Podcast Summary: American History Hotline

Episode: The Surprising History of Vaccines in America with Kathryn Olivarius
Host: Bob Crawford
Guest: Kathryn Olivarius (Associate Professor of History, Stanford University)
Date: December 3, 2025
Podcast by: iHeartPodcasts

Overview

This episode tackles the complicated and often surprising history of vaccines in America, with a particular focus on smallpox, the first vaccine mandates, and the evolution of vaccine policies from the Revolutionary War to the present. Host Bob Crawford is joined by historian Kathryn Olivarius, who shares her expertise on 19th-century American history and the public health measures that shaped modern society, weaving in accounts of early inoculation, vaccine hesitancy, and the persistent tension between public good and individual rights.

Key Discussion Points & Insights

1. Smallpox and the Origins of American Vaccination

[04:26 – 07:22]

• Smallpox's Devastation:
  Smallpox (caused by variola virus), introduced to North America via European ships, was described as "one of the most horrifying diseases that’s ever existed." In colonial Massachusetts, about 30% of those infected died.

  “It’s sort of hideous to behold… Many, many accounts—we have from John Adams, for example—just wrote these disgusting sort of accounts of what it was like to actually see somebody who had experienced a serious case of smallpox.” (Kathryn Olivarius, 06:03)

• Early Inoculation (Variolation):

  • Originated in ancient China, the Middle East, and West Africa.
  • The process involved grinding smallpox pustule material and introducing it into the body (via nose or skin wounds).

    “You take a pustule of somebody with smallpox that’s pussing, you dry it, you put it into a mortar and pestle and basically sort of grind it down and then you snort it, or you put that into your arm…” (Kathryn Olivarius, [00:00]/[06:34])

• Folk Knowledge & Key Historical Figures:

  • Lady Mary Montagu brought the practice from the Ottoman Empire to England after her disfiguring experience.
  • Cotton Mather, a Puritan minister, learned variolation from Onesimus, an enslaved man from West Africa.

    “Cotton Mather… was told how to do this by his enslaved man… from West Africa named Onesimus, who basically told Cotton Mather how to do this.” (Kathryn Olivarius, 07:54)

2. America’s First Vaccine Mandate

[07:22 – 13:04]

• George Washington and Mass Inoculation (1777):

  • During the Revolution, smallpox outbreaks among troops threatened the Continental Army’s survival.
  • Washington mandated inoculation for soldiers, despite the controversial nature and the need for secrecy.

    “Washington mandated that the entire Continental Army would be inoculated for smallpox.” (Kathryn Olivarius, 11:31) “And it was controversial at the time… it was kept secret because Washington rightly said…if the British find out that we are doing this… it would leave all manner of cities very vulnerable to attack.” (Kathryn Olivarius, 11:44)

• Risks and Societal Backlash:

  • Notable deaths, such as theologian Jonathan Edwards, highlighted the risk of inoculation—notably the 1-2% death rate compared to 30% from natural infection.
  • Religious and practical objections included claims of violating divine will or concerns about spreading infection via inoculation campaigns.

    “In seeking to cure yourself or seeking to protect yourself long term, you actually then kill yourself.” (Kathryn Olivarius, 09:36)

3. The First True Vaccine: Jenner and the Cowpox Connection

[13:11 – 15:26]

• Edward Jenner’s Breakthrough (1790s):

  • Noted that milkmaids who contracted cowpox didn’t catch smallpox.
  • Developed the first vaccine by inoculating with cowpox, which spurred immunity to smallpox.

    “This is actually the origin of the word vaccine: ‘vacca,’ cow. So that’s where that comes from.” (Kathryn Olivarius, 14:52)

• Global Impact:

  • Smallpox vaccination is credited with saving millions and is considered a public health triumph.

    “…approximately 300 million people died of smallpox. This is basically the population of the United States today…” (Kathryn Olivarius, 15:04)

4. The Challenge of Vaccine Implementation in the 19th Century

[15:26 – 17:06]

• Adoption and Controversy:
  • Early vaccine rollouts were not widespread state efforts but often private or hospital-based.
  • The state didn’t begin implementing mandates until the 20th century; debates over public good vs. individual rights are rooted in this era.

    “We don’t see [state] mandates again until much, much later, until the 20th century actually.” (Kathryn Olivarius, 15:52)

  • Seeds of anti-vaccination sentiment: These date back to the 18th-19th century.

5. Pasteur, Live Attenuated Vaccines, and Expansion

[17:14 – 20:20]

• Scientific Advances:

  • Louis Pasteur discovers live attenuated vaccines (for chicken cholera, rabies).

    “We have here we have Lily Pasteur coming up with these lab attenuated vaccines, not just for chicken cholera, but then for rabies.” (Kathryn Olivarius, 18:54)

• New Vaccines:

  • Typhoid, cholera, plague, tuberculosis, diphtheria, tetanus, pertussis, yellow fever, and finally, polio (Salk and Sabin).

    “Probably the one that most people… are sort of familiar with and probably had themselves were the polio vaccines…this saved generations of children from having to be in iron lungs or from death…” (Kathryn Olivarius, 19:20)

6. School Vaccine Mandates and Evolving Attitudes

[20:20 – 24:05]

• Vaccinating Children:

  • Mandates for childhood vaccines (measles, mumps, rubella, polio) arise patchwork in the early-mid 20th century.

