The ScotPublicHealth blog was born in 2015. It was established to provide a space for Public Health reflections relating to Scotland. In 2016 we ran a series of webinars, bringing people together from across the country and beyond. I then took a series of diversions – into quality improvement, General Practice and Twitter analysis. X (formerly Twitter) no longer provides the means for social network analysis, so the blog entered a hiatus from 2021.
I have tidied up the blog, archiving most of the old content, including the Twitter analysis. Please get in touch if you would like access to any of that old material.
So we’re back looking at Public Health.
I thought that it would be timely to talk about vaccine misinformation, disinformation and malinformation. The WHO has a useful summary of the first two terms. The main point is that misinformation is the spread of false information without the intent to mislead, while disinformation is designed or spread with full knowledge of it being false. Malinformation can be “any type of true content used to cause harm“, for example by quoting it out of context. Each of these can be difficult to counter and can impact very significantly on vaccinators, other healthcare staff and vaccine uptake.
I stumbled across a great example of vaccine misinformation on call last weekend when looking up jazz trumpeter Cootie Williams (1911-1985) during an idle moment. He rubbed shoulders with Duke Ellington and Benny Goodman in the 1930s and 1940s. Flicking through his Wikipedia entry I saw mention of a track called Cowpox Boogie. A number of different webpages claimed that he had contracted smallpox infection from smallpox vaccination, which is not possible. I could not, however, find any posts or articles countering the claim.
The erroneous claim is particularly ironic given the nature of smallpox vaccine and its central role in establishing vaccination more generally in the UK and further afield, saving hundreds of millions of lives in the process. Smallpox was a particularly unpleasant disease causing disfigurement, life-long disability and mortality (in the 18th century estimated at 10-30% of cases). Truly a high consequence infectious disease, with impact across the world for 3-4,000 years. Jenner was not the first to vaccinate people against smallpox, but his proposal was very widely discussed, with early examples of mis-, dis- and no doubt mal- information. Smallpox vaccine was the subject of the famous picture by satirist James Gillray, showing people with bits of cows growing out of various parts of their body, ridiculing the claims against the vaccine but also capturing the anxiety in a section of society. The much longer history of the earlier discovery of smallpox vaccination in other cultures is well worth a read.
Gillray’s classic cartoon – The cow-pock,-or-The wonderful effects of the new inoculation! – Vide – the Publications of ye Anti-Vaccine Society (1802)
It is two hundred and thirty years since Edward Jenner first vaccinated a child with the cowpox virus (James Phipps, 14 May 1796), successfully protecting him from the smallpox virus. Jenner’s proposal was to use pus from the hand of a milkmaid called Sarah Nelmes who had caught cowpox from a cow called Blossom. Jenner had observed the protection against smallpox that cowpox infection offered to dairy workers. The word vaccination is of course directly derived from the Latin for cow (vacca). Though the mechanism was not understood at the time, this exposed James Phipps to the cowpox virus, stimulating an immune response that was also protective against smallpox. Phipps developed a scab and slight fever, recovered well, and did not contract smallpox infection a few weeks later following exposure in a further experiment by Jenner. The coxpox virus was finally isolated in 1937.
Compulsory smallpox vaccination had been introduced in England and Wales in 1853 and in Scotland in 1864. The twists and turns of vaccine development in the 19th century meant that by 1937 the smallpox vaccine was based, as it is now, not on cowpox but a related orthopoxvirus called vaccinia. Successive generations of smallpox vaccine have been developed since, with the current version rendered “replication-defective“. It is not possible to catch smallpox from vaccines based on the vaccinia virus – or historically the cowpox virus – modified or otherwise.
Back to Cootie Williams. In 1947 the band leader was worried about the smallpox outbreak in New York, March-April. Over 6 million people in New York were vaccinated over a short period, and the outbreak was contained to just 12 cases, 2 of whom died. A newspaper article a few weeks later pokes fun at Williams for forcing his band members to get vaccinated only to succumb to the smallpox infection himself. The article does not make a direct causal link between the two, but several social media posts and websites have made that leap subsequently.
Source: Afro American, 3 May 1947.
So, what might have happened? Some people developed fever and rash following smallpox vaccine, and this was potentially more likely with earlier generations of the vaccine. But the implication from other sources is that he was quite unwell, enough to want to mark the period and his recovery with this new tune. If it was smallpox infection, it was not due to the vaccine and he could not even have contracted the infection while waiting in the queue to be vaccinated. The incubation period of smallpox was 7 to 19 days, with an average of 10 to 14 days and we know he became unwell two days later. So if William did catch smallpox, he must have contracted it well before he and band mates attended for vaccination. But the story is out there now. Curiously I have not been able to find a recording of Cowpox Boogie. Please let me know if you track one down.
Smallpox infection was finally eradicated in 1977 (with the exception of a lab worker in 1978 who contracted smallpox after a workplace accident), with eradication marked formally in 1980. It is still the only infectious disease in humans to have been eradicated.
So how do we counter mis/dis/ mal- information about vaccination? It is unlikely that people repeating and embellishing claims about Cootie Williams and smallpox vaccine will be persuaded to take down their Facebook posts and amend websites and books. If we do come across people questioning the safety of the vaccine – e.g. when offering vaccine for mpox protection – we can easily point to information in the Green Book, patient-facing literature and other sources that explain clearly that Modified Vaccinia Ankara (MVA) vaccine – and indeed earlier smallpox vaccines – do not and could not cause smallpox infection.
More generally, when coming up against vaccine hesitancy or outright antivaxx sentiment we can draw on the 5C model. Of course each strand of this model takes very considerable, continuous and repeated effort across the health service and beyond. We can use such approaches, for example, when discussing MMRV versus MMR, a topic well covered here.
The TURAS website also has a useful set of resources including the CASE model (corroborate, about me, science, explain).
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Graham Mackenzie, Consultant in Public Health Medicine, 13/7/2026
