Vaccine: The Human Story -Part 2...Series Review and Q+A With Annie Kelly
Including 5 unexpected people who helped defeat smallpox
When I get to the end of a series, I find it helpful to go back and think about The Promise Of The Premise as a way to frame my reflections about these hours I’ve spent listening.
The term is borrowed from screenwriting, and what this essentially means is this: What was the bigger goal of this series, ie: What did it promise you it would do, and then, did it do a good job?
You can also flip this phrase (although it loses some elegance when you do):
What is the premise of this series? And then…what does it promise to will do, in order to deliver on the premise?
Here are some of the detailed questions I ask myself to answer these questions:
Was it able to keep a strong focus on the theme, tone, format, and overall quality?
Does it stay consistent throughout all episodes?
Is the premise believable, or, achievable?
Is it hard to follow? Or conversely, too basic and then comes off as boring?
Does it all add up to mean something, by the end of x#-hours?
Here’s the Promise of the Premise for Vaccine: The Human Story:
To examine the roots of the anti-vaccine movement today, by examining the struggle, the hope, and the eventual triumph, over the smallpox virus.
Here’s where the series scores very high for me:
The examination of the struggle, the hope…and indeed the eventual triumph over smallpox.
Here’s where the series scores lower for me:
Exposing and discussing the anti-vaccine movement of today.
Let’s dig into this with a producer's brain
Vaccine: The Human Story went as far as it could go to offer a satisfactory answer to the question of the contemporary roots of anti-vaccine sentiment, given the format of the series. The entire series is scripted and read by the host, or recreated by actors.
Had the producers decided they could slot in contemporary interviews in the later episodes, or a discussion among academics about the anti-vaccine moment of today, it would not have fit with the style and tone of the series.
The format they used was a scripted historical series. This works to deliver the promise of the series: to walk us through the struggle and eventual triumph over the smallpox virus. It spectacularly joins the effort, ingenuity, and risk that went into the last 100+ years of science to bring us to the moment of vaccination.
But I noticed there were some waypoints in the series that indicated to me that this series might not fully deliver on its premise: to expose the roots of anti-vaccine of today by looking back at history.
First: the “theme” of the show, a series of clips edited together as a montage, sets up this series as though it is a documentary. It uses a range of archival tape from around 1980, when the WHO declared an end to smallpox, leaving you with a voice that says: “The world and all its people have won freedom…”
The “theme” is good, I like the style, and it gives me all the information that I need to stay interested in this show…but the problem is that it creates a disconnect with the historical presentation style that the show actually employs. For me, it set up the expectation the story would be told predominantly with archival tape, which was not possible, given the large historical scope of this story.
The second was at the end of the series, which is set in the contemporary era of history. When it came time to hear from the doctors on the ground who helped to bring smallpox to an end, the show did not transition out of the historical format. It continued to have actors read from actual text written by these living people.
As I have mentioned before, I bent toward a non-fiction documentary style…however, I do agree that the stylistic choice to maintain that editorial choice was the right choice for this series. It’s hard to imagine how to maintain a cohesive style for the series if you use actors for the past, and then pivot to interviews for the present.
“Ignorant women, illiterate people” and orphan boys
One of the gifts of Vaccine: The Human Story is that it rips non-consecutive pages out of a history book and puts them side by side, so that you get a whole new view of history. The mark of quality historical work is if it can successfully reframe your understanding of history.
Here’s a non-exhaustive list of unexpected people who we can thank for the end of the war on smallpox, and the arrival of the vaccine:
High society women - from Lady Mary Montagu to Mary Antoinette in the 1700s
Slaves who spoke of their ancient practices to their colonizers
Orphan boys
The maverick scientists and doctors - Dr Edward Jenner, Dr William Foege and Dr Connie Davis.
The anti-vaccine movements who protested against the establishment, both to make the practice better, and then eventually to help create a public health mandate, in opposition.
Episodes 3 & 4
The war against smallpox is thought to go back to the earliest history, but the first written records of this go back to the Kangxi Dynasty of China, from the 1660s, when a young boy, only 6-years-old, was crowned Emperor after his father died from smallpox. Records indicate that although he had seven older brothers, Kangxi was chosen based on his strongest trait—he had survived smallpox as a child.
