The Role of Smallpox Vaccination in Mortality Decline in the Great Britain through Eradicating the Disease
The Role of Smallpox
Vaccination in Mortality Decline in the Great Britain through Eradicating the
Disease between XVIII-XX centuries – Facts or a Political Arithmetick?”
Mamurjon Rahimov
University of
Illinois at Chicago
Department of
Economics
“Whoever would understand the political
phenomenon known as ‘The Anti-Vaccination Agitation”- and its magnitude would
seem to indicate it as being at least worth understanding – must remember some
one or two facts, facts obvious enough indeed, but constantly forgotten. And chief amongst them this, that every
opponent of the practice, every skeptic, without exception, as to its benefits,
has in the first instance approached the question in a spirit at least of impartiality,
and probably all his prejudices strongly in its favor”
Alfred
Milnes
Introduction
In October of 1979,
The World Health Organization (WHO), officially declared smallpox, also known
as variola, eradicated. The disease
that was known to mankind as early as 1122 BC in China, took millions of lives
throughout the world (Britannica.com).
We all know that WHO is a branch of the United Nations Organization, and
is dedicated to protect the health of the mankind. However, UN also has many other branches dealing with issues like
business, economy, culture, education, migration, to name a few, and
furthermore, the eradication of smallpox is believed to be a collaborative
achievement of most of these branches, both on local and on global level. If so, this eradication must have been
announced jointly with, if not all, then at least few other UN branches such as
World Bank, UNDP, and UNICEF. It would
be very unfair for medical men to appropriate this great achievement of mankind
all to themselves. Although medical men
do not like to mention it too much, they all recognize that eradication of
smallpox was not only their merit.
Economic history has
contributed significantly to the formulation of various economic theories. Among the economists who have found history
to be an important source for their ideas one can cite Adam Smith, Thomas
Malthus, Alfred Marshall, John Maynard Keynes, Milton Friedman, Robert Solow,
and Gary Becker. For economists it is
very important to study population history in order to come up with policies
that decrease mortality and morbidity of the population. Factors like life expectancy, infant
mortality are considered to be key indicators of progress in any country. Longer life expectancy means more manpower
to move the industry, larger consumer base for products and services.
My purpose here is to
elaborate in theoretical and statistical plausibility of smallpox vaccination
eradicating the disease based on papers written about the smallpox disease, and
to seek whether the vaccination, if efficient at all, weighed substantially in
the light of other forces that caused decline in mortality. It is quite striking to read from Memoirs of
Jacques Casanova, a contemporary, that “More people perish at the hands of
doctors than are cured by them” in those centuries, and in contrast the common
belief that in those centuries medical men suddenly came up with
“one-size-fits-all” cure for one of the most dreadful diseases of all time,
which, with little modifications, if any, continued to be administered
worldwide up until the second half of the XX century.
For several centuries
until now, proponents of vaccination hailed smallpox vaccination to be a proven
wonder weapon in the hands of mankind in eradicating the disease in the world,
although there have been a number of schools of thought that, if not disprove,
then diminish the role of smallpox vaccination in fighting the disease to an
insignificant level, which is the change in the virulence of smallpox.
We must remember from
European history that the period in which the most drastic decline in British
smallpox mortality took place coincides with the time Britain experienced
industrial revolution, and thus improved standards of living must have played
crucial role in reducing susceptibility of the population towards infectious
diseases (Krause, 1958). A good example is a paper written by several
researchers from the University of Liverpool and Manchester that used
time-series analysis to study the dynamics of smallpox in Britain in 1550-1800,
and found a striking correlation between wheat price fluctuations and epidemics
(Duncan, 1993; also see Helleiner, 1957).
Economists almost
always try to use models in order to come up with logical interpretations of
current and past events. One such paper
(Mokyr, 1993) that tries to explain decline in mortality in the light of
economic forces, used standard theory
of utility maximization as a starting point: Uj = Uj (Xij…Xnj, Lj) where
L is composite family life expectancy variable, subject to the usual budget
constraint ∑XiPi = Y. It further
goes on and tries to estimate the rise in knowledge (in hygiene and sanitation,
in particular), relative prices, public goods (convergence towards best
practices), and the like and their consequent influence on decreased
mortality. Economists agree that
knowledge always has indirectly influenced every single area of man’s life,
however the paper attempts to go beyond indirect relationship towards
autonomous causality, and since lion’s share of mortality and morbidity is
attributed to smallpox at that period in history, it does seem that a general
rise in the level and scope of knowledge had direct effect on mortality decline
throughout Britain.
