ETHICS
LESSONS FROM SMALLPOX
A
pproximately 40 years ago, the World Health Assembly adopted a resolution declaring the accomplishment of a global goal. Smallpox had been eradicated. This was a significant achievement, as the disease had been a devastating part of our human experience for thousands of years. This achievement took place the technique safer, to demonstrate its scienabout 200 years after Edward tific effectiveness and to promote the technique, Jenner’s vaccine experiment, spreading its use. when the English doctor made There are some initial lessons that we can take discoveries that inoculation from Jenner’s work. Jenner experimented with incould provide protections from jecting cowpox into a test subject, James Phipps, the illness. So, the discovery of a the 8-year old son of his gardener. One scholar vaccine did not immediately re- Blake Edward DeLeon, has defended this action sult in defeating the disease. The as being moral in the time that the decision was BRIAN journey from global pandemic made, because inoculation, while not a common KANE to eradication offers some ethi- practice, was being used to develop immunity.4 cal lessons as we grapple with From our perspective today, it is clear that the current pandemic, COVID-19. we would not reach the same conclusion. It was Most of us are familiar with the general story common practice in Jenner’s time to use slaves, of Jenner’s discovery of a vaccine. He knew that children and prisoners as test subjects for medical dairymaids who were infected by cowpox devel- experimentation. Among the developments in the oped a natural immunity to smallpox. So, he found ethical considerations of clinical trials in the past a young woman, Sarah Nelms, who had open le- century, safeguards have been established to prosions from cowpox and transmitted the pus in her tect children and other vulnerable persons from wounds to his test subject. Although there were any research that would not offer some expected some reactions to the infection, these were short tangible benefit to them. To be fair to DeLeon, he lived, and upon recovery the person was immune to smallpox.1 Jenner is often unIn the past century, ethicists have derstood to be the founder of immunology. rightly condemned the misuse of Medical historians, though, have a power by health care personnel much more nuanced understanding of the origins of immunization and Jentoward patients and subjects ner’s role. He was not the first to note the connection between cowpox and smallwho lack the ability to protect pox, nor was he the first to deliberately themselves. inoculate in order to prevent smallpox.2 In the century prior to Jenner’s use of cowpox to inoculate against smallpox, physicians does argue that the second inoculation of smalldeliberately infected patients with smallpox to es- pox was consistent with the accepted practice of tablish immunity. Jenner was himself inoculated trying to mitigate the disease. There is a confusion with smallpox when he was eight years old and, here between culpability and immorality. One can by a contemporary’s account, the experience was say that someone who acted immorally may not quite horrible.3 Jenner’s contribution was to make be morally responsible because of ignorance. But,
HEALTH PROGRESS
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FALL 2020
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