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 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, 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 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 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.
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.
I read that he built a hydrogen balloon that flew twelve miles, That he played the violin, that he wrote poetry.
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.
Of course, give it to me, okay.
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
that tremblingly crawl. No more be afraid You're quite safe in our gun, for Dr Waite has finished making his gingerbread nuts.
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.
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.
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?
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 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 that revolting fluid into the skin on the arm of a healthy child.
Does it work?
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 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.
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 spreading it to other people. That was it. Those were the options.
Absolutely.
How does he go from being an eight year old boy getting very related to inventing the first vaccine in the world.
Okay, if you want the conventional story, yeah.
I feel like you're gonna give me two stories. One is it Jenner classic, So give me Jenner clas.
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, 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.
It was folk knowledge that had not sort of crossed over to kind of high brow medical knowledge.
A lot of people didn't want to believe it because it had come up from the peasantry.
Interesting, so you're saying, that's kind of the classic tale. Do you think it's true.
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. 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.
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.
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 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 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.
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 small dose of smallpox and it didn't take So that, if you like, was the Eureka moment.
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.
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.
They reject his paper, They reject the guy just invented vaccines.
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.
But he doesn't give up. What's he doing next?
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.
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.
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.
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.
That absolute absolutely.
What do we know about how many people are being vaccinated? How widespread it is, Like, tell me more about that.
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 divine gift of vaccination to be sent out to all the Spanish colonies and the Caribbean, South America around the back of the world.
So this is all happening in his lifetime, right, He's seeing this happen.
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 infection from kyle pox having get scratched into your arm. And the other thing was that it needed to be topped.
Up, meaning like a booster, you needed what.
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.
What's the end of his story.
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 from across the world. He was able to look around the world and see a world that was already changed.
By the way, how does it come up with the name vaccine?
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 call them all vaccines today.
Thank you for your time. Was a delight to talk with you.
Pleasure. Thank you for yours.
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 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 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.
The outbreak of a bad.
Disease is checked by modern medical science.
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 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?
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 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.
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.
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. 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.
You're like Indiana Jones, You're wearing a hot.
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 the mother's co wife.
When you say co wife, what does that mean?
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, and later about ten days later, when I came back, I saw that the vaccination was taken and that baby was saved.
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?
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,
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 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. 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.
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?
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 for his funeral.
This is a giant alarm bell. It's very bad news for you. In nineteen sixty.
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.
So tell me about what containment meant at this time in this context.
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 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 four five percent of the population rather than eighty percent of the population.
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.
That's exactly what you're doing. And the radius of that circle was at least five miles.
Okay, so you have your information right, you have your epidemiological surveillance, you have your your ring on a map. What do you do?
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.
And you just show up in a village where if your briefcase full of a vaccine and say here we are, come line up.
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 are out on their farms, which could be two or three miles away in many different directions, et cetera.
So how long does it take you to with your team go to all of the villages inside this ring and vaccinate everybody.
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.
So it worked.
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 it electrified the entire global smallpox eradication program to see that this worked so well in Sierra Leone, which had so much smallpox.
So we have the good news. What did you do next? How long were you in Siri Leone? What happened next?
Ord? I was in Siri Leone for a total of two years.
That was.
I left sierri Leone in August of nineteen sixty nine. Smallpox was gone from Sierra Leone by April May of nineteen sixty nine.
So by the time you left, you and your team had eradicated smallpox from one of the worst affected countries in the world.
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.
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 gone yet. Was smallpox unanomaly?
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 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.
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.
Well, thank you, I am too.
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.
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.
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.