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Benjamin Franklin championed childhood inoculation against the deadly virus of his era

(Bloomberg News)

Should I vaccinate my children or not? Millions of parents are asking themselves this question as children return to school amid an unprecedented spike in coronavirus cases fueled by highly contagious omicron variant. But it’s not a new question, and the lessons learned 286 years ago by one of the nation’s founders, Benjamin Franklin, offer a resounding answer for parents in 2021: Vaccinate your children.

Franklin was a longtime champion of variolation — as the primitive form of vaccination was then called — against smallpox, the deadly virus of his era. Franklin embraced the scientific advances of the Enlightenment, and as publisher of the Pennsylvania Gazette he thought it was his civic duty to warn the citizens of Philadelphia about the virus and encourage them to take variolation. As early as 1730, his newspaper announced that a smallpox epidemic in Boston had killed a third of its victims, while observing that only those who had been inoculated had survived.

While this claim was factual, the Gazette’s pro-variolation stance was controversial. Primitive by contemporary standards, variolation placed live smallpox virus into the bloodstream of a healthy individual. Fluid was taken from the pox of a sufferer and scratched into the arm or thigh of the inoculant. (Contemporary vaccines contain the cells of dead viruses, but in the Colonial era physicians had no choice but to use live virus.) Several days of illness usually followed, but most inoculants survived and achieved permanent immunity.

Some, however, considered variolation more dangerous than smallpox itself. Others thought it unnatural, dangerous to their health, against God’s will or even the work of the Devil. As a result, thousands of Philadelphians refrained from getting inoculated.

Franklin repeatedly tried to change their minds. When smallpox swept through Philadelphia in March 1731, the Gazette announced: “The practice of inoculation for the smallpox begins to grow among us. How groundless all those extravagant reports are, that have been spread through the province to the contrary.” To dispel those reports, Franklin cited a respected English journal that supported inoculation. Even so, by July the epidemic had killed nearly 300.

When smallpox again raged through Philadelphia in September 1736, Franklin resumed his pro-variolation campaign in the Gazette. But this time, the dangers of smallpox tragically struck close to home for Franklin, producing lifelong regret and illustrating just how crucial inoculation was.

Franklin and his wife, Deborah, were evidently immune, either from variolation or from having survived smallpox. But their 4-year-old son, Francis Folger Franklin, was not. Little Franky was seriously ill with the “flux,” or dysentery, with its fevers, bloody diarrhea, abdominal cramps and malaise, and his father decided it was too risky to have the child inoculated against smallpox. Weeks passed as his parents worried over Franky’s failure to rally. And then in mid-November the child developed a high fever, followed by the ominous sores of the “pox.” On Nov. 21, Franky died of smallpox just a month after his fourth birthday.

The Franklins never recovered from their son’s death; 36 years later, Benjamin Franklin told his sister that he still mourned the child’s death. Franky, he wrote, was an unusually gifted child “whom to this day I cannot think of without a sigh.” Neighbors reported that Deborah displayed Franky’s portrait prominently in their home for the rest of her life.

Decades later in his autobiography, Franklin acknowledged, “I long regretted bitterly and still regret that I had not given it [smallpox] to him by inoculation.” Franklin wanted this regret to serve as a warning to parents who might avoid inoculating their children for fear that they would “never forgive themselves” if their children died of smallpox due to inoculation. Both paths posed risk and the regret would “be [the] same either way,” if the child died, he wrote. To Franklin that made it clear that parents should choose the proactive, safer option: inoculation.

When rumors erupted two months after Franky’s death that Franklin had secretly inoculated the child — thereby causing his death — it left Franklin enraged. The Dec. 30 Gazette bluntly declared that Franky “was not inoculated, but received the distemper in the common way of infection. … Inoculation was a safe and beneficial practice.”

Franklin’s words were prophetic. At the dawn of the 19th century, Edward Jenner’s successful smallpox vaccination, which injected cowpox into an 8-year-old boy, replaced the earlier variolations and was subsequently given to children. Before long, American cities and states required that children be vaccinated against smallpox before attending school. A global vaccination effort gradually ensued, leading the World Health Organization to announce in 1949 that the scourge of smallpox had been eliminated.

In the early 1950s, American pediatricians routinely administered four new vaccines to children by age 2, for diphtheria, tetanus, pertussis and smallpox. By 1954, children also participated in a massive polio vaccination campaign. Thirty years later, officials added other vaccines to the pediatric vaccination list: measles, mumps, rubella and an oral polio drink.

Despite these and more recent medical advances, an anti-vaccination movement has always persisted. Since 1998 when British physician Andrew Wakefield erroneously linked the measles, mumps and rubella vaccine (MMR) to autism, the anti-vaccine movement has become internationally prominent.

Ironically, the movement has gathered steam as the coronavirus pandemic has killed over 5 million people, disrupted global economies and created social havoc. In the United States over 800,000 Americans have died, and the toll is still rising. Thousands of those who have survived the infection have become “long-haulers,” left with devastating damage to their internal organs. Even so, millions of Americans have refused vaccine, thanks to ignorance and misinformation.

The history of the long anti-vaccine movement — which dating to the 19th century has often focused on required immunizations for children — makes it unsurprising that the Centers for Disease Control and Prevention’s recent approval of a pediatric coronavirus vaccine for ages 5 to 11 has sparked a firestorm of controversy.

While millions of parents have rushed to get their children vaccinated, many have resisted. They cite the high survival rates and low hospitalization rates for children who get covid-19 and the instances of young men suffering myocarditis after vaccination, though that number is small, as reasons not to get their children vaccinated, according to a recent report from the Kaiser Family Foundation.

This choice matters more than ever with the omicron variant spreading through the American population like wildfire. During the week of Dec. 23, at least 325,340 cases among children were reported, compared with 198,551 cases the previous week. On Jan. 3, the American Academy of Pediatrics reported a sharp rise in pediatric covid-19 cases. And while most infected children will survive, complications from the disease can affect their organs and may have serious implications for their future health.

Vaccine can minimize the odds of these complications and protect against severe illness or death. A study published in late December by the CDC, analyzing 915 covid-19 cases among children and teenagers hospitalized in six medical centers last summer, found that 78 percent were hospitalized because of complications from covid-19 — nearly all of them unvaccinated.

Medical professionals and advocates of vaccination are citing this evidence to plead with parents to immunize their children against the coronavirus, including recommending that schools require vaccination. In many ways, they are echoing Franklin’s pleadings to people in the 18th century to get variolated against smallpox — and to variolate their children, a lesson he learned in the hardest way possible.