United States: The Many Roads to Vaccination
"I have planted the true vaccine disease in the Province of Maine; in New Hampshire; in the state of Vermont, Rhode Island, Connecticut, New York, Virginia, South Carolina, Georgia, Kentucky and Tennessee; and in every part of Massachusetts, including the Islands of Nantucket, and Martha’s Vineyard. The physicians in the states of Pennsylvania, Delaware, North Carolina, and Maryland, were supplied from my stock, through Mr. Jefferson..." --Benjamin Waterhouse (Esparza, 2020, p. 2742)
When Edward Jenner began to propagate the practice of vaccination at the tail end of the eighteenth century, the United States was a newly formed country whose borders lay to the east of the Mississippi River; it is perhaps, unsurprising, then, that smallpox vaccination arrived in the continental United States through different avenues. Indeed, knowledge of vaccination was spread to the U.S. by people from three different countries: Great Britain, Spain, and Russia.
It is believed that the first person to promote vaccination in the United States was Benjamin Waterhouse, one of the first faculty members at Harvard Medical School, who encountered Jenner's Inquiry into the Variolae vaccinae known as the Cow Pox while studying medicine in Britain. On July 8, 1800, Waterhouse vaccinated his young son Daniel, the first recorded vaccination in the U.S., possibly in all the Americas. Other physicians later claimed they brought the vaccine to North America before Waterhouse--Dr. John Chichester claimed to have vaccinated children in Charleston, South Carolina and Rev. Dr. John Clinch received shipments of vaccine in Newfoundland days before Waterhouse vaccinated his son-- but Waterhouse has retained his title as the first U.S. vaccinator due to having official records of performing the procedure, as well as his more active contributions to promoting vaccination in later years. He reached out to President John Adams for help propagating the vaccine through the country, but his greatest ally would ultimately prove to be Vice President (and later President) Thomas Jefferson. After receiving vaccines from Waterhouse, Jefferson vaccinated his family, the slaves at his plantation Monticello, and his neighbors around Charlottesville, Virginia while taking careful records of how people reacted to the vaccine and how to best keep vaccines stable. Jefferson's vaccine advocacy also motivated him to ship vaccines across the country, namely to New York, Pennsylvania, Washington D.C., and major cities in Virginia.
El Camino Real
2013 photo of a plaque marking a segment of El Camino Real, located near Camp Pendleton, north of San Diego County
Meanwhile in Spain, King Charles IV commissioned the Royal Philanthropic Expedition of the Vaccine to spread smallpox vaccination to the country's colonies, with the mission departing A Coruña on November 30, 1803, with 22 children on board to maintain a supply of vaccine lymph through arm-to-arm vaccination. The nearly three-year voyage ventured from the Caribbean to Mexico to South America to the Philippines; it made landfall in the Viceroyalty of New Spain (comprising modern-day Mexico and the southwestern United States) on June 25, 1804, in the small port town of Sisal on the Yucatán Peninsula. From there, the vaccine traveled to Veracruz and from there to Chihuahua, which Nemesio de Salcedo, the General Commander of the Interior Provinces of New Spain, transformed into a hub for vaccine transmission. The vaccine would arrive within the present-day borders of the United States thanks to the efforts of Dr. Cristobal María Larrañaga, who conducted a little vaccination expedition of his own when he took a group of children from Santa Fe to Chihuahua to get vaccinated, then spread the vaccine to other villages along the road home to New Mexico, thereby immunizing 257 children. de Salcedo would also aim to spread vaccination from Chihuahua to Texas, but the long trip would frustrate his quest until March 1806. When smallpox vaccines finally arrived in Texas, uptake was reportedly so vigorous that the disease was essentially eradicated in the region until returning in 1830.
Orthodox Holy Trinity St. Nicholas Chapel
2016 photo by Frank Schulenburg of a Russian Orthodox chapel at Fort Ross Historical Park in California
Mexican officials also sought to spread vaccination to California, but the region was too geographically distant for traditional transmission techniques to work. Although some reports suggest vaccination arrived at the Presidio of Monterey thanks to José Antonio Verdía, a Spanish explorer headed to the Pacific Northwest, historians believe it is more likely that the vaccine was delivered by the Russian-American Company, a joint-stock company chartered by Tsar Paul I to trade with the New World and support Russian colonies in North America. In 1817, one of the company's ships, the Kutuzov, picked up vaccines in Lima, Peru and stopped in Monterey, San Francisco, and Fort Ross on their way back home to Sitka, Alaska. Later in the 1820s, after Mexico had declared its independence from Spain, Russian traders would help the governor of Alta California, José María de Echeandía, secure a stable supply of vaccines for his province.