Learning about the Roots of Progress from the History of Smallpox Eradication

The excellent Jason Crawford at the Roots of Progress has a long-form read on the history of smallpox eradication. It’s an important and insightful piece especially because Jason is interested not just in what happened but why it happened when and where it did and what the lessons are for today:

In 1720, inoculation had been a folk practice in many parts of the world for hundreds of years, but smallpox was still endemic almost everywhere. The disease had existed for at least 1,400 and probably over 3,000 years. Just over 250 years later—it was gone.

Why did it take so long, and how did it then happen so fast? Why wasn’t inoculation practiced more widely in China, India, or the Middle East, when it had been known there for centuries? Why, when it reached the West, did it spread faster and wider than ever before—enough to significantly reduce and ultimately eliminate the disease?

The same questions apply to many other technologies. China famously had the compass, gunpowder, and cast iron all before the West, but it was Europe that charted the oceans, blasted tunnels through mountains, and created the Industrial Revolution. In smallpox we see the same pattern. [Why?]

  • The idea of progress. In Europe by 1700 there was a widespread belief, the legacy of Bacon, that useful knowledge could be discovered that would lead to improvements in life. People were on the lookout for such knowledge and improvements and were eager to discover and communicate them. Those who advocated for inoculation in 1720s England did so in part on the grounds of a general idea of progress in medicine, and they pointed to recent advances, such as using Cinchona bark (quinine) to treat malaria, as evidence that such progress was possible. The idea of medical progress drove the Suttons to make incremental improvements to inoculation, Watson to run his clinical trial, and Jenner to perfect his vaccine.
  • Secularism/humanism. To believe in progress requires believing in human agency and caring about human life (in this world, not the next). Although England learned about inoculation from the Ottoman Empire, it was reported that Muslims there avoided the practice because it interfered with divine providence—the same argument Reverend Massey used. In that sermon, Massey said in his conclusion, “Let them Inoculate, and be Inoculated, whose Hope is only in, and for this Life!” A primary concern with salvation of the immortal soul precludes concerns of the flesh. Fortunately, Christianity had by then absorbed enough of the Enlightenment that other moral leaders, such as Cotton Mather, could give a humanistic opinion on inoculation.
  • Communication. In China, variolation may have been introduced as early as the 10th century AD, but it was a secret rite until the 16th century, when it became more publicly documented. In contrast, in 18th-century Europe, part of the Baconian program was the dissemination of useful knowledge, and there were networks and institutions expressly for that purpose. The Royal Society acted as an information hub, taking in interesting reports and broadcasting the most important ones. Prestige and acclaim came to those who announced useful discoveries, so the mechanism of social credit broke secrets open, rather than burying them. Similar communication networks spread the knowledge of cowpox to from Fewster to Jenner, and gave Jenner a channel to broadcast his vaccination experiments.
  • Science. I’m not sure how inoculation was viewed globally, but it was controversial in the West, so it was probably controversial elsewhere as well. The West, however, had the scientific method. We didn’t just argue, we got the data, and the case was ultimately proved by the numbers. If people didn’t believe it at first, they had to a century later, when the effects of vaccination showed up in national mortality statistics. The method of meticulous, systematic observation and record-keeping also helped the Suttons improve inoculation methods, Haygarth discover his Rules of Prevention, and Fewster and Jenner learn the effects of cowpox. The germ theory, developed several decades after Jenner, could only have helped, putting to rest “miasma” theories and dispelling any idea that one could prevent contagious diseases through diet and fresh air.
  • Capitalism. Inoculation was a business, which motivated inoculators to make their services widely available. The practice required little skill, and it was not licensed, so there was plenty of competition, which drove down prices and sent inoculators searching for new markets. The Suttons applied good business sense to inoculation, opening multiple houses and then an international franchise. They provided their services to both rich and poor by charging higher prices for better room and board during the multiple weeks of quarantine: everyone got the same medical procedure, but the rich paid more for comfort and convenience, an excellent example of price differentiation without compromising the quality of health care. Business means advertising, and advertising at its best is a form of education, helping people throughout the countryside learn about the benefits of inoculation and how easy and painless it could be.
  • The momentum of progress. The Industrial Revolution was a massive feedback loop: progress begets progress; science, technology, infrastructure, and surplus all reinforce each other. By the 20th century, it’s clear how much progress against smallpox depended on previous progress, both specific technologies and the general environment. Think of Leslie Collier, in a lab at the Lister Institute, performing a series of experiments to determine the best means of preserving vaccines—and how the solution he found, freeze-drying, was an advanced technology, only developed decades before, which itself depended on the science of chemistry and on technologies such as refrigeration. Or consider the WHO eradication effort: electronic communication networks let doctors be alerted of new cases almost immediately; airplanes and motor vehicles got them and their supplies to the site of an epidemic, often within hours; mass manufacturing allowed cheap production at scale of needles and vaccines; refrigeration and freeze-drying allowed vaccines to be preserved for storage and transport; and all of it was guided by the science of infectious diseases—which itself was by that time supported by advanced techniques from X-ray crystallography to electron microscopes.

