The article is from our special issue on Mpox. You can access the full issue here.

If I were to ask you to picture “Gay Mecca,” you might think of Palm Springs, Fire Island, or a similar place that makes you feel especially fruity. In my experience, the hottest spot for finding ready and willing man-meat was the line for mpox vaccines during the summer of 2022. Energized by personal responsibility and the patriotism of “doing their part,” those men were ready and willing to serve after enduring their preventative prick—and serve they did. But what if I were to tell you that this is just one chapter in a long lineage of fluid-swapping in the name of public health? Let me explain:

What we know today as mpox (formerly monkeypox) is but one variation in the family tree of ‘poxes that have ravaged humanity for thousands of years. Smallpox, the most notorious and deadly of orthopoxviruses, can be traced back as far as ancient Egypt, China, and India around 1100 BC. Between then and its official eradication in 1980, smallpox moved as fluidly along trade routes as the gold that powered them and boasted a mortality rate up to 30% for those infected. Unlike other orthopoxviruses (camelpox, horsepox, cowpox) which spread primarily from animals to humans, smallpox was uniquely devastating because it could be transmitted between humans. Mpox does the same, which is why it has gained so much attention as outbreaks continue. Smallpox killed millions around the globe in its 3,000 year run, but advances in vaccine manufacturing would end its reign of terror.

Our modern-day vaccines are built off the simple premise that our immune systems can adapt to keep us safe from new threats, but only if they’re exposed to the threats in the first place. Modern vaccines contain a small concentration of a dead or inactive virus which our bodies attack as if they are genuine threats. Two things happen here: you get a little sick (your immune system’s “attack” causes typical symptoms of immune activity, like soreness, swelling, etc.) and your body learns how to fight the virus. Once your body has learned to fight, you’re prepared to tackle the real thing if you’re exposed to it.

As early as 1549, the Chinese practiced insufflation, wherein dried and powdered smallpox scabs were inhaled through the nostrils. In India, through a process called variolation, a needle was used to transfer material from smallpox pustules to the skin of healthy children. These techniques may seem wild with the benefit of modern hindsight, but faced with a one-in-three chance of death, I’d inhale as much scab dust as I could get my hands on. Luckily for us, contemporary vaccines are safer, more effective, and have fewer side-effects compared to those of our ancestors.

The first smallpox vaccines were designed from observation: those who survived smallpox didn’t contract it twice. Edward Jenner, the creator of the first smallpox vaccine as we use it today, observed that dairymaids who had contracted cowpox were somehow protected against smallpox. In 1796, he put this information to work with an experiment: he found a dairymaid (Sarah Nelms) with fresh cowpox lesions, sampled some material from them, and used it to innoculate an eight year-old boy (James Phipps). Again, this sounds like mad science from today’s standards, but the resulting smallpox vaccines worked so well that in 1980, smallpox was declared globally eradicated by the WHO.

Now, the smallpox vaccines are doing their magic again—this time, against mpox. Scientists have known since the 1960s that smallpox and mpox responded in similar ways to smallpox vaccines. The first round of smallpox vaccines to treat an outbreak of mpox was deployed in the Democratic Republic of Congo in 1980–1986. Today’s vaccines, notably Jynneos and ACAM2000, are considered effective and safe for preventing the transfer of mpox. Jynneos boasts an efficacy range of 66–89%, based on the three most oft-cited studies, and the single-dose ACAM2000 boasts a similar figure. Of the two vaccines, ACAM2000 “has more side effects.” The connection between smallpox and mpox is distinct and proven, and it is this connection (and the decades of research that have proven it out) that enables us to embrace this protection today.

So with that in mind, get pricked if you haven’t already, and do so with the knowledge that hundreds of years of human ingenuity is on your side.

The article is from our special issue on Mpox. You can access the full issue here.