Since the onset of the COVID-19 pandemic, the figure of the “anti-vax mom” has loomed large in the public consciousness and the popular press. She is the monster emblematic of our moment: She attends rallies maskless, pulls her children out of public schools to dodge state-mandated vaccinations, and takes to her blog to pen screeds that are at best ill informed and at worst deliberately manipulative. She wears a MAGA hat to match her Trump bumper sticker; she is the embodiment of disinformation as a cultural woe.

Doubtless such women exist; doubtless many do. And doubtless, too, their beliefs and actions are both harmful and deeply wrong. But the societal hyperfixation on the mother specifically—after all, if these unvaccinated children are being brought up by a cis heterosexual couple, then presumably they have a father who is also weighing in on medical decisions—deserves careful scrutiny. Such a preoccupation with mothers seems rooted in old tropes of women as emotional, irrational creatures whose failures as parents pose a unique threat to the social order. 

What’s more, it does a disservice to the role that women have played in the success of vaccines since Edward Jenner discovered a smallpox vaccine in 1798. Here, I am talking not merely about the women scientists and physicians responsible for the development and administration of vaccines. I am talking also about the myriads of women across centuries and cultures, many of whose names we no longer know, who pushed to bring vaccines to their families, their neighborhoods, and their cities at a time when the practice was even more contentious (hard to believe though it may be) than it is now. Widening the scope of the story in this way allows us to see the history of vaccination not as the lonely battle of a few scientists against a sea of unlearned people but as a collective effort.

“In the literary imagination of the early modern period, smallpox figured as a ruiner of beauties, liable to dash a young woman’s chances at marriage and, therefore (the logic ran), a fulfilling life.”

Prior to the creation of the first vaccine against smallpox in the late 18th century, Europeans’ understanding of the disease’s effects was deeply gendered. Those who survived it—and an estimated one third of those infected with smallpox did not, even in populations with lengthy prior exposure to the virus—were likely to bear deep lifelong scars, particularly on the face. In the literary imagination of the early modern period, smallpox figured as a ruiner of beauties, liable to dash a young woman’s chances at marriage and, therefore (the logic ran), a fulfilling life. After the princess royal died of smallpox in 1660, Thomas Shipman wrote an elegy entitled “Beauty’s Enemy” in which he laments not merely the young woman’s untimely death but her vanished charms, which he attempts to turn around through the use of rather clumsy heavenly metaphors: “Each Spot upon her Face a Comet show'd, / which did, alas, this fatal ruine bode!”

Before the availability of the vaccine, the most trusted method of smallpox prevention was a procedure known as variolation, in which patients were exposed to the pus or scabs of smallpox survivors with the goal of provoking a mild case that would spare them the disease’s most devastating effects. The technique was popularized in Britain in the 18th century by Lady Mary Wortley Montagu, herself a smallpox survivor, who observed that in Ottoman Turkey the procedure was carried out systematically by old women. And Jenner could not have completed his now-famous cowpox experiment without Sarah Nelmes, the milkmaid who allowed him to take a sample from her infected hand to test his hypothesis that exposure to smallpox’s tamer bovine cousin would provide immunity to one of the great diseases of the age.

Jenner’s development would prove highly divisive: Particularly in the first years after his experiment, fierce scientific debate raged about how introducing matter from an ailing animal into a sick human could possibly benefit anyone. Poorly managed and lacking in standardization, early attempts to replicate Jenner’s findings yielded mixed results that muddled matters, leaving space for opponents to allege not only that the vaccine was ineffective but that it caused outlandish reactions such as boils, intellectual disability, and even the sprouting of horns. Notably, these anti-vaccine figures sometimes repeated the same fears about matrimonial prospects that characterized much discourse around smallpox. “Who would marry into any family [that has received cowpox],” asked William Rowley, one of Jenner’s chief critics, “at the risk of their offspring having filthy beastly diseases?”

