vaccine is cowpox lymph, in reality this is oversimplified.

Many different substances were used as vaccine lymph. One of the most common was to use horsepox instead of cowpox, and this lymph was used by high profile vaccinators and was in wide circulation. Another type of vaccine lymph was smallpox passed through the cow, because they believed that cowpox was smallpox somehow modified via passage through the cow. Other sources were sampled, such as sheep pox and goat pox. So long as the vaccine source raised a correct ‘Jennerian vesicle’ it was considered protective.

The use of various sources for vaccine lymph creates difficulties in believing in its effectiveness as it is difficult to argue that all the extracted sources are equivalent and thus equally protect against smallpox.

Extensive post on vaccine lymph can be found here.

Sanitation Acknowledged – But Ignored in the case of Smallpox

There was some decline in deaths from all forms of eruptive fevers throughout the nineteenth century. This was generally due to sanitary reform that ameliorated the terrible conditions created by city living and the Industrial Revolution. Most people would acknowledge that sanitation was the cause of this decline, but dissent when it comes to smallpox. This is inconsistent logic.

Did Smallpox Decline at the Beginning of the 19th Century Due to Vaccination?

Vaccinationists point to a decline at the beginning of the 19th century as a reason to believe that smallpox declined due to vaccination. However this is flawed logic for a few reasons.

Firstly, it is possible that smallpox declined indirectly due to vaccination. Previous to vaccination, inoculation had been used (that is, deliberately infecting people with smallpox). This practise caused the spread of smallpox in some cases and introduced it to areas where it was not present. The use of cowpox, horsepox, and whatever other substances used for vaccination, regardless of their problems, were not capable of spreading smallpox. This meant that replacing inoculation with vaccination reduced the spread of smallpox but this had nothing to do with the effectiveness of the practise.

The second issue with this logic is that vaccinationists generally argue that most of the population has to be vaccinated for it to work, they call this herd immunity. Yet, whether the majority of the population was vaccinated at that time is a highly dubious proposition. Vaccination spread quite rapidly among the elite in Britain, but the working classes were a different matter. While there were some attempts by Jenner’s followers to offer free vaccination to the poor, it is doubtful this reached the 90-95% of the population required by vaccinationist claims of herd immunity. White shows evidence that under the first few years under the National Vaccine Establishment, which provided vaccination free of charge to the poor, that births far outstripped children vaccinated. This shows many working class people were not even bothering with free vaccination.

The 1871 Smallpox Outbreak

There was a very large smallpox outbreak across Europe in 1870-71. Focusing in on the United Kingdom, mandatory vaccination had been in force since 1853, nearly 20 years. Due to this policy the majority of children were vaccinated, although there were some conscientious objectors. Working class families could generally not afford the fines associated with vaccination refusal, particularly after the mandate was made more stringent in 1867.

Vaccination did not prevent this outbreak. Pro-vaccinationists tend to argue that this outbreak started with the unvaccinated, but this is not relevant. If vaccination was protective, it would not matter if the outbreak started with the unvaccinated, as the vaccinated should be protected regardless if it was effective.

The Case of Leicester

Leicester – a city in the United Kingdom – turned against vaccination after the 1871 smallpox outbreak. Most children in the city were no longer vaccinated, and in 1885, there was a huge protest against the mandatory vaccination law introduced in 1885. Instead Leicester practised quarantine to reduce smallpox infections.

Vaccinationists would predict that Leicester would have severe smallpox outbreaks and a high number of deaths. However, this was not the case. J. T. Biggs, in his book Leicester: Sanitation versus Vaccination, explained how the statistical evidence showed Leicester outperforming other more vaccinated areas in death rates.

Vaccination Declines – So Does Smallpox

After the vaccination mandates were loosened in the early 20th century, vaccinationism would predict a resurgence in smallpox. However, this did not occur. In fact, smallpox continued to decline.

Conclusion

The case for vaccination eliminating smallpox – one of the central myths of vaccinationism – is much weaker than vaccinationists would like to suggest.