Kangxi would later be very public about adopting the ritual of inoculation, and speaking publicly about his pride in protecting his family with this metod.
Over the next 100 years, news began to spread around the world of the practice of inoculation, and how it was saving lives. This was especially when children were the ones being inoculated, because they were able to pass the infection quickly, and then live a long life as a result. Previously, smallpox would claim fully one-third of its victims.
It was the high society women who were the first to adopt these practices. Lady Mary Wortley Montagu lived in what was then called Constantinople (Istanbul), where inoculation was already commonplace, and so she inoculated her children using their techniques. She later wrote about that experience in England publications.
Mary Antoinette, child bride to Lous VVI, King of France, in 1770, had survived smallpox as a child. When she allowed her children to be vaccinated, and then the King himself became inoculated, this set the pace for French society.
This event inspired the milliners of Paris to create a wig to celebrate this event, called “le pouf à l’inoculation.” The effect of Marie Antoinette wearing this wig became an instant symbol of the success. Poof! Inoculation was fashionable.
Inoculation, Vaccination and Immunization
There are three terms that are used as synonyms, but they all actually mean separate things. Let’s dig into this.
Strictly speaking, inoculation was an old way of doing things. When we’re talking about smallpox, it meant that practitioners would take a sample of the live virus (usually by extracting something from one of the active scars) and then injected into the body of another human.
The idea here is that a small and controlled amount of the virus could do the same task of inoculating someone, rather than risking the full-blown disease. By the vast majority, this worked, and it was an important scientific contribution (though this was mostly through ritual and non-medical practitioners). However, it was risky, and sometimes went very badly. This eventually caused the anti-vaccination movement (or perhaps the anti-inoculation movement) to claim that it wasn’t worth the risk.
Vaccination evolved out of the risk of inoculation. Dr Edward Jenner, born in 1749 in Gloucestershire, England, discovered that the less risky cowpox virus could be used to vaccinate against smallpox, rather than run the risk of a runaway infection of inoculation, which was what had happened to him as a boy. Vaccines were the innovation of using similar but different to produce the same outcome: immunization.
Immunization is then the body’s response to a virus, which means that it cannot become infected again after exposure. Sometimes that’s one dose, sometimes that’s multiple doses. Or as we’ve seen with Covid, it’s a changing vaccine as the virus itself changes.
Inoculation was what was practiced for hundreds of years. While it was not a guarantee, it did do the job of substantially reducing the risk of death. But, as with many early medical practices, things did go wrong on occasion.
Inoculation also had true limits. It was only possible by a human chain, where one person delivers immunity to the other within a short time window. So the question persisted…How could this technique be brought overseas, by ship, for months at a time?
That’s where the orphan boys come in. This series tells the story of the ship The Camarthen, which sailed from Bengal, India, to the British outpost Bencoolen, in modern-day Indonesia, with a dozen unvaccinated ophan boys.
The technique was to innoculate one child at a time, on the arm, and then wait for the scab to form. At that point, the doctor would then retrieve some of the active virus from the scab, and then daisy chain this material to the next arm, a few days later. It was an unbroken chain of vaccination, from a perfect storage vessel—a human body.
This technique was also used to bring vaccines to the shores of the New World, North and South America, where Indigenous populations were being decimated by the virus.
These unnamed, unthanked and long-forgotten children were a crucial link in the story of how vaccines came to be what they are today.
Episode 6
Follows the story that led to New York City dealing with a mass smallpox immunization program in 1947, decades after it thought that it needed it.
What I note is that the public health officials used all of the same tools we still use today: advertising, influencers, and a media blitz to satisfy the public. There was even a Fauci-type character, a chief scientist, who took the lead in the public education campaign.
With a message akin to “We’re All In This Together,” smallpox was swiftly and successfully eradicated, once again in America. This story could have been ripped from the headlines from almost anywhere in the last two years. Lesson learned: vaccinating the public requires a full-court press.
