Vaccines for everyone, for the poor: examples from Pius VII and Pius IX

By Andrea Tornielli

It was 1822. Edward Jenner, the father of modern immunization who created the smallpox vaccine, was still alive when the Papal States, under the leadership of Pope Pius VII, activated a massive vaccination campaign. It was highly encouraged and prepared in detail outlined in a decree signed by the Cardinal Secretary of State Ercole Consalvi. There has been an age-old alliance between the Catholic Church and providing forms of preventive care to prevent the outbreak of epidemics and pandemics. A look at history allows us to better contextualize what Pope Francis has said and proposed regarding the Covid-19 vaccine and what he has put in action in terms of making the vaccine accessible to Rome’s poor and homeless. There is nothing new about the orderly lines of people in the atrium of Paul VI Hall, accompanied by the Cardinal Almoner Konrad Krajewski and welcomed personally by the Bishop of Rome, who are also gifted with a small gift of food.

The Consalvi decree

Between the end of the 18th and the beginning of the 19th centuries, the growth of the smallpox epidemic was alarming in Europe. Central Italy recorded a peak in 1820. The Pontiff did not stand by looking on. Through the legislative provision of 20 June 1822 (recently commented on by Marco Rapetti Arrigoni at breviarium.eu), Pope Pius VII’s Cardinal Secretary of State prepared the vaccination campaign since the Pope had “recently ordered the inoculation with the Smallpox Vaccine in his States”. It is interesting to read these timely words that appear at the beginning of this document regarding smallpox that “maliciously robs man of even a minimal life […] and rages against the human species to destroy it at its infancy. This very sad thought, renewed and provoked each time the disease causes repeated massacres, should have persuaded every person to embrace with the most vibrant enthusiasm and to welcome the vaccinal inoculation with equal gratitude, a method as simple as it is efficacious in stemming the poisonous strength of the illness”.

The “single vaccine test” promulgated by the Papal States two hundred years ago called the vaccine a gift from God, “an energetic means granted by divine Providence as a disposition from the Father’s Love for the salvation of offspring at the dawn of life when it is the object of the most affectionate care, and in assuring the hope of the family and the nation since it was certainly expected that once it had overcome every obstacle, it would have been propagated everywhere with the greatest rapidity”.

But even then, prejudices prevented human lives from being saved. “But surely it is not so”, the text continues. “A prejudice was rooted in some parents that was even stronger than love for their own offspring”.

Vaccination campaign and obligation for doctors

By order of Pope Pius VII, a central Vaccination Commission was created “for the propagation of the vaccinal inoculation throughout the entire extension of the Papal States”. The Commission was in charge of supervising the work of the doctors providing the vaccine “for the proper execution of the vaccinal inoculation” and it established rules “regarding the constant conservation of a deposit of the viral vaccine both in Rome and in all the State’s Provincial Commissions”.

In addition, a consultative Vaccination Council was instituted. Its members were chosen from the professors in the faculties of medicine at the University of Rome and Bologna. Provincial vaccination commissions were instituted in every Legation. They were dependent on the Central Commission with directive and supervisory powers so as to guarantee sufficient availability of vaccines “to distribute them free of charge to all doctors and surgeons in need of them”. Particular attention was paid to children, and the decree provided for an inoculation campaign in orphanages.

Doctors had to be or become experts in vaccination and there was no possibility to be opposed to it or not having experience, to the point that to practice medicine in the Papal States, someone had to attest that they were capable of vaccinating according to Jenner’s method: “Among the prerequisites necessary to present oneself as a Doctor or Surgeon when aspiring to conduct oneself as such, there must be a certificate of knowing well how to execute all that pertains to the administration of the Smallpox Vaccine. […] Without said certificate he cannot conduct himself as a doctor or surgeon”.

Incentives to get vaccinated

The population was called to adhere to the vaccination campaign, and to overcome fear and prejudice. Further legislation specified that to obtain subsidies, benefits or grants, it was necessary to attach “the certificate proving that the applicant, being the father of a family, had been vaccinated”. The “reprehensible conduct” of ‘no vax’ was censured at the time since these people had rejected “the vaccination that would safeguard their offspring and the individuals of the family over whom they govern”. They would thus lose their place in the rankings if they had asked for subsidies: “on the basis of merit, they will be moved back in favor of those who have carefully adhered to it [the vaccination campaign] as objects dependent on Sovereign benefaction”.

Pope Leo XII and ‘no vax’ Belli

This ambitious vaccination program failed to take off, however, because of difficulties in convincing the population to overcome their prejudices. In September 1824, Pope Pius VII’s successor, Leo XII, abolished with a circular legacy the obligation that had been established two years earlier, stating that one could obtain the vaccine that was always free of charge, on a voluntary and optional basis. Welcoming this with satisfaction, Giovanni Gioacchino Belli, a famous ‘no vax’, wrote a sonnet entitled Er linnesto”. In it, he blessed Pope Leo for having “liberated our children” from the smallpox vaccine. Belli attributed the idea behind inoculating against the smallpox virus to the “masons” and lamented the fact that the vaccine replaced the role God had entrusted to Mother Nature and robbed a creature of “the fortune of gaining Paradise”!

Pope Leo’s successor, Gregory XVI, gave new impulse to the vaccination campaign, reinstating a good part of the legislation of Pope Pius VII and Consalvi. In 1834, he instituted the Special Congregation of Health. It was Pope Gregory who made the vaccine obligatory for prisoners in the Papal State’s prisons.

Pope Pius IX offers ‘two paoli’

With the election of Giovanni Maria Mastai Ferretti, the last Pope-king, the vaccination program continued and the campaign to vaccinate the poorest against smallpox was intensified. Faced with the reappearance of the smallpox epidemic, in 1848, Pope Pius IX promoted a vaccination campaign specifically aimed at the most disadvantaged among the population, involving the parishes who were asked to provide the names of those who had been vaccinated. Through a notification dated 23 April, Pope Pius IX also instituted a small cash prize – two paoli – to anyone who returned to their doctor eight days after receiving the free vaccine to verify that it was successful.

This is a working translation of the Italian original