Read the whole thing and follow the roots of progress.


Saved to favorites. And as to "(Why?)" Niall Ferguson touches on these things as well, the 'killer apps' of Western Civilization.

I hate that book.

"progress begets progress"

... but liberty sparks progress

"European" politics, philosophy, science and communications were radically reoriented during the course of the “long 18th century” (1685-1815) as part of a movement referred to as the Age of Reason, or simply the Enlightenment.

The traditional authority shackles of state & religion were greatly diminished, as individual liberty expanded in mind and body.

Free Market-"Capitalism" is the economic mechanism of liberty and progress.

"Progress" is stifled by authoritarian control, everywhere and always.
That lesson of history is completely lost on the current vocal crop of American socialists and "progressives".

There may be much truth in what you say. So you will be deplatformed.

Why did the West eradicate censorship when the Chinese had the technology centuries earlier?

Progress: the temporal myth sponsored by modernity that we live already in an irrevocable future.

Time really is a one way street. We're no more going to return to, say, the Renaissance than I'm going to be a teenager again.

Lucky the Pope didn't get involved.

Actually he did. The Pope specifically endorsed vaccination in 1814. Later in Italy, priests would lead the congregation directly from Mass to get vaccinated.

In reality, the biggest historical opponents of vaccinations where secular humanists who decried the coercion of the 19th century vaccination campaigns. Something about inviolable individual liberty and all.

On the whole, the Christian religious establishment was overwhelming in favor of vaccination and in many societies, such as Italy and Bohemia, was the dominant social mover backing vaccination.

Excellent point. But what do you tell a weeping mother whose baby got killed by a lightening strike two years after being vaccinated?

Since this is the internet, I am obliged to clarify that I'm not claiming that vaccination causes lightening strikes.

My point, to be clear, is that anti-vax attitudes are mostly non-logical (or rather, about feelings not about evidence). In a 24 country study there was a moderate (.33) correlation between belief in conspiracies (the average of beliefs in four conspiracies) and anti-vax beliefs averaged over the 24 country samples (other variables had weaker associations). Researchers in this field are unsure what might be effective in getting parents to have their kids protected against preventable diseases, but arguing logically with them seems non-effective and even counter-effective. So non-logical tactics may be the better option, such as having religious leader tell followers to just do it because God wants it. Obviously that requires a religion where there is a single leader and would be difficult where everyone is free to create their own religion or sect and interpret anything anyway they please.
It is a myth that the catholic Church was anti-science (I'll save book recommendations for later).
As for anti-vax attitudes, Hornsey, Harris, & Fielding 2018 is a good place to begin. See google scholar for others.
Recommended reading:
Hornsey, M. J., Harris, E. A., & Fielding, K. S. (2018). The psychological roots of anti-vaccination attitudes: A 24-nation investigation. Health Psychology, 37(4), 307.

While capitalism supplied the funds for a lot of the work of eradicating smallpox, it was an international effort coordinated among many governments that lead to success. That effort included not just vaccination but also containment, especially in densely populated areas.


These are values only shared by an active minority in Western countries, even nowadays.

Tell that to the people rich anti vaxxers in Marin County or Brooklyn failing to inoculate their kids.

And I got a phd in Progress Studies and I can't get job!

Great post, rather points to the early underpinnings of the public health movement

If smallpox made a comeback today and we urgently needed a vaccine, some technologically advanced countries could readily produce one. And some could not.

I don't necessarily see religon as being absent from the explanation. Every major Western scientist or "natural philosopher" until somewhat recently(mid 20th century) was a young Earth creationist and basically thought they were unraveling God's secrets. The abolitionist movement was basically one of English Quakers who for religious reasons were trying to ban slavery almost everywhere on Earth. I think that during the Enlightenment modern humanism mixed with the religiosity of the medieval period in a very postive way.


But factors number one and two are clearly a result ultimately of factor number three - because the printing revolution happened in Europe and not in China, because the Europeans had better things to print (Bibles on codices written in the superior Roman script) than they did - leading to so many more "information hubs" at so many scales throughout society, as a consequence.
(The Gutenberg theory of Western dominance was once mainstream and seems to have fallen out of favour for no good reason.)

