I would like to clarify that, contrary to your article (The microbes are fighting back, and if anyone thinks there is a simple solution, they are wrong, 25 January), a few decades ago precisely no one in drug discovery thought that the war against infectious diseases had been won. Sir Alexander Fleming, who first discovered antibiotics, warned of microbial resistance and it has been known about ever since.

The reason drug companies have shied away from antibiotic research is, as mentioned in the article, that it is extremely difficult to discover new ones. Unfortunately, a proposal to alter the way new drugs are rewarded will not change this. Every drug company knows that any new, effective antibiotic will be an instant “blockbuster”. The problem is that, even with the best minds in the world, most efforts at discovering new antibiotics will fail. Hopefully some will not, but there is no way to pick a winner until they have gone through the long, exacting, expensive process of clinical trials. We must therefore be willing to pay for research. The “winners” will pay for themselves many times over. But to find out which is the winner, we must pay for the “losers” too.

Dr Dominic Pye

Research chemist, London

• While Edward Jenner (Letters, 26 January) is credited for the smallpox inoculation discovery, actually made by Lady Mary Wortley Montagu while in Istanbul, the real credit lies much further east. The technique was discovered in China and taken by merchants along the silk road. They had developed two methods of administration – either by rubbing some pus from a smallpox lesion (from a mild case) into the scarified skin of a healthy recipient, or by removing the pustular crusts, grinding to a fine powder, and then introducing it into the nostril – with typical Chinese precision, the right nostril for a girl and the left for a boy. Both methods were recorded as being successful, but appear to have been only used by the nobility and moneyed classes.

Jenner received the acclaim and rewards, but this was a period when many people were involved as variolation (using material from active smallpox cases) was quite widely practised. A Mr Fewster, a variolater neighbour of Jenner, read a paper to the Medical Society of London in 1765 titled “Cow Pox and its ability to prevent Smallpox” and Benjamin Jesty claimed to have carried out the first vaccination in 1774. There was much controversy about a public award for Jenner. Eventually Fewster was made an honorary member of the Royal Jennerian Society and Jesty was awarded a gold medal, 10 guineas and had his portrait hung in the society’s headquarters. Jenner received £10,000.

Dr Bruce Vivash Jones

Cirencester, Gloucestershire

• Lady Mary Wortley Montagu was not alone in advocating inoculation against smallpox before Edward Jenner. In Dorset, Benjamin Jesty (1736-1816), like many other dairy farmers, was aware of the immunity from smallpox that prior exposure to cowpox conferred. He successfully treated, among others, his wife and two sons. Vaccination is intrinsically safer than the “variolation” (introducing the virus from a smallpox victim) that Lady Montagu had observed in the Ottoman empire. Presumably the former was forbidden there on religious grounds.

Chris Miller

Portesham, Dorset

• Lady Mary was not the only forerunner of Edward Jenner to develop a safe and effective vaccine against smallpox. John Williamson was a self-educated weaver in Shetland, known locally as Johnnie Notions on account of his many skills and inventions. He somehow devised an effective means of attenuating the material he obtained form the pustules by drying it in peat smoke and burying it covered with camphor. He used it successfully several decades before Jenner in a population with very little immunity to smallpox on account of their remote location, but who had suffered several epidemics in the 18th century with a very high mortality. Like Lady Mary, his ideas were rejected by a medical establishment who refused to accept that anybody not of their number, let alone a humble weaver, could possibly be taken seriously.

Peter Wemyss-Gorman

Lindfield, West Sussex

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