The support of influential women proved invaluable for the vaccine’s acceptance among the British public. Women’s learned societies worked to spread knowledge of vaccination and supported research into the then-new concept. The Ladies’ Sanitary Association  sponsored prizes for papers on the efficacy of the vaccine, while a similar group in Liverpool trained women as sanitation inspectors who would go from door to door educating families about the importance of getting their children vaccinated. This did not come without pushback: Some male doctors insisted on referring to these women as “lady health visitors,” prompting a caustic reply in the British Medical Journal: “Dr. Bostock Hill objects to the term ‘inspector’ as applied to a woman; we object even more strongly to the term ‘visitor’ as applied to officials.”

Noble women, including royals, counted among many of the patrons of the Royal Jennerian Society, which likewise championed the virtues of the vaccine and sought to honor its inventor. Rowley attributed British society’s increasing acceptance of the vaccine to its endorsement by “clergymen, ladies of rank, old women, and many others … all united with zeal, vehemence, and alacrity to promulgate, recommend, and extend the utility of this novel Cow-pox practice.” He likely included women among his list of Jenner supporters as a mark of disparagement. Nevertheless, his text points to the fact that women were a key part of the struggle to win broader acceptance for a medical intervention that ran counter to contemporary intuitions about health and the body.

“Because of its implicit connection to homemaking and motherhood, vaccination was seen as an acceptable point of entry into political discourse at a time when such options for women were limited.”

Because of its implicit connection to homemaking and motherhood, vaccination was seen as an acceptable point of entry into political discourse at a time when such options for women were limited. As historian Michael Bennett writes, “The vaccination cause was well suited to harness the energies of women who were concerned for their families and communities and who sought a larger role and purpose for themselves beyond the domestic sphere.”

Women’s role in Britain’s campaign against smallpox went far beyond lending financial support. Women across the country trained as vaccinators and served their communities, and the careful records they kept provided crucial data points that could be used in both scientific research and public awareness campaigns (Jenner himself was a notoriously sparse note-taker). What’s more, records of clinic visits in 19th-century England show that it was mothers, more often than not, who arranged for and brought their children to receive their vaccine doses. Diary entries from the period show that mothers played an active role in family discussions and debates around healthcare. This may seem at first blush a modest contribution—but consider where the vaccination effort would end up without the combined effort these women made to educate themselves on the merits of the cowpox vaccine, argue convincingly in its favor, schedule a doctor’s visit, transport the child to the clinic, and care for them after the ordeal was over.

If the dips and spikes of the coronavirus pandemic’s successive waves have taught us anything about the nature of medical revolutions, it is that they are waged and won not at the level of the single charismatic scientist doing battle with ignorance but at the level of the collective, the great chain of person upon person whose decisions to better the health of themselves and others together sum to something. An account of the smallpox vaccine that encompasses in its telling not merely Jenner’s experiments but those who took up its cause, in whatever capacity they could, would paint a truer picture of the collectivist spirit needed to tackle any public health disaster.

Further Reading 

Bennett, Michael. (2008). “Jenner’s Ladies: Women and Vaccination against Smallpox in Early Nineteenth-Century Britain.” History, 93(312), 497–513.

Bennett, Michael. “Note‐Taking and Data‐Sharing: Edward Jenner and the Global Vaccination Network.” Intellectual History Review 20, no. 3 (2010): 415-432.

Kerr, Matthew L. Newsom. “‘An Alteration in the Human Countenance’: Inoculation, Vaccination and the Face of Smallpox in the Age of Jenner.” Chapter. In A Medical History of Skin: Scratching the Surface, edited by Jonathan Reinarz and Kevin Patrick Siena, 129–46. Pickering & Chatto, n.d.

Shuttleton, David. Smallpox and the Literary Imagination, 1660-1820. Cambridge University Press, 2007.

Image credit: A milk maid shows her cowpoxed hand to a physician, while a farmer or surgeon offers to a dandy inoculation with cowpox that he has taken from a cow. Coloured etching, ca. 1800. (Wellcome Collection | Public Domain)