Vaccine hesitancy as a threat to global health? Rokitansky's De Varioloide Vaccinica-core issues in today's vaccination debates.

This contribution explores Carl von Rokitansky's 1828 dissertation De Varioloide Vaccinica in light of contemporary vaccination debates. At a time when smallpox was still a major global threat and vaccine hesitancy was widespread, Rokitansky systematically analyzed post-vaccination disease patterns. He proposed a differential diagnosis distinguishing between variola vera (true smallpox), variola vaccinica (vaccinal cowpox), variolois vaccinica (mitigated smallpox in vaccinated individuals), and varicella vaccinica (often misclassified chickenpox). Rokitansky anticipated modern immunological concepts such as genetic predisposition, vaccine failure, immunosenescence, and even booster vaccination. His critical yet empirically grounded approach represents a pioneering contribution to evidence-based medicine and immunology.