New Worlds: Vaccination

(This post is part of my Patreon-supported New Worlds series.)

During the periodic waves of plague that struck London in the early modern period, people noted that the best nurses for the afflicted were those who had survived the plague already, as they wouldn’t be susceptible a second time.

We’ve known for a long time that some diseases confer immunity on survivors. In fact, much of the category of “childhood diseases” is constructed around the assumption that once you’ve gone through that particular gauntlet, you won’t have to worry about it again — and in many cases you’ll have a milder case of the disease if you catch it early, which is what led to parents sending their kids to hang out with whoever in a particular cohort caught the chicken pox first.

Figuring out what exactly granted lifelong immunity had to wait on modern science and the discovery of antibodies. But you may be surprised to know that the concept of vaccination predates that understanding by a long time.

The most widely-known version of the history involves a man named Edward Jenner in late eighteenth-century England, who decided to experiment with the general adage that dairymaids never got smallpox — because their work infected them instead with cowpox, which is much milder in humans. I have no idea how he acquired his volunteer, but he experimentally infected an eight-year-old boy with cowpox, and then afterward exposed him repeatedly to smallpox, which had absolutely no affect on him.

This is technically not vaccination, which involves exposing someone to a weakened or dead version of a micro-organism, but rather inoculation with a live virus. When applied specifically to the prevention of smallpox, it also got called variolation (after Variola, the genus name for many poxes). It’s more dangerous than vaccination, which is why we don’t do it much these days.

But Jenner’s work was far from the earliest effort at conferring immunization on people. And if you think scratching a boy’s arm with pus from an infected dairymaid’s hand is gross, you might not want to read the next paragraph.

Accounts of Chinese immunization vary widely as to when it began, with hints of the practice going back as far as the tenth century. Certainly by the fifteenth century they were using a method known as nasal insufflation: they took smallpox scabs, dried them out, ground them to a powder, and then blew the powder up a patient’s nose. European scholars commented on this about sixty years before Jenner’s experiment, but seem to have assumed the whole thing was a superstition, no more meaningful than the countless folk medicine treatments practiced around the world.

China wasn’t the only region to experiment with immunization, either. It’s difficult to trace how exactly the idea spread, or whether it was independently invented in different places, but there are reports of it from West Africa, Ethiopia and the Sudan, the Middle East, and the Circassian region. In many cases the procedure was like the one Jenner used, transferring pus via a scratch or cut on the person to be inoculated. Lady Mary Wortley Montagu encountered the practice in Constantinople, and later had her children variolated, even convincing the Princess of Wales to do the same. But using the smallpox virus directly was more dangerous than Jenner’s cowpox approach, and variolation killed one of the sons of King George III.

The real boom in immunization came in the late nineteenth and early twentieth century, when the concerted efforts of scientists led to the development of vaccines for a host of diseases. It’s hard to even fathom how revolutionary this was: the standard assumption that children would spend extended periods of time too sick to attend school and might carry the consequences of their illness for life just . . . went away. Epidemics of cholera, typhoid, and the plague itself ceased to be a thing in developed nations; they’re not gone entirely, but we can list the places where outbreaks are common, rather than just waving a hand at the map and saying “everywhere.”

In a very few cases, we’ve been able to eradicate them entirely. Smallpox still exists in a few labs in the U.S. and Russia, but nowhere in nature. And as of 2010, rinderpest is also gone: a virus related to measles that used to devastate livestock. We’ve gotten rid of two of the three strains of polio, quite a bit of dracunculiasis and yaws, and there’s a serious effort underway to eliminate malaria. Regionally, we’re working on wiping out hookworm, measles, rubella, syphilis, rabies, and more.

But these achievements aren’t done movie-style, with a lone scientist cooking up some kind of counter-pathogen that spreads throughout the world and solves the problem in one fell swoop. Eradication requires widespread and consistent labor by thousands of people, making the usual hosts of these micro-organisms so inhospitable for the germs that they have nowhere to live. That means vaccinating millions or even billions of people, and keeping up the effort until enough time has passed without reported cases that we can relax our guard.

