In a year when one presidential candidate endorses vaccines, another is ambivalent and a third is staunchly opposed, it’s worth remembering that immunization played a key role in America’s War of Independence.
In 1776, as George Washington was leading the Continental Army through some of the earliest battles of the American Revolution, disease posed a greater threat to his forces than British troops. To win American independence, he not only had to defeat the British army; he had to defeat smallpox.
At the time, 90% of deaths in the Continental Army were due to disease. Smallpox was so feared by Washington’s troops that it was a major deterrent to enlistment. The year before, a smallpox outbreak decimated American forces entering Canada, delaying a planned attack on Quebec. When it was finally attempted, the lack of healthy forces led to a crushing defeat.
Writing about the debacle to his wife Abigail, John Adams observed, “Our misfortunes in Canada are enough to melt a heart of stone. The small-pox is ten times more terrible than Britons, Canadians, and Indians together.”
Because smallpox was common in Europe’s crowded cities, most Europeans contracted it in childhood. Those who survived were immune to the disease. This observation led to the risky but effective practice of inoculation, a procedure that involved deliberately introducing pus from a smallpox patient into the skin of an uninfected individual. The disease that followed was sometimes difficult, but less likely to be fatal than natural infection. Once the inoculated individual recovered, they had lifetime immunity to smallpox.
Because most American colonists lived on farms, few encountered smallpox in childhood. As a result, they were highly susceptible to infection. In the early to mid-1700s, Colonial Boston and Philadelphia were repeatedly hit by outbreaks of smallpox. Although inoculation was accepted in Europe, it was initially resisted in the colonies. Cotton Mather was an early advocate of inoculation, but many clergy members preached that smallpox was God’s punishment for sin. Therefore, inoculation interfered with God’s will. Other people mistakenly believed that inoculation was more deadly than natural infection.
In 1736, Benjamin Franklin’s 4-year-old son “Franky” died of smallpox. Because Frankin was a well known advocate of inoculation, rumors swirled that it had caused Franky’s death. In response, the grieving father wrote the following in his newspaper, the Pennsylvania Gazette.
“Inasmuch as some People are, by that [rumor] … deter’d from having that Operation perform’d on their Children,” he wrote, “I do hereby sincerely declare, that he was not inoculated, but receiv’d the Distemper in the common Way of Infection…I intended to have my Child inoculated as soon as he should have recovered sufficient Strength from a Flux [diarrhea] with which he had been long afflicted.”
In Franklin’s diary, published posthumously, he wrote that he “long regretted bitterly” his decision to wait.
The Colonies’ doctors did their part. After a smallpox outbreak in 1721, Dr. Zabdiel Boylston noted that the death rate from natural infection was 14%, but the death rate from inoculation was only 2%. Four decades later, Dr. Joseph Warren opened an inoculation clinic on Castle Island in Boston Harbor. In 1764, he inoculated John Adams. Dr. Warren continued inoculating Bostonians until his death at the Battle of Bunker Hill in 1775. The following year, Abigail Adams inoculated herself and her children against the disease.
General Washington, who had survived smallpox as a young man, was aware of this history and his forces’ vulnerability to the disease. He also knew that the British had used smallpox as a biological weapon against native tribes during the French and Indian War. After taking these factors into consideration, he made a fateful decision. In 1776, as his Army entered winter quarters, he ordered the mass inoculation of his troops. It was the first time in history that an army was immunized by command order.
Washington later explained his decision in a letter to Dr. William Shippen Jr., director of the medical department of the Continental Army: “Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army in the natural way, and rage with its usual Virulence, we should have more to dread from it than from the sword of the enemy.”
The inoculations were carried out in secrecy, lest the British attack at a vulnerable moment. But by late 1777, the wisdom of Washington’s decision was apparent. As fear of smallpox receded, the Continental Army saw a surge of new recruits. In a 2020 essay for National Geographic, Andrew Lawler wrote that “George Washington’s embrace of science-based medical treatments—despite stiff opposition from the Continental Congress—prevented a potentially disastrous defeat, and made him the country’s first public health advocate.”
Twenty years later, in 1796, Edward Jenner determined that inoculation with cowpox, a far milder virus, conferred equally powerful immunity against smallpox. He named the procedure “vaccination” after the Latin word for cow (vacca).
Two centuries after General Washington’s fateful decision, a vaccination strategy devised and implemented by another American, CDC epidemiologist Dr. William Foege, enabled the global eradication of smallpox.
Today, we know far more about the biology of infectious diseases and human immunity than our predecessors did in the 1700s. As a result, diseases that ravaged humanity for millenia have been largely contained or controlled. But the battle is unrelenting. Despite these achievements and the proven safety of vaccines, a cascade of disinformation is eroding public confidence in vaccination.
As we approach Independence Day, it is worth recalling the difficult choices our Founding Fathers had to make. In April 2020, as COVID-19 swept the globe, Kathleen Higgins wrote a commentary about that earlier time for The American Revolution Institute. In it, she observed, “After the disaster at Quebec, smallpox never overcame an American army. Washington and his senior officers worked ceaselessly to prevent the spread of disease among their troops. There was no glory in it, but it saved lives, and ultimately saved the Revolution.”
“Our republic was founded by people who committed themselves to the greater good.” She added, “We are called to do the same. Washington protected his troops, and we are called to protect ours. The soldiers on our front lines include grocery clerks, medical professionals, delivery men on scooters, sanitation workers and the thousands of others risking exposure while working to maintain essential services. We are protecting the republic Washington and his generation fought to create.”
“Washington learned from experience,” Higgins concluded. “We should learn from his example.”
