The early years of inoculation
Prior to 1796 there was very little to protect people against infectious diseases. In the 18th century, smallpox was ravaging Europe with no known cure and a 10-30% mortality rate.
Efforts to protect people against smallpox originated in Asia and were known as variolation. This involved grinding smallpox scabs into powder and blowing them into the nose. This practice reduced mortality among those who later contracted smallpox to 1-2%. By 1713 English physicians were aware of the practice, but were not convinced that the risks outweighed the benefits until concerted campaigning by Lady Mary Wortley Montagu, who had observed it in Constantinople, convinced British doctors to try it.
In the UK inoculation was done at this time by introducing the pus or ground viral scabs under the skin on the end of a pin or needle. The practice was risky in that the patient could themselves spread smallpox, and some of those inoculated still died of the disease.
Edward Jenner is credited with the first successful smallpox vaccine using cowpox bacteria in 1796, when he inoculated 8-year-old James Phipps using pus from a cowpox sore on a milkmaid’s hand. In 1853, it became compulsory for all children to be vaccinated against smallpox during their first three months of life, paid for through taxes, though there were pockets of significant resistance to the law. This was exacerbated by rumours that the vaccine could turn people into cows or give them cow parts.
In 1879, while researching chicken cholera, Louis Pasteur accidentally discovered that weakened bacteria caused a mild illness and long-term protection against severe illness, and the first attenuated or weakened bacterial vaccine was invented. He went on to develop an anthrax vaccine in 1880, and a post-exposure rabies vaccine in 1885.
During this period research into other illnesses led to vaccines for diphtheria in 1894, Plague in 1897, and Typhus. Rudolph Wiegl’s Typhus vaccine, created in 1918, required the infection, incubation and dissection of cloth lice to harvest their intestines, meaning that only small amounts of vaccine could be produced at a time. In 1938, bacteriologist Herald Rea Cox discovered that bacteria and viruses could be grown in fertile egg membranes, a breakthrough that enabled the mass production of vaccines and is still in use today.
A devastating global pandemic drives vaccine research
But in 1918 a bigger killer was spreading. The flu pandemic of 1918-1919 was believed to have originated at Fort Riley in the US, just as the United States was gearing up to join the war in Europe. War priorities caused military leaders to ignore recommended containment measures, and infected troops were shipped overseas. Aided by troop movements and conditions in the trenches, the flu pandemic killed an estimated 20-50m people globally.
Indeed, more people are thought to have died of the flu pandemic than over the course of the entire First World War. It was this impact that drove the search for a flu vaccine.
However, it wasn’t until 1933 that the Influenza A virus was isolated and identified by British researchers Wilson Smith, C.H. Andrewes and P.P. Laidlaw. The breakthrough enabled US researchers Thomas Francis Jr and Jonas Salk to produce a vaccine, but the realisation that the vaccine did not offer total protection from flu led to the discovery of the Influenza B virus in 1940. The bivalent flu vaccine followed two years later.
Salk later developed the inactivated polio vaccine in 1955 and, within ten years, polio cases in the US had dropped from 58,000 to 61. Five years later, Albert Sabin developed a live-attenuated, orally delivered polio vaccine, enabling easily deliverable vaccination programmes in regions where medical supplies were less readily available. Today, only one strain of poliovirus still survives in the wild, in circulation only in Pakistan and Afghanistan, with only 99 wild cases reported globally in 2024.
Vaccinating a nation: the NHS mass vaccination programme
In 1948 the National Health Service Act came into effect. The establishment of the NHS enabled a national programme of vaccinations, starting with the BCG vaccine, drastically reducing infectious diseases across the UK. In 1901, 36.2% of all deaths and 51.5% of childhood deaths were from infectious diseases. By contrast in 2000, 11.6% of all deaths and only 7.4% of childhood deaths were from infectious diseases.
In 1967 the World Health Organisation (WHO) announced the Intensified Smallpox Eradication Programme, aiming to eradicate smallpox. This goal was achieved in 1980.
The 1960s also brought us the Measles, Mumps and Rubella vaccines, with these vaccines being combined into the single MMR vaccine in the 1970s, although this wasn't used until the late 80s.
In the 1980s vaccine research moved from targeting the virus or bacteria, to targeting their surface proteins, launching a new wave of research into disease prevention.
Targeting the world's biggest killer
Meanwhile, tuberculosis has killed more people than any other infection throughout history, and is still responsible for 2 million deaths per year. A vaccine was developed between 1908 and 1921 by Albert Calmette and Camille Guérin: the BCG vaccine.
The UK was sceptical of the BCG vaccine until the 1950s when major trials were conducted, which showed the efficacy of the vaccine against the most severe forms of tuberculosis. In 1953 a mass vaccination programme began, and continued until 2005, when the focus shifted to targeting high risk newborns. The BCG vaccine is not a silver bullet, however. It does not protect against pulmonary TB, the most common form of the disease, and is less effective at protecting adolescents and adults.
A new TB vaccination targeting pulmonary TB is currently being trialled in adolescents and adults which, if successful, would be a game-changer, potentially saving millions of lives. Other BCG replacement vaccines are also being trialled which it is hoped will be effective in adolescents and adults as well as infants.
Could we see tuberculosis or polio completely eradicated in the same way as smallpox?
More recently, vaccines targeting RSV and HPV as well as vaccines for non-communicable diseases have been developed. In January this year, the College celebrated the uptake of the RSV vaccine with 140,000 pregnant women vaccinated since September 2024.
Our history and archive
You can access our , where you can see the records we hold about our past as the British Paediatric Association (BPA) and a Royal College, and of the history of child health.
We also have Subject Archive Guides on vaccines and other topics. If you would like a guide to a topic not currently covered, please contact us using our email below.
We also have a small exhibition about the history of the Annual Conference in the Members' Room at the moment, so do have a look next time you visit the RCPCH office in London.
If you would like to access the archives, or you would like more information about our history and archives, please contact us on information.governance@rcpch.ac.uk.