What If The Smallpox Vaccine Was Never Created?

The Actual History

Smallpox was one of humanity's most devastating diseases, plaguing civilization for at least 3,000 years. The disease, caused by the variola virus, killed approximately 30% of those infected and left survivors permanently scarred, often blind, and socially ostracized. By the 18th century, smallpox was killing an estimated 400,000 Europeans annually and was responsible for one-third of all blindness.

Prior to modern vaccination, various forms of variolation—the deliberate infection with smallpox material from mild cases—had been practiced for centuries in Asia and Africa. This technique reached Europe in the early 1700s, championed by figures such as Lady Mary Wortley Montagu, who observed the practice in Constantinople. While variolation reduced mortality rates compared to natural infection, it still carried a significant 1-2% risk of death and could spread the disease to others.

The pivotal moment in smallpox history came in 1796 when Edward Jenner, an English physician, conducted his famous experiment. Jenner had observed that milkmaids who contracted cowpox (a related but milder disease) seemed protected from smallpox. On May 14, 1796, Jenner took material from a cowpox lesion on the hand of milkmaid Sarah Nelmes and inoculated 8-year-old James Phipps. The boy developed a mild fever but no serious illness. Later, when Jenner exposed Phipps to smallpox material, the boy showed no signs of infection, demonstrating immunity.

Jenner published his findings in 1798 in "An Inquiry into the Causes and Effects of the Variolae Vaccinae," introducing the term "vaccination" from the Latin word for cow (vacca). Initially met with skepticism and resistance from the medical establishment, Jenner's technique gradually gained acceptance as its efficacy became apparent. By 1840, the British government banned variolation and provided Jenner's vaccination free of charge.

Vaccination spread globally throughout the 19th century, with several countries making it mandatory. In 1959, the World Health Organization (WHO) initiated a global smallpox eradication program, which intensified in 1967 with a coordinated international effort. The last naturally occurring case of smallpox was diagnosed in Somalia in 1977, and in 1980, the WHO officially declared smallpox eradicated—the first and only human disease to be completely eliminated through deliberate intervention.

This monumental achievement marked a turning point in public health history. Smallpox eradication saved countless lives and established vaccination as a cornerstone of preventive medicine. The success inspired global immunization programs against other diseases such as polio, measles, and diphtheria. Modern vaccination schedules, herd immunity concepts, and infectious disease control strategies all build upon the foundation laid by Jenner's discovery. The development of the smallpox vaccine represents one of medicine's greatest triumphs and set the stage for modern immunology and public health practices that have saved hundreds of millions of lives worldwide.

The Point of Divergence

What if Edward Jenner never developed the smallpox vaccine in 1796? In this alternate timeline, we explore a scenario where humanity's first successful vaccine—and the foundation of modern immunization—never materialized.

Several plausible variations could have prevented Jenner's breakthrough:

First, Jenner might never have made the crucial observation about milkmaids' immunity to smallpox. While folklore about milkmaids' protection existed, Jenner's systematic investigation was not inevitable. Had he focused his scientific curiosity elsewhere or dismissed the connection as coincidental, the cowpox-smallpox relationship might have remained unexplored for decades.

Alternatively, Jenner's experiment with James Phipps could have failed due to subtle differences in implementation. Perhaps he might have collected cowpox material at the wrong stage of infection, or unknowingly used a sample from a cowpox variant that provided less cross-immunity. The failure of his most famous case study might have discouraged further investigation.

A third possibility lies in the publication and reception of Jenner's work. His initial submission to the Royal Society was rejected. In our timeline, Jenner persisted, self-publishing his findings. But had he been more thoroughly discouraged by professional rejection, or lacked the personal funds for publication, his discovery might have died in obscurity.

Perhaps the most likely divergence would be a cultural or ethical objection to Jenner's methods. His deliberate exposure of a child to a disease—even a mild one—raised ethical questions even in his time. Had contemporary moral standards been slightly different, or had James Phipps suffered unexpected complications, Jenner's experiments might have been prohibited before they could prove vaccination's effectiveness.

In this alternate timeline, we assume that due to some combination of these factors, Jenner either never conducted his vaccine experiments, failed to achieve convincing results, or was unable to successfully disseminate his findings. The practice of variolation would have continued as the primary preventive measure against smallpox, with its inherent risks and limitations. The concept of using a harmless related disease to provide immunity against a deadly one—the fundamental principle of vaccination—would remain undiscovered until a much later date, with profound consequences for global health, demographics, and the development of medical science.

Immediate Aftermath

Continued Reliance on Variolation

Without Jenner's breakthrough, variolation would have remained the primary defense against smallpox throughout the early 19th century. This procedure, while better than no protection, carried significant disadvantages:

Mortality Risk: Variolation itself caused death in approximately 1-2% of cases—far better than the 30% mortality from natural smallpox, but still resulting in thousands of preventable deaths annually.
Disease Spread: Unlike vaccination with cowpox, variolation used actual smallpox material, meaning patients were contagious during their induced mild case. This inadvertently caused new outbreaks, particularly in urban areas.
Access Inequality: The procedure required skilled practitioners and was often available only to the wealthy, leaving lower classes disproportionately vulnerable to smallpox epidemics.

