Historical perspectives on vaccine hesitancy: what variolation teaches health professions education

Abstract

Disease prevention has always depended on more than biomedical efficacy, and the history of variolation offers a useful humanities-based case for health professions education. Before Edward Jenner pioneered the smallpox vaccine in 1796, variolation–a technique that deliberately exposed individuals to smallpox material to produce a milder infection and, later, immunity–was used. While this technique widely lowered the mortality rate, there was still a great risk of death, continued severe illness, and further transmission. When Lady Mary Wortley Montagu brought back the knowledge of variolation from the Ottoman Empire to Britain, she was met with hesitation or even direct opposition. As this method spread to the New World, George Washington mandated variolation against smallpox among his soldiers during the American Revolution. Therefore, trust, effective risk communication, and the surrounding social context were important in convincing British physicians of this new technique. By examining these historical examples, this discussion seeks to help learners analyze the various reasons for modern vaccine hesitancy or resistance beyond mere ignorance or other reductive interpretations. Health profession educators can use this history to encourage students to investigate who communicates risks, why certain audiences trust or distrust specific messengers, and how individual fears intersect with collective responsibility, and make comparisons with current vaccination debates, such as those with coronavirus and measles, through a historical analytical lens. Consequently, the history of variolation can serve as a valuable case study in healthcare humanities, public health ethics, and clinical communication.