Daniel Johnson’s reflections on the continuing importance of vaccination against Covid-19, and the problem of the “militant or indifferent” anti-vaxxers (TheArticle 26 July here), were timely in more ways than one. In his recent book, How To Make a Vaccine: An essential guide for COVID-19 & Beyond, Dr John Rhodes celebrates the 300th anniversary of the first well-recorded inoculation against smallpox in Britain in August 1721. At the time smallpox was killing up to 400,000 people in Europe every year, including a grandchild of King George I.
The story begins in Constantinople with the wife of the British Ambassador to the court of the Ottoman Sultan. Once a beauty, Lady Mary Wortley Montagu was disfigured by smallpox. She survived to become an advocate of inoculation, or as she called it “ingrafting”, a practice performed on the Sultan’s wives. Lady Mary’s son was successfully inoculated against smallpox in 1718. On her return to London, a grand promotional event for the inoculation of her daughter was organised, with royal court physicians and the King’s physician, Sir Hans Sloane, in attendance.
The then Princess of Wales, Caroline of Ansbach (later Queen Caroline as wife of George II) was well read in the science of the day. She instigated an experiment with the aim of protecting her own children. Six prisoners due to be hanged in Newgate were offered their lives and freedom if they volunteered as guinea-pigs to test the safety and effectiveness of inoculation, or as it was also known, variolation. With celebrity endorsement from London’s good and great, this became a high profile event which Fellows of the Royal Society and some 25 members of the College of Physicians came to observe. In charge was the Scottish physician Charles Maitland, a former embassy physician in Constantinople, where he had learned the technique.
What followed was not for the faint-hearted.
Maitland made an incision into in an arm and a leg of each convict and then inserted material from the pustules of an infected person. He had to repeat the procedure as not enough local reaction could be detected. One of the condemned received the material up the nose. A 19-year old girl who had been inoculated was later exposed to a child smallpox victim and proved to be immune. All six were given a royal pardon and walked free a month later.
Public opinion about inoculation was divided and, as it is today, politicised: the Whigs at court justified the experiment on utilitarian grounds, while the Tories opposed it with the argument that physicians should not play God. The anti-vaxx movement in Britain had begun.
Doctors in Asia had been playing God and evoking opposition for many years. Rhodes quotes the Chinese emperor, K’ang-hsi in the late 1600s: “The method of inoculation having been brought to light during my reign, I had it used upon you, my sons and daughters,” he wrote. “In the beginning when I had it tested on one or two people, some older person taxed me with extravagance, and spoke very strongly against inoculation. The courage which I summoned up to insist on its practice has saved the lives and health of millions of men”.
The next big step, from inoculation to vaccination, came courtesy of a Gloucestershire milkmaid, Sarah Nelmes, who caught cowpox from a cow called Blossom. It’s the better known story of two rural physicians, Edward Jenner and John Fewster, proving that pathogens administered in a weakened form could protect against a more virulent variant. Result: many millions of lives saved. Blossom’s hide hangs on the library wall of St. George’s Medical School a bovine equivalent of Jeremy Bentham’s stuffed hide displayed in University College London.
But there is a lot more to Rhodes’s informative book than some captivating medical history. He is at his most instructive when teasing out the complexities of the human immune system, a little army of interactive defenders against foreign intrusion, each with its own task: surveillance cells patrolling, helper T-cells, killer T-cells, B-cells which have daughter cells that produce the antibodies we’ve all heard about, regulatory T-cells that shut down the immune response once the pathogen is defeated, memory B-cells that, I imagine, must trigger the amplified response from a booster dose of vaccine, and memory T-cells. I wish the word awesome hadn’t been voided of all meaning. The immune system is simply awesome. Though it can and does make mistakes.
How To Make a Vaccine is an important contribution to the genre of science popularisation. It is clearly written, but asks a lot of a reader without any biological or scientific background. This is not because it is aimed primarily at a scientific audience, but because it is narrating and explaining the intricate complexity of the immune system. There were well over two hundred different Covid vaccines at different stages of development as Rhodes was writing. They fall into eight distinctive categories, depending on what part of the virus biochemistry is targeted and how: inactivated or attenuated forms of the virus, its DNA or messenger RNA or its protein configuration, for example. This is good news, as variant mutations are unlikely to counter the effectiveness of all available vaccine categories, and currently deployed vaccines are still achieving much higher levels of immunity than flu vaccines, which vary between 40-60 per cent effectiveness.
Opposition to protective measures against viruses and bacteria has a long history. It has varied from Voltaire’s jibe — that the British were “fools and madmen”, not because they went out in the midday sun, but because they promoted inoculation — to Andrew Wakefield’s spurious claim in 1998 that the MMR jab, the combined vaccination against measles, mumps and rubella, was linked to autism.
A minority of the public with enough scientific knowledge to worry them, but not enough to reassure them, will always be prone to making bad health decisions. And this will inevitably have a knock-on effect, creating major public problems.
The scientific progress presented in this book is, in many ways, comforting. It puts flesh on the bones of “following the science”. Anti-vaxxers, especially those addicted to conspiracy theories, should read this book and ask themselves how the medical profession, with their Hippocratic Oath, has sustained a cunning conspiracy for the last three hundred years — and yet managed to save so many lives.
They won’t even open it, of course. The persistence of opposition to vaccination is sad, difficult, obstinate and dangerous.
Ian Linden is a visiting Professor at St Marys University, London. A past director of the Catholic Institute for International Relations, he was awarded a CMG for his work for human rights in 2000. He has also been an adviser on Europe and Justice and Peace issues to the Department of International Affairs of the Catholic Bishops Conference of England and Wales. His latest book was Global Catholicism published by Hurst in 2009.
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