European and American medical establishments would have continued refining variolation techniques, potentially reducing its risks somewhat, but the fundamental limitations would remain.

Delayed Development of Immunological Science

Jenner's vaccination concept provided a crucial intellectual foundation for understanding immunity. Without this breakthrough:

The field of immunology would develop significantly more slowly, lacking its first clear demonstration of acquired immunity principles.
Louis Pasteur's later work on creating attenuated vaccines for other diseases in the 1870s-1880s would have lacked its conceptual predecessor, potentially delaying his investigations or sending them in different directions.
The general principle of using modified or related pathogens to provide immunity might not have been established until the emergence of microbiology in the late 19th century.

These delays would have significant ripple effects on the broader development of medical science and germ theory.

Impact on Early 19th Century Epidemics

The early 1800s saw several major smallpox epidemics that, in our timeline, were mitigated by the growing adoption of vaccination:

The 1837-1838 Great Plains epidemic among Native American populations might have been even more catastrophic without any vaccine protection reaching indigenous communities.
European smallpox outbreaks of the 1820s-1830s would likely have been more widespread and deadly, particularly affecting urban centers during the early Industrial Revolution.
Colonial expansion would have carried even higher disease burdens, with smallpox continuing to devastate indigenous populations worldwide at higher rates.

Military Implications

Smallpox significantly impacted military campaigns throughout history. Without vaccination:

Napoleonic Wars: Armies would have continued suffering substantial casualties from smallpox. In our timeline, Napoleon had his troops vaccinated, giving him a strategic advantage. Without this option, disease would have played an even larger role in determining military outcomes.
War of 1812: The American forces, which benefited from early vaccination programs, would have instead suffered higher disease casualties, potentially altering the course of conflicts with both European powers and indigenous nations.

Early Government and Public Responses

In our timeline, early vaccination programs represented some of the first systematic public health interventions by modern governments:

Without Jenner's vaccine, the development of organized public health infrastructure would have followed different patterns, potentially focusing more on quarantine and sanitation rather than preventive medicine.
The 1840 Vaccination Act in England, which provided free vaccination and banned variolation, would never have occurred, delaying the concept of government-provided preventive healthcare.
Religious and philosophical objections to variolation would have persisted longer without the safer alternative of vaccination to gradually normalize the concept of disease prevention.

By the mid-19th century, alternative approaches to disease prevention would have gained more prominence. Sanitation movements and quarantine practices would have received even greater emphasis as primary public health strategies. The absence of vaccination as a success story might have directed more scientific attention toward environmental theories of disease, potentially accelerating some aspects of sanitation reform while delaying germ theory acceptance.

Long-term Impact

Demographic Consequences

Without smallpox vaccination and subsequent disease eradication, global population patterns would be dramatically altered:

Persistent Mortality Patterns

Continued Childhood Mortality: Smallpox remained a primary killer of children well into the 20th century in many regions. Without vaccination, childhood mortality rates would have remained significantly higher worldwide.
Cyclic Epidemics: Major urban centers would continue experiencing smallpox epidemics every 7-10 years as population immunity waned and new vulnerable individuals were born.
Population Growth: Global population growth would have been meaningfully slower throughout the 19th and 20th centuries. Conservative estimates suggest that smallpox alone killed 300-500 million people during the 20th century in this alternate timeline.

Regional Variations

Indigenous Populations: Already devastated by smallpox, indigenous groups worldwide would have faced even greater challenges to recovery and growth without eventual access to vaccination.
Developing Nations: Countries in Africa and Asia that benefited enormously from vaccination programs in the mid-20th century would have continued experiencing high smallpox mortality into the present day.
Urban Development: The pattern of urbanization might have evolved differently, with more emphasis on dispersed settlements to limit epidemic spread in the absence of effective prevention.

Alternative Medical Developments

The absence of Jenner's vaccine would have fundamentally altered the development trajectory of modern medicine:

Delayed Immunology

Later Vaccination Discovery: The principles of vaccination would likely have been discovered eventually, perhaps during the microbiological revolution of the late 19th century. Louis Pasteur or Robert Koch might have made similar observations about attenuated pathogens providing immunity.
Different Priorities: Medical research might have focused more intensively on therapeutic treatments rather than preventive approaches, potentially accelerating developments in pharmacology while delaying preventive medicine.
Institutional Development: Without the early success of vaccination programs, specialized public health and research institutions might have emerged later or taken different forms.

Altered Disease Control Approaches

Emphasis on Quarantine and Isolation: More resources and innovation would likely have gone into developing sophisticated quarantine systems, potentially including dedicated isolation facilities and more rigorous contact tracing methods.
Environmental Interventions: Theories linking disease to miasma and environmental factors might have persisted longer, potentially accelerating urban sanitation improvements while delaying germ theory acceptance.

