Milkmaids, George Washington and the End of the Pandemic

Two remarkable events in the 18th century that were a consequence of the viral disease smallpox have lessons for us today: How a simple method for vaccination was reduced to practice and presented to the medical community and how a mandate to vaccinate the Continental Army was key to winning the Revolutionary War.

But we are still enduring the COVID-19 pandemic. Some observers are now suggesting that the pandemic may decline substantially by the end of next year, 2022. How can this be?

Smallpox outbreaks were once a dreadful fact of life in Europe. Back then, in a rural area hit hard by the virus, 10% of the population would die and the death toll might be as high as 20% in towns or cities where the virus could spread more easily.

Edward Jenner (1749-1823), who trained as a physician in rural England, noticed that milkmaids never seemed to get smallpox although the cows they worked with had a similar disease: cowpox. He wondered if this resistance to smallpox might be transferable and tested the idea by inserting or rubbing powdered cowpox (and eventually smallpox) scabs or fluid from pustules into superficial scratches on the skin of a susceptible person. Most of the time this led to a mild infection in the recipient, but it also induced immunity to the smallpox virus. He described his work publicly; others readily repeated his general vaccination method; his fame and his method spread widely in the late 18th and early 19th centuries.

Jenner may have been aware of reports that similar methods had been practiced in China, India, the Middle East and Africa long before the 1700s. People have been successfully preventing some infectious diseases for hundreds of years with these general methods. Word also spread to England’s colonies in North America, and then Lt. Gen. George Washington was paying attention.

Early during the Revolutionary War, American forces were sent north to drive the British Army out of the area around Quebec. Despite some early successes in this campaign, the Continental Army was defeated by winter weather, lack of supplies, and casualties, many of which were due to smallpox. Some historians have speculated that when the Continental Army was pinned down, laying siege to Quebec City, Gov. Carleton sent prostitutes from the city infected with the virus to visit the American troops. If true, this could be an early example of biological warfare.

The Continental Army was defeated there and its remnants retreated south early in 1776. Washington was keenly aware of how smallpox was devastating the Army, prompting him to quietly order (so the British would not learn how sick his troops were) that all American troops be vaccinated. The program was successful, infection rates plummeted, and vaccinated troops fought at the Battles of Saratoga and Trenton, early victories for America.

In Washington’s view the scourge of smallpox was worse than the British enemy and this mandate has been described “as important as any military measure Washington adopted during the war…”

Then, as now, a minority of Americans resisted vaccinations, and this is not a surprise since we prize individual freedoms so highly. But our courts have made it clear that citizens do not have a constitutionally protected right to harm their colleagues, their friends and people in their communities: One individual’s right to a healthy life is greater than another individual’s right to decline a vaccination.

The Supreme Court held in the landmark 1905 case Jacobson v. Massachusetts that states have the authority to order compulsory vaccination when there is a threat of epidemic. Justice John Harlan declared that nothing in the Constitution permits people to behave however they choose and “… real liberty for all could not exist …” if people could act “… regardless of the injury that may be done to others.”

So, where does that leave us regarding the current pandemic if some people will never be vaccinated? Over 700,000 Americans have died due to COVID-19 as of this writing, and many people who were hospitalized because of the virus have lingering health problems. When will this end?

The CEO of Moderna, Stephane Bancel, recently said the pandemic will end “as of today, I assume in one year” in a recent interview. He pointed out that since the durability of COVID-19 vaccines depends on the age of the recipient, seniors will need annual boosters, while everyone else will benefit from boosters every three years. He referred to the activity of OC43, a less dangerous cousin of SARS-CoV-2, as an example.

OC43 tends to infect older people each year while younger people are infected once every three years. Bancel believes COVID-19 will follow the same path. He said that Moderna is testing a combination vaccine for the flu and COVID-19 as well as a flu vaccine that has activity against four flu variants (rather than a single variant).

Happily, right now cases of COVID-19, hospitalizations and deaths are all starting to decline, and this may be due to increased vaccination and mask mandates. A former head of the Food and Drug Administration, Scott Gottlieb, believes that “this is the last major wave of infection.”

Let us hope they are both correct.

Richard Gelinas, Ph.D., whose early work earned a Nobel prize, is a senior research scientist at the Institute for Systems Biology. He lives in Lakebay. Suggestions for further reading are at keypennews.org.