World health officials and organizations are currently involved in a final push to eradicate polio, the paralyzing disease that was once a crisis in the United States but now remains in just three countries—Pakistan, Nigeria and Afghanistan. If the efforts succeed, polio will join smallpox as one of the only human infectious diseases to have been eliminated, entirely. Such a feat involves cooperation, coordination and determination, but it also rests on one crucial development: vaccines, what career immunologist John Rhodes calls “the most successful medical measure of any.”
Rhodes has spent his life studying how the immune system reacts to first encounters with infectious agents and other fundamental aspects of vaccine development and success. His research interests have included influenza, malaria and HIV/AIDS vaccines, with time at the U.S. National Institutes of Health, the Wellcome Foundation in London and GlaxoSmithKline, where he was the director of strategy in immunology from 2001 until 2007. In his new book, The End of Plagues: The Global Battle Against Infectious Disease (MacSci), Rhodes traces the long road to vaccination and the twists and turns that are still ahead.
Your story begins with smallpox, widely cited as one of the biggest killers in history. How did that disease affect society?
Up until the 17th century, it was the Black Death, or bubonic plague, which had the most impact. The Great Plague of London, which happened in 1666, was the last major visitation, at least in Britain. After that, there was a considerable change in the pattern of disease in that smallpox became the biggest killer. The difference between the plague and smallpox is that smallpox afflicted people across the social scale. Those at the very highest, the very top of society, the highest in the land, seemed equally at risk, whereas in the case of the plague it was just the poor people who tended to die in very large numbers.
How many people were affected?
If you lived in London in the 18th century, then most children would have smallpox during their childhood. The mortality rates were about 20 to 30 percent. It was a common experience in virtually every household in the cities.
Help came from an unlikely source, a woman who was an aristocrat rather than a member of the medical profession. Who was Lady Mary Wortley Montagu, and what role did she play?
She was a remarkable woman and a pioneer of women’s rights. She went in 1717 to Constantinople, modern-day Istanbul, with her husband who was ambassador, where she found out the customs of ordinary people and discovered that the Greek people in Constantinople had this long-standing custom of protecting their children with the forerunner to vaccination, which is called variolation. By giving small amounts of the smallpox germ under the skin, preferably from a non-serious case of smallpox, they could protect their children. When she came back to London, she championed and pioneered this against a good deal of resistance, especially from members of the medical profession, who were still promoting the classical ideas of upsets in the four vital humors as being the cause of disease. Purging, vomiting, bloodletting were the treatments of choice at the time.
Mary was a lone voice. Then she convinced Caroline of Ansbach, the wife of the Prince of Wales, that this was the way to protect aristocratic children who could afford the treatment. Mary and Caroline pioneered it, which led to the first trial in 1721, the so called Royal Experiment in Newgate Prison, where a handful of prisoners were injected with smallpox on the understanding that if they survived they would be pardoned. (They were all due to be hanged.)
Was this approach seen as, well, gross at the time?