    “No one moment when these sort of schools…would adopt requirements for vaccine mandates for children. Happened in patchworks…” (Kathryn Olivarius, 21:10)

• Hesitancy and Public Perception:

  • Vaccine hesitancy has existed but surged in recent decades, notably with the debunked MMR-autism paper and, later, COVID-19.

    “Fundamentally it’s about balancing risk with reward…mothers and fathers would have killed for a vaccine for, you know, measles if they… had access to it.” (Kathryn Olivarius, 22:47) “Of course this took off during COVID especially fueled by social media and by everyone being a sort of armchair physician themselves, becoming a self styled expert.” (Kathryn Olivarius, 23:45)

7. Public Health Beyond Vaccines: Yellow Fever and 19th Century Strategies

[27:50 – 34:23]

• Yellow Fever Immunity as Social Currency:

  • Before the vaccine (1937), immunity was prized in the American South; “immunes” gained economic and social power.

    “If you wanted to be a successful person, you had to demonstrate somehow that you were immune to yellow fever, because otherwise people wouldn’t invest in you, you couldn’t get a job, you couldn’t get credit because you were just considered to be too risky.” (Kathryn Olivarius, 29:14)

• City Public Health Responses:

  • Northern cities (New York, Philadelphia) experimented with quarantine and sanitation; Southern cities like New Orleans often resisted for economic reasons.

    “In New Orleans, essentially the political culture was, we can’t prevent yellow fever. We’re going to throw our hands up. We’re never going to institute quarantines, because they’re unpopular, because they stymie business…” (Kathryn Olivarius, 32:01)

• Investments in Infrastructure:

  • Quarantine stations, public hospitals, and early data collection efforts heralded modern state involvement in public health.

8. Backlash, Vaccine Hesitancy, and Trust

[34:23 – 39:30]

• Backlashes and Distrust:

  • Vaccine resistance is not new and has been heightened by recent events—especially COVID-19.

    “We’ve seen a sort of a massive increase in hesitancy.” (Kathryn Olivarius, 34:39)

  • Cohabitation of vaccine skepticism and suspicion of expertise, exacerbated by rapid science development (e.g., rapid COVID-19 vaccine rollout).

    “It’s the criticism lodged at the COVID-19 vaccinations…that it happened so quickly, it came out so quickly…” (Bob Crawford, 35:17)

• American Exceptionalism?

  • Vaccine opposition exists globally but has taken on a distinctive style and prominence in the US.

    “There’s a particularly American kind of flair right now…The Internet speaks with an American accent, and…the discourse on vaccines very much is always…put through the lens of the American situation.” (Kathryn Olivarius, 37:43)

• Human Perspective:

  • The importance of remembering past tragedy and familial loss when contemplating risks and benefits.

    “It’s…the height of historical arrogance in some sense to say that we know better…She would kill for a vaccine if she possibly could have known what that was.” (Kathryn Olivarius, 39:13)

Notable Quotes

• On early inoculation’s risk and community response:

  “In seeking to cure yourself or seeking to protect yourself long term, you actually then kill yourself. And…many religious people thought…if God wants you to die from smallpox, you should.” (Kathryn Olivarius, 09:36)

• On the political weight of the first mandate:

  “Washington mandated that the entire Continental Army would be inoculated for smallpox…It was kept secret because…being quartered in private homes, it would leave all manner of cities very vulnerable to attack.” (Kathryn Olivarius, 11:31-11:44)

• On the value of modern vaccines:

  “Vaccines are safe, they are reliable…as a historian…if I were to talk to a mom…I feel so much community with that woman…She would kill for a vaccine if she possibly could have known what that was.” (Kathryn Olivarius, 39:13)

• On the uniquely American vaccine discourse:

  “The internet speaks with an American accent…discourse on vaccines very much is always sort of put through the lens of the American…the particular American situation.” (Kathryn Olivarius, 37:43)

Timestamps for Key Segments

• What is variolation and how did it work? – 00:00, 06:34–07:22
• Smallpox, variolation, and first vaccine mandate – 04:26–13:04
• Edward Jenner and the first smallpox vaccine – 13:11–15:26
• Spread and controversy of smallpox vaccine – 15:26–17:06
• Louis Pasteur’s advances: Modern vaccine era – 17:14–20:20
• School vaccine mandates and hesitancy history – 20:20–24:05
• Yellow fever and pre-vaccine immunity culture – 27:50–34:23
• Vaccine hesitation and the COVID-19 era’s impact – 34:23–39:30
• Global vaccine controversy – 37:30–39:30

Memorable Moments

• Description of early inoculation technique:
  The unvarnished explanation of grinding and snorting smallpox pustule material elicits both disgust and awe about early medical ingenuity. (00:00; 06:34)

• Washington’s gamble:
  The urgency, secrecy, and strategic risk of mass inoculating the Continental Army resonated with modern debates on public health and national security. (11:31–12:19)

• Vivid imagery of 19th-century epidemic cities:
  “Every street was essentially just a sewer. So you're in constant proximity…living in urban life at this time.” (Kathryn Olivarius, 33:50)

Conclusion

Kathryn Olivarius provides a comprehensive history of America’s battle with infectious disease, charting a path from crude folk remedies to the public health triumphs (and controversies) of the vaccine era. The story is marked by cycles of fear, innovation, backlash, and ultimately, hope—a reminder that debates over science, individual rights, and the common good are as old as the republic itself.