The Distribution of Vaccines in the 19th Century

Distributing a COVID vaccine to billions of people will be challenging. We will require vials, needles, cold storage, air travel, trained health care professionals and much more. The challenge of distributing a smallpox vaccine in the 19th century was even greater because aside from fewer resources the vaccine, cowpox, was geographically rare and infected humans only with difficulty. Moreover, the best method of storing the vaccine was in a person but that worked only until the person’s immune system defeated the virus. Thus, a relay-race of vaccine couriers was created to distribute the vaccine around the world.

In 1803, the [Spanish] king, convinced of the benefits of the vaccine, ordered his personal physician Francis Xavier de Balmis, to deliver it to the Spanish dominions in North and South America. To maintain the vaccine in an available state during the voyage, the physician recruited 22 young boys who had never had cowpox or smallpox before, aged three to nine years, from the orphanages of Spain. During the trip across the Atlantic, de Balmis vaccinated the orphans in a living chain. Two children were vaccinated immediately before departure, and when cowpox pustules had appeared on their arms, material from these lesions was used to vaccinate two more children.

The British tried the same thing to get the vaccine to India but heat and shipwrecks led to many failures until, as Andrea Rusnock writes, Jean De Carro successfully delivered live cowpox to Bombay from Vienna via Baghdad.

De Carro, a Genevan who had received his M.D. from Edinburgh and who practiced medicine in Vienna, became one of the staunchest supporters of Jenner on the continent. It was through De Carro’s effort that vaccination was introduced in Austria, Poland, Greece, and the cities of Venice and Constantinople. In a letter to Jenner, De Carro carefully described his successful shipping technique. First he saturated lint with cowpox lymph and then placed the lint between two pieces of glass, one concave, one flat. He then sealed it with oil. “To prevent the access of light,” De Carro continued, “I commonly fold it in a black paper, and when I was desired to send to Baghdad, I took the precaution of going to a wax-chandler’s, and surrounded the sealed-up glasses with so much wax as to make balls. With this careful manner it arrived still fluid on the banks of the Tigris.

In the United States, Thomas Jefferson also wanted to be vaccinated but after several failures to deliver live cowpox from the Harvard Medical School, “Jefferson designed a new container: An inner chamber would hold the fluid lymph, while a surrounding chamber, filled with cool water, insulated the lymph.”

[Later] President Thomas Jefferson gave some cow lymph to Meriwether Lewis and William Clark to take on their explorations west of the Mississippi River. Antoine Saugrain, the only practicing physician in St. Louis when Louisiana was purchased by the United States from France in 1803, received some cowpox lymph from Lewis and Clark and began to vaccinate individuals free of charge, including Native Americans. Saugrain’s free vaccination program established cowpox in the Mississippi valley roughly a decade after Jenner published his inquiry.

Talk about Operation Warp Speed!

Even when delivered, the vaccine had to be kept alive so each cohort of vaccinators was incentivized to provide the vaccine for the next cohort:

In Glasgow, parents had to put down a deposit of 1 shilling (1801) and later 2 shillings (1806) to be refunded only when the child was returned to the clinic [and more cowpox could then be extracted from the children’s lesions]. In Boston, Waterhouse resorted to paying parents to vaccinate their children in order to keep a supply of cowpox.

Occasionally, herd immunity would be reached but that meant there was no way to store the vaccine for the next generation! Physicians, therefore, looked to newly created institutes that shipped the vaccine by one method or another around the world.

Returning to the British and India, after cowpox was delivered through De Carro’s efforts to Baghdad an Armenian child was infected and lymph from his arm was taken to Basra where an East India Company surgeon established a an arm-to-arm relay race that brought cowpox to Bombay:

On 14 June, 1802, Anna Dusthall became the first person in India to be successfully vaccinated against smallpox. Little else is known about her, except that she was “remarkably good tempered”, according to the notes of the doctor who vaccinated her…The following week, five other children in Bombay were vaccinated with pus from Dusthall’s arm. From there, the vaccine travelled, most often arm-to-arm, across India to various British bases – Hyderabad, Cochin, Tellicherry, Chingleput, Madras and eventually, to the royal court of Mysore.

As today, there was fear and opposition to the vaccine, especially in India, because it was foreign, threatened local healers who used variolation, and the use of vaccine couriers meant that “the vaccine was passing through bodies of all races, religions, castes and genders, and that ran counter to unyielding Hindu notions of purity.”

To counter the opposition, the British started an advertising campaign featuring Indian royalty. The picture above, for example, according to one compelling interpretation shows three Indian queens of Mysore with the queen on the right prominently portraying her arm where she has been inoculated with cowpox while the older queen on the left shows the discoloration around the mouth associated with smallpox. Thus, the younger queen on the right symbolizes health, vigor and the value of British science.

The challenges of delivering a vaccine in the 19th century–storage, transportation, fear, and incentives–are surprisingly similar to the challenges we face today. The 19th century effort to deliver the smallpox vaccine was impressive. Within years of Jenner’s pamphlet, the vaccine had made its way around the world. The 21st century effort will need to be much larger. Our civilization has many more resources than that of the 19th century. I hope we can match their will and ingenuity.

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