I very much enjoyed reading two very different articles about vaccination in last Sunday’s Monitor: Ray Duckler’s front-page article about Dr. Oge Young and his remembrance of polio in the 1950s, and Robert Azzi’s “My Turn” article about “The challenge of vaccination in America, 1721-2021.”

I’d like to make a minor correction and a clarification to Azzi’s historical article and also add additional history to the 1770s time period.

Like Dr. Young, I’m a physician member of the newly formed group called Healthcare Voices of New Hampshire. We’re all types of health care providers with vaccination now as our goal.

I believe studying the history of vaccination is by itself a motivator. Azzi’s article states Cotton Mather convinced Dr. Zabdiel Boylston, both of Boston, in 1721 to do inoculation for smallpox for the first time in America. He goes on to state that “Harvard Medical School was opposed because it wasn’t Western medicine.” Here’s the correction: Harvard Medical School didn’t exist until 61 years later, so maybe Azzi was thinking Harvard College.

Here’s the clarification: Inoculation, variolation, and vaccination are used interchangeably in Azzi’s article. They are not the same. Inoculation is a general term meaning injected into the body; variolation means transferring material from a smallpox sore and injecting that into the body with the hope of acquiring immunity.

As Azzi stated, this was practiced in China, India, and Africa centuries before Mather and Boylston brought it here. The problem was that a large population of those treated this way died of smallpox, usually just a little better than the death rate without treatment (passive treatment). Hence it wasn’t widely adopted in the West, especially England.

In 1798 Edward Jenner, an Englishman, published a different way called vaccination where immunity was produced in a much safer way. Instead of inoculating the disease itself, he used cow pox, a mild disease gotten from milking cows. It worked, and Harvard Medical School then (now 16 years old in 1798) promoted it. Maybe this is the Western medicine Azzi wrote about. Vaccination really caught on by literally stopping epidemics in their tracks.

Here’s the additional 1770 history: Important to our winning the American Revolution was the variolation policy adopted by George Washington while commanding the Continental Army. British soldiers were assumed to be immune from herd immunity obtained in Europe, but the American population, including our army, was assumed to not be immune. No antibody testing back them.

Washington took his chances, like Mather and Boylston. When Boston was occupied by the Red Coats during 1775-76, smallpox-infected Bostonians were sent into Washington’s camps by the British to infect the Continental Army. It didn’t work because quarantines were set up and all troops and large parts of the population were forcefully variolated. This was administered and financed, at Washington’s insistence, by the Continental Congress. Our very first national health program!

Military deaths from smallpox during the war were heavily British. Even then you couldn’t count on passive herd immunity. Dr. Scott Atlas, adviser to President Trump last year, was promoting passive immunity; a bad idea in 1775-76 and bad idea in 2020-21.

We successfully won the revolution in part by our gaining immunity from smallpox by acting beyond just passive methods. If Jenner’s vaccine, available 20 years later, were available to Washington there’s no doubt he would have used it. He had faith in the scientific method. The only time Washington ever left America was as a young man when he and his older brother visited Barbados, where they both got very sick with smallpox. His brother died. For Washington, infectious disease control was strategic and personal. History teaches us lessons.

Let’s not forget. Get vaccinated.

(Dr. Nick Perencevich lives in Concord and is a member of Healthcare Voices of New Hampshire.)