The Washington PostDemocracy Dies in Darkness

Deep political disagreements can coexist with universal support for vaccines

The Founders fiercely disagreed — except when it came to a smallpox vaccine

President Trump speaks during a news conference at the White House on Wednesday. (Al Drago/Bloomberg)

As covid-19 continues to wreak havoc on our economy, schools and civic life, the pressure for a vaccine has intensified. Many medical experts worry that in the rush to a speedy vaccine, politics may take precedence over science — compromising essential testing trials, for example.

This concern is nothing new. Politics have long shaped public health debates, and the quest for a safe and effective vaccine also occupied the attention of many of America’s Founders. Their focus: smallpox, a constant threat to people’s health in the founding era. Then as now, the subject of health care in times of crisis was often politicized. As Benjamin Franklin noted in 1749 of contemporary smallpox treatments, “the practice of Inoculation always divided the people into parties, some contending warmly for it, and the others against it.” But their experiences show politics and economic interests don’t have to undermine the scientific process.

With the memory of Revolutionary War devastation due to smallpox in his mind and propelled by his keen interest in public health, President Thomas Jefferson was determined to address the epidemic. He quickly grasped the innovative vaccination method introduced by Edward Jenner in England in 1798 was far more effective than inoculation.

By the first years of the 19th century, Jefferson partnered with Benjamin Waterhouse, a Boston doctor, to help ensure this newer and safer weapon against smallpox, the Jenner vaccine, was available at little or no cost throughout the United States. Jefferson had often asserted that science was his true passion, and medicine had always been of special interest to him. He actively used the power of the presidency to improve general medicine in the United States and support people’s health.

Jefferson wanted to see the results of the Jenner vaccine with his own eyes. Such an approach, however, relied partly on his wealth and power as an enslaver: He demonstrated empirically through the use of the Jenner vaccine on his own family members — as well as on hundreds of enslaved people — that it prevented smallpox with few, if any, side effects.

But it is disheartening, although not surprising, to learn Jefferson first experimented on his Black enslaved people, making sure the vaccine was safe before using it on his own family. Jefferson’s enslaved people probably had little, if any, say in whether they wished to be vaccinated, and eradicating smallpox on Jefferson’s plantations was far from a purely humanitarian act because it made economic as well as medical sense to try to keep enslaved people healthy and prevent the fearsome disease from spreading.

Participating in the process gave Jefferson faith in the product, and he wanted to extend these benefits to the broader public. In 1802, Jefferson wrote a physician friend: “I think it important … to bring the practice of the [smallpox] inoculation [vaccine] to the level of common capacities; for to give to this discovery the whole of value, we should enable the great mass of the people to practice it on their own families & and without an expense, which they cannot meet.” Jefferson even designed a new container to transport the vaccine matter to minimize contact with heat and air to ensure its potency. In 1806, he wrote Jenner to extend his appreciation for his discovery of the vaccine. He asserted: “Medicine has never before produced any single improvement of such utility. … You have erased from the calendar of human afflictions one of its greatest.” Together with Waterhouse, Jefferson helped make the smallpox vaccine widely accessible, which was pivotal in bringing smallpox under control in America.

James Madison followed in Jefferson’s footsteps in addressing the threat of smallpox. In 1813, he went one step beyond Jefferson when he signed into law a statute to encourage wider smallpox vaccination, one of the nation’s earliest public health bills. Not only did the Vaccine Act of 1813 oversee drug purity, but it also allowed the president to appoint an agent to obtain regulated smallpox vaccine to provide it to any American citizen by mailing packages of the matter weighing under a half an ounce free of charge through the U.S. postal system.

Despite their political differences, even Jefferson and Madison’s political rival, John Adams, agreed on the importance of the need for widespread availability of the Jenner vaccine. Adams had been an early adopter of smallpox inoculation and had undergone the controversial procedure in Boston in 1763 while a young man. He also witnessed the terrible devastation the disease brought to Continental Army soldiers during the war, and he wrote his wife, Abigail, in 1777 that “Disease has destroyed Ten Men for us where the Sword of the Enemy has killed one.”

This didn’t make Adams a fan of his rivals though. During Jefferson’s presidency, Adams wrote critically about his political opponents as life-threatening themselves: “There are Some Deleterious Effluvia in the American Atmosphere,” he told his son John Quincy Adams, “which engender political Delirium, and Spread Contagion endemically or epidemically, from one Man and one State to Another.” Still, Adams continued to support medical advances for Americans, proving such support could coexist with deep political gulfs.

Even Jefferson and Adams, once fast friends, but then for a long time political enemies, were able to eventually reconcile and focus on shared values rather than divisive issues. Their belief that the president should play a role in ameliorating suffering and preserving public health paid off when the government was able to expand access to a lifesaving vaccine. Following their example, it would be heartening if the next president is able to combine the desire for a successful covid-19 vaccine with careful, empirical testing to ensure its safety for all people.