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Lessons of Edward Jenner, father of vaccination

Jenner saved the lives of more people than any other figure in history.

As the US Covid-19 vaccination pro gramme reaches full stride, approximating three million shots per day, the time is ripe to recall the contributions of the physician-scientist who first put vaccines on the map, Edward Jenner. Some claim that Jenner saved the lives of more people than any other figure in history, yet his approach is often poorly understood.

1. He built on the work of others Born in England in 1749, Jenner was inoculated as a child against smallpox, a dreaded disease that appears to have scarred 3,000-yearold Egyptian mummies. Caused by the Variola virus, the disease manifested as fever and the development of a blistering skin rash referred to as pox. It is thought that about 30 per cent of infected people died of the disease, especially infants and young children.

At the time of Jenner’s birth, inoculation meant variolation. The skin was scratched and the smallpox scabs or fluid from an infected person were rubbed into it. When successful, it would cause the variolated individual to develop a mild case of smallpox which usually lasted several weeks, after which the patient would be immune. But small numbers developed full-blown disease and died.

2.Jenner took bold risks Jenner was not the first to suspect that prior infection with cowpox provided immunity against smallpox. At least five physicians had tested cowpox, and a farmer named Benjamin Jesty had used cowpox to vaccinate his wife and children during a smallpox epidemic. Jenner, however, was the first to study vaccination in a scientifically rigorous way.

Knowing that milkmaids were generally immune to smallpox, Jenner hypothesised that the pustules on the hands of milkmaids could be used to confer immunity. In 1796, he test-

ed the idea by inoculating James Phipps, the eight-year-old son of his gardener. He scraped material from the hands of Sarah Nelmes, a milkmaid with smallpox, and inoculated Phipps in both arms.

3. Not deterred by uncertainty Today we talk easily of viruses, but in Jenner’s day they were completely unknown. Great microscopist Antony van Leeuwenhoek had discovered bacteria around 1676, but viruses are far too small to be seen through light microscopes. It was not until the invention of the electron microscope in 1931 that viruses were visualised for the first time.

Unanswered questions about the mechanism of vaccination led the Royal Society not to publish Jenner’s first manuscript, but after he conducted other trials, including one on his infant son, his paper was published.

4. Jenner Dreamed Big

Smallpox vaccination quickly spread around the world. Spanish expeditions carried it to far-flung lands such as America and China. Napoleon had his troops vaccinated. Jenner received a host of domestic and foreign honors. To allow him to focus his attention on his investigations, Parliament awarded him huge grants of 10,000 and 20,000 pounds.

Jenner died of a stroke in 1823 at the age of 73. He continued his scientific investigations until the end, presenting a paper on bird migration to the Royal Society in the year of his death. Whether or not Jenner truly saved more lives than any other figure in history, there is no doubt that his habits of mind offer deep insights to readers today.

Richard Gunderman, MD, PhD, is Chancellor’s Professor of Radiology, Pediatrics, Medical Education, Philosophy, Liberal Arts, Philanthropy, and Medical Humanities and Health Studies at Indiana University.