While the virus was stamped out in just a few months in New York, it was still smoldering in other parts of the world…notably in India and Africa. The global goal to eliminate smallpox began in earnest in 1967. This required entire nations to cooperate and work together…and for the World Health Organization, the WHO, to find a way to fund a substantial immunization campaign, which would take approximately 10 years.
The last known case of smallpox was clocked in Somalia in 1977. After a three-year wait-and-see moment, the WHO decided to make it official: smallpox was behind us. The vaccines that had taken 100 years to finally be fully effective, from the first vaccine in 1786, to 1980, after which time they went into deep storage (and were pulled out again last year for monkeypox).
Two modern-day smallpox mavericks
Dr. William Feoge is an American physician and epidemiologist who worked with the Centre for Disease Control (CDC) throughout the 1970s and the early 1980s. But it was his work during the 1960s in the remote regions of eastern Nigeria that he would become known for.
Foege developed a surveillance and containment strategy that changed the worldwide approach to smallpox vaccination.
But the detail of his work is what makes it fascinating. During his college years, he worked as a firefighter with the US Forest Fire Service. While wandering the charred remains of a forest, far from a water source, he recalled how these forest fighters fought fire without water: they separated the fuel from the fire by containment and isolation.
Foege wondered: what if that strategy was applied to epidemiology? Separate the known virus from the potential victims. His technique has become known as Ring Fence Vaccination, and it continues to be important today. The strategy of quarantine and social distancing was successfully used during the Covid pandemic in the last three years.
After the success of Foege’s work in Nigeria in the 1960s, the only part of the world where smallpox was still suffering outbreaks, was India.
Dr. Connie Davis, an African-American woman who was finishing her pediatric residency, got a call from the WHO in 1973. Could she go to the Bengal region of India, which borders both Bangladesh and Nepal, to help achieve the goal of eliminating smallpox by widespread vaccination?
India is a country of people on the move, and border crossings are no exception. At this time, there was also a lot of immigration between Bangladesh and India. The WHO was working with India to contain by stationing officers to vaccinate new arrivals at border crossings.
But what Dr. Davis noticed was that there were as many people crossing at official border crossings, as there were at unofficial border crossings. Without reaching every person who entered the country, the goal of eliminating smallpox was extremely challenged.
Her resolve was unconventional and risked massive diplomatic fallout. Davis took the risky decision to meet with the human smugglers so that they would agree to station vaccination officers at the unofficial border crossings. Her unconventional work paid off, and within a few short years, smallpox was officially eliminated from India.
What is the connection between smallpox and anti-vaxxers?
Looking at this story with a historical lens, especially with the lived experience of these last three years, it’s fascinating to see the role that public health brings into this space. The role of vaccines to combat deadly diseases exactly puts the definition of what is public, and what is private, to the test.
The role of public health is to keep the greatest number of citizens safe from disease, using all known methods of the day. And in that way, it is truly the embodiment of health and politics. It asks that we make an offering to the public good with our bodies, based on the belief that science and politics have it right.
With smallpox, as with Covid, once the emergent threat of death disappeared, the necessity for public health to be absolute changed position; it became a choice, rather than a necessity.
Vaccines have no doubt helped with the goals and outcomes of colonization. The absence of vaccines gave way to the ability to conquer vast swaths of the New World, while the majority of the Indigenous populations were rapidly killed off by smallpox.
When vaccines became available, taken in part from the early iterations of inoculation and ritual, they were then transformed into a vaccination program, which was then exported back out to the New World as the solution, by the same colonizing powers.
Yes, vaccines did lead to the successful eradication of deadly diseases like smallpox; but it must have been hard to separate the science from the politics
In England, when vaccination became mandatory, there was a rise in anti-vaccine sentiment. But interestingly, when the laws were loosened for mandatory vaccination, the rates of vaccination did not bottom out…they remained flat for a time, and then eventually began to rise again. It seems that what people were against was not the vaccine itself, but rather the mandate to get one.
Perhaps the biggest takeaway from this series is that anti-vaxxers are a natural occurrence and that they are as much a part of the ecosystem as the science it strives to resolve. Maybe that’s why the climax and the resolution of this series are hard to spot…because anti-vaccine sentiment is woven into the story and history of vaccines, alongside the science.