Much has been said
and written about the practice of vaccination in general and smallpox
vaccination in particular. If you read
a couple articles and books on how lucky we were to obtain the knowledge about
vaccination, you may feel that, if not vaccines, mankind would be wiped out
from the Earth by the dreadful infectious diseases of all kind. While I am writing this paper, hundreds more
new vaccines are being developed in state-of-the-art medical laboratories and
millions of people, young and old, are being vaccinated, despite the growing
opposition from parents, scholars, and doctors against mandatory mass
vaccination. It is interesting to note that vaccination remains to be the only
medical practice that has to be enforced by law (NVIC.ORG).
A
Remarkable Decline in Mortality
Mortality and
morbidity of a population, although closely related, are two different
things. I do not want to elaborate that
in a number of developed countries, including the United States, morbidity of
the population has been growing, while mortality has been rather low (NVIC.ORG
statistics). In this paper, I tried to
focus on falling of mortality rates in Britain between 18th and 20th
centuries, and the causes of this remarkable decline. Economic gains from falling mortality can never be precisely
estimated, because human life is such the most precious thing one can ever
have. Between 1750 and 1914 mortality
rates went down substantially everywhere in Europe, of course not at the same
pace and the same extent. For instance,
life expectancy in Britain went from 30’s in 1750 to 50’s in 1914, and crude
death rate fell from about 25 per thousand in 1750 to 14-15 per thousand in
1914. The immediate cause of this
dramatic shift is undisputedly decline in infectious diseases in Europe, but
deeper causes of this phenomenon have been fueling debates among three major
overlapping “schools” that have emerged to explain the causes behind the
mortality decline. “Nutritionist”
school stresses improvement in living standards and food consumption as a
result of economic growth to be major causes, whereas “preventist” school
contends that this decline in mortality can be attributed primarily to public
policy such as smallpox vaccination campaigns on mass level and cleaning of
sewage systems. The third school,
“exogenists”, claims that the decline in mortality can be explained by reduced
virulence of major infectious diseases on microbial level and positive changes
in climate (Mokyr, 1993).
First inoculation and
later vaccination is cited to be plausible explanation for this decline.
Inoculation, in primitive and crude way, was practiced mainly in a few Oriental
and African countries. Due to the
limited scale of inoculation, its efficacy was not known well. People of England learnt about it in 1721
when Lady Mary Wortley Montagu’s daughter was inoculated in London (Tucker,
1963).
Inoculation must be
formally defined to avoid mixing it with the more recent practice of
vaccination. Smallpox inoculation is the injection of smallpox virus taken from
actual smallpox wound of a patient, whereas smallpox vaccination is the
injection of cowpox virus. The symptoms
these two practices produce slightly differ, but they are both carried out for
the same purpose – developing immunity in people against the actual smallpox
disease. Edward Jenner was the founder
of smallpox vaccination in Britain, and interestingly, it was by his medical
induction that he believed that exposing a person to cowpox would render the
person immune to smallpox (1798).
Nobody could prove empirically that this exactly was the case, and for
instance William Hewson was not able to verify through numerous experiments
what Jenner supposedly achieved.
Charles Creighton, a learned anti-vaccinator, in his book Jenner and
Vaccination (1889), proved that Jenner not only failed to demonstrate,
experimentally or otherwise, that cowpox and smallpox were biologically
related, but nobody else, until the date Creighton’s own book was published,
had done so (Greenwood, 1930). Besides,
the population, which was subject to various vaccination laws and acts,
stubbornly resisted to vaccination (Milnes, 1897). The City of Leicester became a center of such resistance, and
despite the gloomy prophecies of medical men about huge toll to be paid due to
a large unvaccinated population, it was one of the cities that suffered least
from several epidemics of 19th century (NAVL, 1910).
Legal
Side of the Story
In 1840 British
Parliament passed “An Act to Extend the Practice of Vaccination”, by which
smallpox inoculation that was used prior to smallpox vaccination to prevent
this disease was made a penal offence.
Since the practice of smallpox inoculation dates back to 1721, it turns
out this life-destroying practice lasted for a hundred and twenty years!
The first compulsory
vaccination law was Lord Lyttelton’s Act in 1853. Lord Lyttelton is quoted to have said, “It is unnecessary for me
to speak of the certainty of vaccination as a preventive of small-pox, that
being a point on which the whole medical profession have arrived at complete
unanimity”. Despite a growing number of
post-vaccinal morbidity and mortality cases (Krause, 1958), Britain passed
another landmark vaccine law in 1867 - the vaccination law of England, which at
once was put in force (Milnes, 1897).
Stakes
Behind the Vaccination
Often,
if not always, there are huge financial interests behind political goals. Due to mostly qualitative information
concerning the vaccination in the stated period, and inexistence of reliable
statistical body for the most part of it, “There is no means of accurately
gauging the amount paid for treating diseases subsidiary, or arising from
vaccination” (NAVL, 1910). However, the
below brief table for Ireland will illustrate that substantial finances were
committed to the vaccination practice.
Table 1.
Annual Reports for the Local Government Board for Ireland:
|
Year Ending 31 March
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