As many of us know all too well, this isn’t easy to achieve. Here in the United States, a study used falsified data to link vaccines to autism, and despite debunking, a subset of parents have decided that is an unacceptable risk. After all, they reason, kids used to get childhood diseases all the time, and they were fine, right? They’ve forgotten how many kids weren’t fine — who died or had lifelong scarring and disabilities as a result. And movies encourage us to believe that if an outbreak of something really scary happens, labs will leap into action and produce vaccines overnight to save us.

It doesn’t work that way. And just as we have a spate of near-future science fictional novels about the devastation of climate change, epidemic thrillers are a subgenre of their own — sometimes masked as zombie narratives, but sometimes literally about ordinary disease. Orson Scott Card’s Speaker for the Dead and Xenocide pay a remarkable degree of attention to the difficulty of immunizing against an alien disease that constantly adapts to its treatments. You almost never see immunization in fantasy, though . . . even though snorting scabs or doing pus transfers is entirely within the reach of pre-modern technology. It may be dangerous — but smallpox itself is vastly more so.

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About Marie Brennan

Marie Brennan is a former anthropologist and folklorist who shamelessly pillages her academic fields for inspiration. She recently misapplied her professors' hard work to the short novel Driftwood and Turning Darkness Into Light, a sequel to the Hugo Award-nominated Victorian adventure series The Memoirs of Lady Trent. She is the author of several other series, over sixty short stories, and the New Worlds series of worldbuilding guides; as half of M.A. Carrick, she has written The Mask of Mirrors, first in the Rook and Rose trilogy. For more information, visit, Twitter @swan_tower, or her Patreon.


New Worlds: Vaccination — 14 Comments

  1. Pingback: New Worlds: Vaccination - Swan Tower

  2. One of these things is not like the others: “Regionally, we’re working on wiping out hookworm, measles, rubella, syphilis, rabies, and more.” Hookworm is a parasitic infection by multicellular organisms, and prevention involves changing lifestyles and exposure — there’s no possible vaccination or immunization. (Remember the old imprecation to wear shoes while playing outside? Hookworm is one of the reasons!)

    • Fair! I’ll remove that from the book version — that was me looking at a list of what diseases we’re eliminating, without digging into specifics.

  3. Not fantasy exactly depending on how you classify Dragonriders of Pern, but I could have sworn that Anne McCaffrey’s Moreta had a major plot strand dedicated both to a plague and to developing vaccines against it.

      • I can’t remember for sure either. I do remember that they used a centrifuge setup of some kind to separate blood plasma something something serum something?! But I am so bad at medicine and it’s been so long since I’ve read the book that I don’t recall specifics.

          • Out of curiosity how my childhood favorites stood the test of time, I reread Moreta’s Ride last year. The deadly disease they’re fighting is influenza, and they’re using some sort of vaccination derived from people who have survived the disease. Part the urgency is trying to wipe it out before it mutates and the vaccination is no longer effective. One interesting artifact of history is that the characters keep referring to vaccinations as homeopathic medicine. Which if you define homeopathic medicine as taking a small dose to protect you from substance, it sort of is?

  4. “You almost never see immunization in fantasy, though . . . even though snorting scabs or doing pus transfers is entirely within the reach of pre-modern technology. It may be dangerous”

    I don’t think you see diseases that need immunization often in fantasy, either. 🙂

  5. Rabies is a bit misleading, too, because it is zoonotic in many parts of the world (especially from bats and carnivores). It can be eradicated only in locations where there are too few suitable wild hosts to be a source. Don’t hold your breath in North America for that! It was done in the UK because of our very low number of wild animals, especially carnivores.

  6. It wasn’t a major plot point, but vaccination against smallpox using Jenner’s method came into my fantasy novel SPIRAL PATH. A character was accidentally dumped by a portal into a city, and had to be isolated and either vaccinated, or remain for a period of time before she would be sent home. She could not stay at the magical school without vaccination.