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A Pox on...

I remember getting in line and preparing for pain. I didn’t look as they jabbed my upper arm repeatedly with a needle. It hurt, and during subsequent days the wound reddened and festered into a blister that soon scabbed over and healed, leaving a circular scar that indicated I had been vaccinated against smallpox. That was back in the late ’50s. There were still cases of the disease in the world at that time, though none had been reported in the United States for more than 10 years.

When the Bush administration announced its smallpox plan on Dec. 13, it got me thinking back to this childhood memory. It also got me thinking about the history of this scourge, and wondering why it had replaced anthrax as George W.’s “bioterror disease of the year.”

Smallpox (variola virus) began infecting humans between 3,000 and 12,000 years ago. Some think it first struck northeast Africa; others think China or the Indus Valley. Regardless of where this occurred, the parasitic virus soon developed an exclusive preference for humans. It became dangerously contagious as people began to practice agriculture and settle down into villages, towns and cities. Epidemics of the disease would periodically break out with devastating results: It has been estimated that virulent outbreaks in the 18th century alone led to the deaths of 60 million Europeans.

The disease was introduced to the New World by infected Spanish conquistadors. Smallpox epidemics often flared up in the New World’s native peoples following contact with Europeans. The disease was a major contributor to precipitous population declines that followed contact. For example, within 10 years of contact with Cortez, the native populations of Mexico dropped from an estimated 25 million to six-and-a-half million.

Smallpox apparently got its first duty as a biological weapon in the 18th century when the British used infected blankets against natives during the French and Indian War. The disease would later follow the trade and exploration routes across North America, leaving vast numbers of dead Indians in its wake.

In 1796, English country doctor Edward Jenner performed the first vaccination against the disease after observing that cow milkers who had been exposed to cowpox (vaccinia virus) did not come down with smallpox. Jenner took some exudate from a person infected with cowpox and infected a healthy person with it. His research found that going through the relatively mild discomfort of cowpox resulted in immunity to the closely related smallpox virus. Jenner called his breakthrough procedure “vaccination,” a term derived from the Latin word vaccinus (“relating to cows”). Vaccinia is still used as the live virus in smallpox vaccine today.

Jenner’s smallpox vaccination procedure was simple, and its use rapidly spread. The procedure was adopted in the United States in the early 19th century, and vaccination against the disease was quickly promoted. Whether the U.S. military intentionally exposed Native Americans to the disease has been hotly debated, but the history of U.S. immunization policy tends to support the claim that smallpox was employed as a weapon of genocide. The U.S. government waited 20 years after it mounted an aggressive vaccination program for whites before native peoples were afforded its lifesaving benefits.

In 1967, the World Health Organization, shifting from mass vaccinations, began to target actual infections and vaccinate only those in the area where infections occurred. This focused international effort ultimately led to the disease’s eradication in 1979. The last known naturally occurring case of smallpox was reported in Somalia on Oct. 26, 1977.

While the disease was eradicated in nature, two countries kept the deadly virus alive for “research purposes”—Russia and the United States. Concerns that the virus might fall into the hands of terrorists prompted the W.H.O. to call for the destruction of all smallpox stocks. George W. ignored this important issue in his smallpox plan, providing no details about when the United States will destroy its virus stock. Instead, he called for the immediate vaccination of military and health-care workers.

The vaccine now stockpiled is unlicensed and has not been subjected to, nor would it likely pass, the Food and Drug Administration’s vaccine-testing requirements. The military and health-care workers to be vaccinated will serve as guinea pigs. Due to the wide range of ill effects associated with the vaccine’s live vaccinia virus (based on research done back in 1968!), George W. and gang have gone to the extraordinary length of absolving those who produce and administer it from liability for any resulting harm. Section 304 of the Homeland Security Act leaves the U.S. taxpayer holding the bag for vaccine-related injuries and deaths.

The Centers for Disease Control and Prevention recommends that persons who have ever had skin conditions such as eczema, dermatitis or severe acne, those with weakened immune systems, pregnant and breast-feeding women and children under 18 years of age should not be vaccinated. Women are also warned that conception within four weeks after vaccination could result in miscarriages and stillbirths.

It seems to me that real security from smallpox can be achieved only through the destruction of existing disease stocks. Ironically, the vaccine currently promoted for such security has a higher risk for injury and death than that presented by the current threat of smallpox. The funds and human resources being channeled into George W.’s smallpox program also drain resources from other far more appropriate public health efforts against the real epidemics and health care problems before us. When offered a smallpox vaccination, I’ll just say “No.”

—Tom Nattell

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