Lessons from the past: how 19th-century anti-smallpox efforts enlighten current pandemic control

Abstract

Abstract Background In the first decades of the 19th century, vaccination was a brand-new innovation in Lombardy, Northern Italy. Yet, anti-smallpox vaccination campaigns were successfully carried out despite organisational and communication obstacles. By establishing a parallel with current COVID-19 vaccinations, we aimed to study how laws were enforced for outbreak control through vaccination services and to evaluate how health authorities handled public communication on vaccination. Methods A systematic search of original documents was conducted at the State Archives of Pavia and Milan, that of the City of Pavia and the Museum for the History of Pavia University. The search timeframe was between 1797 and 1830. Results Luigi Sacco introduced anti-smallpox vaccination in Lombardy in 1801 (1769-1836). He inoculated a million and a half citizens with his team in seven years. Student of Johann Peter Frank, generally known as one of the founders of modern Hygiene, Sacco was appointed General Director of Vaccination for the Kingdom of Italy and designed vaccination campaigns. Church parishes acted as organisational units: they were assigned to a vaccinating doctor, and priests were asked to provide a register of newborns to plan infant immunisation sessions. Authorities adopted a mixed approach towards vaccination mandates: these were formally effective but not imposed with coercion. When new outbreaks exploded, extraordinary vaccinations were implemented with easier compliance than in the absence of contagion. Great attention was paid to effective communication: priests were involved in scientific divulgation and vaccination promotion. Of note is the sermon written by Sacco impersonating an imaginary bishop from the city of Goldstadt who condemned vaccine refusal. Conclusions 19th-century public health officials and authorities dealt with the same issues we face nowadays: effective organisation of vaccination services, vaccine hesitancy and related mandates, and communication strategies. Key messages • To ensure broad vaccination coverage, the most dependable structure consists of locally based and socially integrated organisational units, such as districts. • Effective vaccination coverage was achieved through targeted communication, a gentle approach to mandatory vaccinations, and focusing efforts during epidemic periods.