20th Century Public Health Evolution

The absence of early vaccination success would dramatically reshape public health priorities and approaches:

Delayed Infectious Disease Control

No WHO Eradication Programs: Without the smallpox eradication success story, ambitious global programs to eliminate diseases like polio might never have been attempted.
Persistent Global Disease Burden: By 2025, smallpox would likely remain endemic in many developing regions, with periodic outbreaks even in developed nations despite quarantine efforts.
Alternative Control Mechanisms: International disease surveillance systems would emphasize border control, quarantine, and rapid response rather than preventive vaccination.

Technological Adaptations

Advanced Isolation Technologies: In the absence of effective vaccines, the 20th century might have seen the development of more sophisticated isolation facilities, personal protective equipment, and infection control protocols.
Therapeutic Focus: Greater resources might have been directed toward antiviral research earlier, potentially yielding more effective treatments for viral diseases by the mid-20th century.
Remote Interaction: Social and technological adaptations to limit disease spread might have emerged earlier, including precursors to remote work, distance learning, and telehealth.

Modern Society in 2025

By our present day, this alternate timeline would differ profoundly from our own:

Medical and Public Health Landscape

Persistent Smallpox: The disease would remain a significant global health threat, with estimated annual mortality between 1-2 million people worldwide.
Different Vaccination Timeline: Other vaccines would likely exist, having been developed through alternative pathways in the late 19th or early 20th century, but would cover fewer diseases and have been adopted more unevenly.
Emergency Response Infrastructure: Nations would maintain more robust systems for epidemic containment, including ready-to-deploy field hospitals and isolation facilities.

Social and Cultural Impact

Facial Scarring Norms: In regions where smallpox remained common, facial scarring would remain a normal part of appearance for a significant portion of the population, with different cultural adaptations surrounding beauty standards and identity.
Infectious Disease Awareness: Public consciousness of infectious disease risks would be higher, with more ingrained cultural practices surrounding disease avoidance.
Different Public Health Ethics: The balance between individual liberty and collective action in disease control would have evolved differently, potentially with greater acceptance of temporary restrictions during outbreaks.

Technological Development

Medical Technology Focus: More resources might have been directed toward environmental control technologies, air filtration, and pathogen detection rather than vaccine development.
Different Research Priorities: Medical funding priorities might emphasize therapeutic treatments and rapid diagnostic capabilities over preventives for diseases considered inevitable.

Global Politics

Disparate Disease Burden: The gap between developed and developing nations might be even wider, with smallpox and other vaccine-preventable diseases creating persistent health crises in poorer regions.
Different International Organizations: Rather than WHO's focus on disease eradication through vaccination, international health bodies might emphasize containment, rapid response, and therapeutic distribution.

By 2025, medical science would have eventually developed vaccination principles, but through a different, delayed pathway. The absence of early vaccine success stories would have created a vastly different approach to public health—one more focused on managing persistent diseases rather than eliminating them, with profound consequences for global development, demographics, and daily life.

Expert Opinions

Dr. Margaret Chen, Professor of Medical History at Oxford University, offers this perspective: "The absence of Jenner's smallpox vaccine would represent one of the most significant divergences in medical history imaginable. Beyond the direct mortality from smallpox itself—which would number in the hundreds of millions—we must consider the absence of the intellectual framework vaccination provided. Jenner's work arrived at a crucial moment in the early scientific revolution and helped establish the possibility that diseases could be prevented through deliberate intervention. Without this cornerstone, the entire edifice of preventive medicine might have been built decades later, or taken entirely different forms. The conceptual delay alone might have cost as many lives as smallpox itself."

Professor James Watanabe, Epidemiologist and Public Health Policy Expert at Johns Hopkins University, suggests: "In this alternate timeline, I believe we would see a much greater emphasis on what we might call 'non-pharmaceutical interventions' developing much earlier and more extensively. Sophisticated quarantine systems, contact tracing methodologies, and social distancing practices would have evolved as the primary defenses against epidemics. The intriguing possibility is that when COVID-19 eventually emerged in this timeline, global systems might have been better prepared in some ways—having maintained robust quarantine infrastructure rather than relying primarily on vaccination strategies that required rapid development. Nevertheless, the overall public health infrastructure would be substantially weaker without the foundation of vaccination success."

Dr. Elena Volkov, Director of the Institute for Global Disease Security, provides a contemporary perspective: "The persistence of smallpox into the 21st century would fundamentally alter our modern security landscape. Nations would maintain dedicated smallpox hospitals and emergency response systems as standard infrastructure. International travel would include more rigorous health screening protocols, and temporary border closures during outbreaks would be considered routine. The economic and social costs would be enormous, but perhaps the most profound difference would be psychological—modern societies would maintain a constant awareness of epidemic vulnerability that our timeline largely abandoned after smallpox eradication. This would permeate everything from architectural design to social customs. The 'victory' over smallpox in our timeline provided a powerful narrative about humanity's ability to conquer disease that would be absent in this alternate world."