The tool of vaccines is strong. The creation of vaccines is on par with the greatest achievements of the Anthropocene: The Pyramids, space travel, the Theory of Relativity. But yet, because it requires citizens to take part, by offering their own bodies as a measure of public good, these efforts have never been universally supported.
Q + A with Annie Kelly, Producer and Host
The business story of this podcast:
Samantha Hodder: Tell me about the Patreon community, and the rest of the funding community who helped to fund this project. What percentage of the budget was able to be covered by this, and how long did it take to get to that goal?
ANNIE KELLY: I wouldn’t have been able to get the project off the ground without Fall of Civilizations paying the upfront costs, like hiring researchers, so our budget was a mixture of initial investment, Patreon subscribers and YouTube ad revenue.
I was really overwhelmed by how generous our Patrons were and how many signed up after just one episode. They allowed me to take more time with each episode, and spend a bit of time interviewing the researchers I’d hired about their own fascinating research interests, which I then released as premium content.
SH: I notice that each episode has its own cover art, instead of the same image for all of them. Was this a conscious decision? How do you keep the integrity of the whole, to listen to the entire series, instead of the one-by-one listening approach?
Annie Kelly: Paul Cooper from Fall of Civilisations produced our videos, and I think chose the cover art based on an image he’d found particularly striking or relevant to the story. I have to admit it hadn’t occurred to me to do it another way!
SH: Did you attempt to contact the living researchers or doctors who work that you cover in the series to include their voices? Episode 6 covers both Dr. Cornelia Davis (Connie) and Dr. William Foege.
ANNIE KELLY: I actually didn’t, and maybe I should have! It felt like quite a leap going from talking about people three hundred years ago to the current moment, and I suppose I was still in “history mode”. I suppose I also felt that being medical professionals, they probably had enough on their plate during a global pandemic.
SH: You end with a poem - what was the thinking for that? How did that fit into your overall story arc?
ANNIE KELLY: I knew that I wanted to end the episode with a tribute to the past, to leave my audience on the emotional level with which I tried to engage on the project – of thinking about people on the past as real, human people, rather than as abstracted populations.
I think poetry is a lovely way to do that, because it strikes an emotional chord with you, a feeling that you may not have known was anything but unique to you or the age you’re living in. The poem we finished with, by the 17th century English poet Owen Feltham, had that quality for me. I particularly loved these lines:
“Yet fear not Maid, since so much fair
Is left, that these can those impair.
Face-scars do not disgrace, but shew
Valour well freed from a bold foe.”
SH: Did your work on this podcast lead you to the correspondent work you do with the QAnonAnonymous podcast? Or were you already working with them? Do these two projects overlap anywhere?
ANNIE KELLY: I had already been working with QAnon Anonymous as their UK correspondent for a couple of years when I created Vaccine. I wouldn’t have been able to do it, or be confident enough to embark on my own project like that without the experience I built up there.
I think the projects do overlap, in that a lot of my episodes for QAA are about me trying to connect strange ideas or theories from history to our current moment, like the “Paul is Dead” Beatles hoax, or the Princes in the Tower mystery. I find it very comforting to think that there is a common human thread running from our time, which can feel so disordered, weird and chaotic, to the past.
SH: What is YOUR biggest takeaway of the connection between the current anti-vaccine movement, to the anti-vaccine protests and leaders from history? What is the common thread?
ANNIE KELLY: The common thread in vaccine-sceptic movements from then to now is trust, or rather the lack of it. We can complain about misinformation all we like, but it seems to me that this material only works on people who have that feeling of mistrust in their governments, or public health institutions in the first place – and who fundamentally do not believe that the people in charge have their best interests at heart.
With institutions, just as with our individual relationships, it is incredibly easy to lose trust, and a very difficult and long process to win it back again. But history shows that it can be done, since trust rises and falls even with incredibly marginalised groups of people who have every reason to be suspicious of those in power. So I think the onus is on our institutions now, to prove that they are worthy of people’s trust. I’m not pretending that it’s an easy or quick fix, but I think this would tackle the root cause of these protests, rather than just the symptom.