Here’s the second part of the interview on our most recent episode of History Factory Plugged In, host Jason Dressel spoke with Robert Hicks, Ph.D., senior consulting scholar and William Maul Measey Chair for the History of Medicine at The College of Physicians of Philadelphia.

Jason Dressel: What other pandemics or vaccine developments throughout history do you find relevant or interesting in the context of the COVID vaccine?

Dr. Robert Hicks: I wouldn’t say COVID is unparalleled. This country has a history, as other countries do, of disease outbreaks, and we’ve got to remember that devastating disease shapes human populations just as human populations shape the contours of how diseases spread. We could look back at another big crisis in American history for a good example, the Civil War.

Where we are today in ’21 with both a political crisis as well as a pandemic—well, during the American Civil War, while the North fought the South, the South found itself with a smallpox epidemic. Now, they knew at the time they could apply the Jenner technique, take the cowpox, and inject it.

They also, of course, knew about this older inoculation, a variolation technique of taking lymph from smallpox sores of actual smallpox-infected people and putting it in healthy people. But the South had a big obstacle here because it was fighting a war. The ports were all blockaded, so they could not import vaccines. They also could not manufacture them. They had to find other means.

Now, where vaccines were available, they were administered, but soldiers quickly figured this out. They said, “Wait a minute, I see Private So-and-so over there. He’s got smallpox, and you’ve isolated him in a tent. Why, I should just go over there with a knife and prick his sores and stick some of that stuff in my body. I ought to be OK, and I’ll do that to my buddies.” The problem is, they were all getting syphilis. So, the person from whom the lymph or the scab material might have been taken from also had syphilis. So, that spread with the virus. And the Confederates effectively did what we do today with contact tracing, trying to figure out who got it from who.

They had an amazing crisis with this throughout the Confederacy, and they were desperate to figure out how to get good vaccines. So, what did they do? One technique was to go around to plantations and look for healthy children who would not have been tainted with disease and lived in isolation. White children who lived on plantations and farms, but particularly black children, and they might deliberately infect those children, come back in two weeks, drain the pustules and make a vaccine out of them.

The Confederacy was largely unsuccessful in containing this problem. One major battle for the Confederacy in Virginia, 1863, Chancellorsville, they had to pull 5,000 Confederate soldiers out of the line because they’d all been vaccinated, and vaccinations went bad. So, the idea was harvesting vaccine with children. Nobody had any say in this. The military just came out, did it and infected the children, came back, harvested them, then re-infected them when they got healthy to keep a steady supply. So, imagine all those Confederate soldiers fighting, among other things, for the perpetuation of slavery, whose health might have been maintained by lymph taken from the bodies of black children and injected into their bodies. They didn’t even know it. So, smallpox was a crisis, and whether it contributed to the defeat of the Confederacy, it’s hard to say.

JD: Amazing. I’m curious, Robert, from a research perspective, in these stories and insights that you’re sharing, how have the research methodologies changed over time?

RH: Well, in just the last few years, museum collections such as those at the Mütter Museum, which has effectively a lot of organs and specimens pickled in jars, those collections are now being transformed into biorepositories because they are now sources of information about early disease. A few years back, the Ancient DNA Research Center at McMaster University in Canada teamed up with the Mütter Museum to look at cholera.

They were trying to map cholera over two centuries. What is going on with cholera and its different strains? How has the DNA of cholera evolved? Nobody had, up until a few years ago, recovered DNA from a pickled specimen from the 1800s. But it now has happened with one of the specimens at the Mütter, and it revealed this interesting and surprising history of cholera.

Now we’ve been doing it with smallpox. We have in the military museum collection small kits that were carried by doctors for vaccination purposes. And it has all the tools, including these little tin boxes inside for smallpox scabs. I was researching them. I had five kits; I opened them up, and they had 19th-century smallpox scabs in them.

JD: Oh my God.

RH: An “oh my God” response was followed by calls to health officials in the Centers for Disease Control. There was a discussion whether I should be quarantined or not. But all of the examples that came to light were much weakened and not infectious. Our samples had to go through the World Health Organization. And of the five kits, three yielded genomes, and they are traceable to women of European ancestry in the Philadelphia area. Through nondestructive testing of a kind that was not even possible five years ago, the DNA was recovered and the genomes reconstructed. And I have to say that for all the documentation—we have all the letters, diaries, publications about vaccination throughout the 1800s and into the early 20th century—we’ve got for analysis no samples at all of actual vaccine material. It probably lurks in some museum collections as it lurked in ours, and now we are testing some materials from other museums that might be candidates for new insights.

JD: Well, it certainly unleashes a new dimension to archives management, doesn’t it? So, the other thing you touched on a few minutes ago is throughout history, disease has been such a major force of society. And over the last 75 years or so, certainly in developed parts of the world like here in the United States, we’ve all just grown up in an environment where the looming threat of disease and pandemics just hasn’t been a part of daily life. COVID has really been the first experience of what humanity has contended with forever. And, you know, I think a lot of us feel that a lot of the anti-vaccination movement or people who distrust vaccines just haven’t sort of been exposed to that threat. And I’m curious to get your take on that.

RH: I think we are seeing a familiar pattern, but on a larger scale, with people announcing they will not take a COVID vaccine when it becomes available to them. These are the same people that would resist, say, the social distancing, refusing to wear masks.

It’s actually been part and parcel of studies conducted by epidemiologists and by the Centers for Disease Control to reckon into the picture of any possible disease outbreak, the unwillingness of people to observe the science, accept the science, or even accept the health-maintaining recommendations, whether it’s masks, the social distancing or something else. In a study years ago, the CDC looked at what in a future pandemic might it look like. What would it take to get people to act? And they estimated that perhaps up to 1% of the U.S. population would have to die before people would be willing to accept mandatory safeguards. One percent of the U.S. population is over 3 million people. We passed the 400,000 mark with COVID. I don’t think we want to get to 3 million.

JD: As you think about the history of vaccinations, as you think about the COVID vaccine, what do you think of its legacy?

RH: I think in a year or two we’re going to see documentaries produced, books written about the real heroic effort to develop these COVID vaccines.

Looking at the long trajectory of history, there’s certainly been devastating pandemics across the world. What we have now, though, is the ability to coordinate scientifically worldwide immediately. Data can be shared and discussed; people can act on it. There are laboratories, safeguards and protocols. We haven’t had in any other era in history the coordinating efforts or the science that we do now. Three independent laboratories can invent viable vaccines and have them tested, make sure all the safeguards are observed, as fast as this all happened in the world today, is absolutely unprecedented. Once we reach the era of not wearing masks anymore, people are going to reflect on this. And there will be international conferences to look at what we were able to accomplish under extreme stress and how can we position ourselves to do this again if we have to. That’s the story. It’s a stellar achievement.

JD: Well, let’s leave it there. Robert, I can’t thank you enough for sharing your insights and perspective with us. Stay safe until you get that vaccine.

RH: Remember, getting the vaccine does not mean that we stop wearing masks. We’re still going to be doing that for a while.


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