SmallpoxinRio

"The Compulsory Vaccine" - Odeon Disc R 40.169 - Mário Pinheiro - 1904

The presence of smallpox1 in Rio de Janeiro is intertwined with the history of the city. The first record of the disease in Guanabara Bay occurred during the French expedition, in late 1555, when some settlers reported an outbreak of cases that lasted until 1562. This epidemic caused the death of more than 30 thousand village-dwelling indigenous people, which drastically reduced the population of the Jesuit villages near Rio de Janeiro.

Missionaries blamed the disease itself on the sick person, as divine punishment for sins committed. The book Várias receitas, prepared by Jesuits and published in the 18th century, recommended that the sick rub fresh horse excrement on their skin, use a mixture of red poppies, preparations made with parts of animals' digestive systems, and resort to prayers and bloodletting. These prescriptions had a dual function: to cure the sick person while also punishing them for their sins, in a process of purification.

Cartoon against the mandatory vaccine campaign: "Na hygiene dando ordens." Casa de Oswaldo Cruz Collection.

Image description: This is a black-and-white cartoon. At the top, there is text mentioning "Semanario Humoristico" and "Encriptorio e Redacção Rua da Assembleia." Below that, it reads "Na hygiene Dando ordens." The cartoon shows a large, caricatured figure holding a syringe and a toothbrush. This figure is wearing a military uniform and has a mustache. The other, smaller figure is wearing a hat and appears to be cleaning something with a toothbrush. There is also a bucket of water on the floor. In the bottom corner, there is a signature and the date "1934."

In 1641, the city experienced a new smallpox outbreak, the result of countless voyages to the Angolan coast – a region known as the quilombo dos corvos, which had experienced epidemics of the disease since the late 1620s. Smallpox was nothing new to Africans, so much so that members of various ethnic groups who arrived in Rio brought with them deities associated with the illness, as well as their own methods of healing and treatment. However, this disease was not restricted to Africa. The earliest records of it were found in Asia around six thousand years ago, and it was already present in Europe before its arrival in the Americas.

In the 17th century, those most affected by the disease were enslaved people who, due to the poor conditions of the voyages on slave ships, arrived infected and died soon after disembarking in Rio. The rising number of infections over the years created the need for more space to bury the dead. In 1665, the Franciscans built a cemetery in the southern part of Largo da Carioca, near the port, to bury deceased enslaved people. The high mortality rate caused by smallpox among the enslaved population gave rise to a racist social stigma that the disease was brought by Africans. However, these numbers were higher among enslaved people because of the poor living and working conditions to which they were subjected.

The disease persisted through the 18th and 19th centuries. Between 1834 and 1835, smallpox claimed countless victims in the city. In 1838, it ravaged the neighborhoods of Prainha, Valongo, Saúde, Gamboa, and Saco dos Alferes.

E comecei eu também a indagar, a querer saber. Então, continuava? Como era? Como se morria de bexigas? As pessoas ficavam muito coradas, sentiam febre. Havia várias espécies. A pior é a que matava sem rebentar, matava dentro, dentro da gente, apodrecendo em horas!

The first vaccine would arrive in the early 1800s, imported from England. In 1811, the Vaccination Institution Board was created in Rio de Janeiro, implementing several actions to control the epidemic, among them the enactment, in 1832, of the law that made child vaccination mandatory. Despite these efforts, the disease still claimed many victims, being responsible for a substantial number of deaths.

At the beginning of the 20th century, amid the outbreak of yellow fever and bubonic plague, cases of smallpox rose dramatically2. In January 1904, the director of public health, Oswaldo Cruz, launched a major vaccination campaign to eradicate the disease, but the mood was tense in the capital of the Republic. Since the late 1890s, Rio de Janeiro authorities had been carrying out urban interventions that resulted in the destruction of several town houses and tenements and drove the working classes out of the city's central region. These interferences heightened the population's hostility and generated a certain resistance to the vaccination campaign. One of the issues was the procedure used in vaccination: the needles were very thick, and it was sometimes necessary, in the case of women and children, to inject them in the buttocks. When administering the immunizing agent, skirts had to be lifted or trousers lowered, something that outraged heads of household, who regarded the action as an assault on decency and an affront to morality.

