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Mandatory immunization for the military: As American as George Washington

George Washington on an engraving from 1859. (iStock)

On a trip to Barbados in his late teens, George Washington caught one of the luckiest breaks of his life: Smallpox.

It probably didn’t seem like good fortune just then. It was a deadly disease, and even survivors suffered miserably from fever, vomiting, headaches and pus-filled pox. But after convalescing for a month at a rented house, young Washington had lifelong immunity — a rare gift at the time for a Virginian, and one that would come in handy decades later.

By 1776, he was the commander in chief of the Continental Army in the Revolutionary War, and his protection from smallpox was a factor in his getting the job. When an outbreak of smallpox devastated the young nation, he made a bold decision to require his troops to be immunized.

Ben Franklin’s bitter regret that he didn’t immunize his 4-year-old son against smallpox

It was an act that has been repeated by presidents and military leaders throughout American history, including Monday, when the Defense Department announced it would require service members to get a coronavirus vaccine.

George Washington knew the threat smallpox posed to the new nation, calling it “the most dangerous Enemy” in a July 1776 letter to John Hancock. He described how, as recruits joined up, “I have been particularly attentive to the least Symptoms of the small Pox” and so far they had quarantined anyone with symptoms so soon “as not only to prevent any Communication [contagion], but any Alarm or Apprehension it might give in the Camp.” If people worried smallpox was spreading in the camp, they might abandon their posts, he was saying.

In one early action in Boston, where the disease was raging, Washington sent a force comprising 1,000 men who had previously had smallpox. In another, an invasion of Quebec was called off because so many of the soldiers had become ill.

By early 1777, Washington knew a more dramatic measure was needed. A method of immunization called inoculation had existed in the colonies since the 1720s, but it was controversial. With inoculation, pus from an infected person was gathered, either in a small vial or by passing a string through one of the sores, and then passed through an open cut in a healthy subject. The subject became ill with smallpox, though generally with a milder case. When they recovered, they were immune.

A Puritan minister incited fury by pushing inoculation against a smallpox epidemic

Critics argued it was playing God, and it was banned in several colonies. Though the death rate was much lower than “natural” infection, it was still dangerous and patients did occasionally die. (The much safer vaccination method using cowpox — the word vaccine derives from the Latin word for cow — would not be developed until 1796.) Plus, because the idea had come from an enslaved African, some alleged it was a trick to get White masters to kill themselves.

Enslaved African Onesimus taught Cotton Mather how to inoculate against smallpox

But inoculation had its supporters, too. Benjamin Franklin supported it constantly in his Philadelphia newspaper. John Adams went through it in 1764; his wife and children followed suit in the summer of 1776. Even Martha Washington underwent the procedure that summer, further convincing her husband of its efficacy.

In February of 1777, from his winter headquarters in Morristown, N.J., Washington wrote to one of his army doctors in Philadelphia:

“I have determined that the troops shall be inoculated ... 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.”

He then instructs the doctor on how to administer it to the troops there, and to keep his order “as secret as possible.”

Why keep it secret? He doesn’t say in the letter, but another letter he wrote the day before gives us a hint. To Maj. Gen. Horatio Gates he said he was “at a loss” about what to do regarding smallpox, and worried that if the army underwent mass inoculation and the British found out, the enemy might attack while they were in a weakened state.

Abigail Adams had her children inoculated against smallpox in 1776 centuries before covid-19

The measure was not popular among the soldiers, according to the Library of Congress. Not unlike the military today, in which vaccine misinformation and resistance festers, Continental Army soldiers came from all over the country, including places unfamiliar with or suspicious of inoculation. Still, there is no evidence of mass refusal; soldiers are trained to obey their commanding officers.

Military leaders are counting on that training again. Earlier this month, when asked if service members might refuse, Defense Department spokesman John Kirby said, “Members of the military understand when you sign up for the military that there are requirements laid upon you.”

So did it work? Did mandatory immunization help America win the Revolutionary War? It is impossible to prove the cause of something that didn’t happen, like, say, a hypothetical smallpox outbreak among American troops right before the decisive Battle of Yorktown. Still, we know the 1775-1782 smallpox epidemic killed more than 100,000 people, and we know that Washington’s scrappy army won the war by the skin of its teeth.

Read more Retropolis:

Ben Franklin’s bitter regret that he didn’t immunize his 4-year-old son against smallpox

The mandatory vaccinations that triggered a riot in Montreal in 1885

Smallpox ‘virus squads’ and the mandatory vaccinations upheld by the Supreme Court

‘The 1918 flu is still with us’: The deadliest pandemic ever is still causing problems today