Are vaccine mandates un-American? Ask the father of our country

Some politicians and pundits have recently become aware of a historical fact that I have been teaching in my first-year medical school history of medicine course for years: Among the first American proponents of mandatory medical therapy to prevent viral infection was George Washington. So much for modern-day anti-vaxxers who say that requiring the COVID-19 vaccine as a condition of employment, school attendance or military service is un-American.

Smallpox is a highly contagious disease caused by the variola virus. It is typically spread by face-to-face contact between people. It causes fever, headache, back pain and red spots on the skin, which turn to blisters filled with clear fluid and then pus. If an attack of smallpox didn’t kill you (and in Washington’s era it often did) then the pox skin lesions would turn to scabs, fall off and leave deep-pitted scars. The disease wiped out large populations throughout history but today has been eradicated due to the heroic efforts of public health workers.

George Washington traveled widely in what would become the United States. But he left the North American mainland only once, when he visited the island of Barbados with his half-brother Lawrence in 1751. While in Barbados he was, in his own words, “strongly attacked with the small Pox.” He was left with facial scars, which some of his future portrait painters would decline to portray and others would hint at. Washington understood, firsthand, the devastation wrought by smallpox.

Vaccination for smallpox would not be discovered during Washington’s time in command of the Continental Army. It would have to wait for the scientific work of the British physician Edward Jenner. Starting in 1796, Jenner demonstrated the ability to prevent the disease by scratching humans with infected material from cowpox lesions. Thus, the name vaccination was derived from the Latin vacca, for cow. 

In Washington’s time, however, it was known that you could create immunity to smallpox by scratching people with material from the skin lesions of smallpox victims. This procedure was called inoculation or variolation. It would, in time, be replaced by vaccination. 

In January 1777 Washington wrote to Dr. William Shippen, Jr., and ordered him to inoculate all Continental forces passing through Philadelphia. A month later Washington ordered mass inoculation of all the troops. “Finding the smallpox to be spreading much and fearing that no precaution can prevent it from running through the whole of our Army, I have determined that the troops shall be inoculated,” he wrote. “The expedient may be attended with some inconvenience and some disadvantages but yet I trust its consequences will have the most happy effects. 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 have more to dread from it than the sword of the enemy.”

Having been exposed to smallpox in Europe, a high proportion of British troops were already immune. But smallpox ravaged Native Americans and former slaves who chose to fight with the British. By inoculating Continental troops, Washington leveled the playing field and made sure that he would have the ability to put troops into combat unimpeded by an epidemic of smallpox raging through his encampments. Washington’s plan worked, and many historians credit his order requiring mass inoculation for helping to win the Revolutionary War.

As part of the first-year curriculum of medical school, all of my students have learned the lesson of Washington’s public health intervention in the face of viral disease. The fundamental lesson is to understand how in some situations the good of the community overrides what some people assert is the “right to do whatever I wish with my body” irrespective of the direct consequences for those around them. Unfortunately, there is no vaccine for selfishness. 

Edward C. Halperin, M.D., M.A., teaches history of medicine at New York Medical College, where he is also the chancellor and chief executive officer. This essay represents his opinion and not that of the College.