Cartoon O Malho, 10/29/1904 - Issue 111, p. 14 Acervo Fundação Biblioteca Nacional - Hemeroteca Digital

Image description: This is a black-and-white cartoon, dated October 29, 1904, published in issue number 111 of "Memórias" magazine, page 14. The cartoon depicts a scene of protest against mandatory vaccination. At the top, there is a title that reads "VACCINE-COMPULSION WAR!". In the center, a doctor in military uniform is being attacked by a crowd. The people are holding objects such as axes, knives, and bottles. On the left, there is a line of people wearing hats and bandanas, holding signs that read "MANDATORY VACCIN...". In the background, buildings can be seen with open windows, with people looking out. Below the cartoon, there is an explanatory text about the event.

On October 31, 1904, the city council approved mandatory vaccination and, nine days later, the Rio newspaper A notícia published the law's regulations, establishing that only individuals who could prove they had been vaccinated would have access to employment contracts, school enrollments, marriage certificates, travel authorizations, among other legal documents. The news triggered several conflicts in the city, which became known as the Vaccine Revolt. On November 16, a state of siege was declared, along with the cancellation of mandatory vaccination. After that, the law was amended and the vaccine became optional.

Image description: This is a black-and-white cartoon. The central figure is a man with smallpox, depicted through spots on his skin. He is sitting in a chair, with one hand raised and the other resting on his knee. The man's face and body also display spots characteristic of the disease. At the bottom of the image, there is a caption written in Portuguese.

In the early 1920s, health services underwent a restructuring (the Carlos Chagas Reform) that resulted in the creation of the National Department of Public Health (DNSP), which later gained ministry status under the government of Getúlio Vargas. This department was responsible for creating several health campaigns to raise awareness about hygiene education among the population and to promote smallpox vaccination. Despite the various campaigns promoted by the DNSP and the Ministry of Education and Public Health, Brazil ended the 1950s as the only country in the Americas that still had records of local cases.

Image description: This is a black-and-white photograph showing two people in an urban setting. On the left side, a man is standing, wearing a floral-patterned shirt. He is holding a medical device, possibly a thermometer or a diagnostic instrument, near the neck of a seated woman in front of him. The woman has her back to the camera, with short hair and a simple blouse. She appears to be receiving medical care. In the background, there are residential buildings with several windows and roofs, along with trees and vegetation.

Throughout the 1960s, the fight against smallpox gained global prominence. International organizations launched campaigns to eradicate the disease. In 1962, the National Campaign Against Smallpox (CNCV) was created here, whose mass vaccination plan involved state agencies and the Ministry of Health. Amid the political instability that marked João Goulart's government, the implementation of the plan did not achieve great success. In 1966, following new international agreements, the Brazilian government took on the eradication of smallpox as a goal and replaced the CNCV with the CEV – Smallpox Eradication Campaign.

Image description: This is a black-and-white illustration depicting a cartoon. At the top, it reads "REVISTA DA SEMANA." At the center, there is a man wearing a suit and top hat, pointing to the left. Behind him stands a skeletal figure with the word "VARIOLA" written on its garment, holding out a bony hand. In the background, there is a landscape with crosses in a cemetery. Below the cartoon, it reads "AO 'HEROE DOS MOSQUITOS'."

Among the measures taken by the authorities was the requirement of the vaccination card, both nationally and for travel to other countries. The campaign relied on two fronts: vaccination and awareness advertising. Health educators visited homes distributing booklets and pamphlets, local radio stations spread the word about the importance of the vaccine, and the responsible agencies carried out mass vaccination. Legislation was enacted to ensure vaccination and revaccination, requiring the presentation of the certificate in order to obtain any public document, to receive salaries, to enroll in schools, and to travel abroad. This time, there was no resistance from the population, especially since these restrictions did not affect most of the population, who neither had official documents nor intended to travel internationally.

1977 smallpox vaccination campaign. Agência Nacional Collection/Arquivo Nacional

The last 19 cases of the disease occurred in Rio de Janeiro, in Vila Cruzeiro, a neighborhood in Penha, in April 1971. Although the disease had been eradicated, smallpox vaccination remained mandatory until 1975.

The experience of combating and controlling smallpox left an important legacy, as it enabled a deeper understanding of strategies for fighting other diseases that are still used today in public health policies.

The disease is characterized by a viral infection transmitted through contact with secretions, saliva droplets, skin, and contaminated surfaces. The infected person experiences body aches, fever, and eruptions of blisters and pustules on the skin.

In the short story "The Plague," published in 1910 in the collection Dentro da noite, the chronicler João do Rio described the sanitary chaos caused by the epidemic.