When in 1798, Edward Jenner propagated vaccination with variolous material from cows, critics spread the fear of beastly consequences for the patients. However, smallpox (Variola) itself was far more dangerous, being the cause of 40 percent of infant mortality. This is why emperors as Catherine the Great already many decades before Jenner’s research endorsed inoculated variolation. To encourage others, she and various European sovereigns had the image of anti-pox-prophylaxis minted to the reverse side of medals. By using this medium they followed a common tradition of communication set by the emperors of antiquity. The new medals were spread to honour doctors and to reward families. Based on the numismatic collection of the German Museum for the History of Medicine in Ingolstadt, this contribution discusses the characteristics of the pestilentia in nummis and how it changed from inoculation to vaccination, from commemorative pest-medal to patient’s reward coin, from the mid-18th century to the 19th century.