"Inoculation began as a folk practice. The inoculator, in one version, took contagious matter from the pocks of an infected person, put the liquid on a needle, and pricked the skin of the patient. They developed the fever in 7-9 days and passed through all the symptoms in a few weeks."

BUT, this "innoculation" (sometimes known as "variolation," to distinguish it from vaccinaton) was not at all the immunization discovered by Edward Jenner in 1798.

Variolation had two big drawbacks:
1. The probability you'd die from it was at least three percent (about one-tenth the risk of death if you'd contracted smallpox naturally). This was a large risk reduction, but nonetheless far more risky than vaccination (with vaccine derived from cowpox). You'd want to carefully evaluate the risk of smallpox you were protecting yourself from.

2. The person who has been variolated becomes fully contagious with smallpox, and anyone who catches it from this person acquires the fully lethal version.

3. Therefore, if anyone in a community variolated then all must do so. But for this to happen most must agree that there is a significant threat of smallpox spreading to the community anyway, which might be difficult to obtain until it was too late.

In short, variolation presents a very different decision tree than did Jenner's vaccination. And, therefore, Occam's razor says it was the relatively low risk from Jenner's vaccine that would ultimately result in the eradication of smallpox, and not some other mysterious, difficult to identify social factor.

Exactly, this confuses the issue. Inoculation is actually pretty dangerous and could easily kill.

Despite the risks Catherine the great of Russia underwent the procedure and inspired huge numbers to take it up probably having a big impact on mortality.

John Adams had his family inoculated. However, the process had a prep side to it where the body had to be "cleansed" and that was very obnoxious. People often were sick for 2 weeks or more of the illness after inoculation. Later, it was made safer and a simpler process.

There must be more to the total equation than just war.

In the cca 500-1100 era, there was a lot of war on the European continent, and yet the most warlike people (Normans, Vikings, Avars) had little scientific progress among them, if any.

In my opinion, the crucial addition was guns. Guns need industrial base much bigger than swords and longbows do, and they were very improvable - unlike cold weapons, which by 1000 were basically a mature, mastered technology, where the only possible advantage on the battlefield was "train your skills harder".

I think there might be something to this, but the "cold weapons" (which I interpret to mean non-gunpowdered weapons) still inspired technological progress. Said progress was not industrial in nature, as you also observe, but there was still technological progress to be made.

English longbows were effective weapons but the Mongol bow was at least as powerful and more mobile -- it could be used on horseback, while the longbow could not. And the Mongol bow was the product of centuries of development: unlike the longbow it was recurved (had that Cupid's bow shape) and composite (made of multiple materials, not just a piece of yew).

I conjecture that improvements in bows (and arrows) led to occasional spectacular victories such as that of the Parthians over the Romans at Carrhae -- after all, heavily armed and armored Western infantry had been defeating Asian armies that were built around the horse and bow for centuries, so what did Crassus have to fear from the Parthians? He didn't realize how deadly the Parthian bows could be -- possibly because they were newly improved, much as the rifled musket was an improvement over the smoothbore musket, with correspondingly deadly results when generals were slow to realize the capabilities of the improved weapons.

There were also ongoing improvements in metallurgy leading to stronger or lighter steel for swords and armor. And also newer weapons such as the crossbow, which though inferior to both the longbow and Mongolian bow as a weapon, had the huge advantage that masses of relatively untrained troops could use it, without needing a lifetime of training and practice the way the longbow and Mongolian bow did.

None of this of course invalidates your point that faster and more important progress was eventually made in firearms, progress that may indeed have been associated with industrialization.

But there was a continual stream of improvements and even new weapons. Some of the metallurgical improvements presumably would've benefited from industrialization too. And there's also the mystery of Greek fire and other chemical weapons, whose technology was lost during the Dark Ages but which in theory could've been re-discovered, again with potential correlation with industrialization.

Is Secularism more important than Protestantism? Should the P in WASP be sustistuted by an S? White Anglo Saxon Secular?

If only Tyler had the wit to apply himself to the science and data behind 'Global Warming', but that would require a day or so of work and what he found would be disturbing, so let that go,I guess.

The importance of the compass is well known. The invention of the compass is one of the best in the millennium. However, there exist various uncertainties about the inventors of the compass. It is said to be invented during the Han Dynasty of China between 300 and 200 BC.

it was invented in India. http://www.whoinvent.com/who-invented-the-compass/

Comments for this post are closed