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Online NEWSHOUR Bioterrorism: Smallpox

NOVA Online: Agents of Bioterror: Smallpox

BBC History Silent Weapon

Smallpox eradication poster
Science and Health:
Bracing for Bioterror
More on This Story:
Smallpox Overview

At the U.N. this week, Colin Powell said that terrorists have many weapons at their disposal, including, possibly, bioweapons. But one of the most aggressive public health programs in our nation's history has already begun: millions of smallpox vaccinations.

Smallpox has a long, destructive history. It is believed to be responsible for one of the greatest pandemic death tolls ever. The smallpox vaccine — itself with a long history — opened the door to a world-changing medical practice. Smallpox is the first, and only, disease the World Health Organization has declared eradicated by man. The Variola virus (smallpox) also has a long history of use as a tool of war. All of this history of both fear and progress affects the current discussion about smallpox.

Aztec smallpox
History of a Scourge

Medical historians place the first appearance of smallpox from three thousand to twelve thousand years ago. The disease is thought to have killed millions more than the Black Plague because of its more constant, less cyclic, nature.

Smallpox was one of the deadliest elements of what is known as "The Columbian Exchange" — transfers from Old World to New, and vice versa. Indigenous populations in the Americas had never experienced the disease before the arrival of Spanish and Portuguese explorers in the late 15th Century and thus had no immunity. Deadly smallpox pandemics raged through Mexico and Central America in the 1520s. All the diseases brought (unintentionally) by the explorers are thought to have led to a reduction in native populations of up to 90 percent.

The New World was the place where the smallpox virus was first used as an intentional weapon of war. During the French and Indian War in 1763 the British Commander-in-Chief Sir Jeffrey Amherst wrote to Colonel Henry Bouquet about the using smallpox against Indians:

Could it not be contrived to send smallpox among these disaffected tribes of Indians? We must use every stratagem in our power to reduce them.
Some historians believe that the British again used this tactic during the Revolutionary War in the battle of Quebec. In December of 1775 the British commander is said to have immunized civilians and sent them out to the American ranks in order to infect them. Whether or not deliberate biological warfare was practiced, smallpox had a devastating effect on the American troops. Elizabeth Fenn has shown in her recent work, POX AMERICANA: THE GREAT SMALLPOX EPIDEMIC OF 1775-82, that the disease was so prevalent that George Washington contemplated inoculating the troops.
The Waggon Masters and Company of Carpenters in Boston, to receive and obey all such Orders and Directions, as Brigadier General Green shall think proper to give The Hospital and Regimental Surgeons to examine carefully the state of their sick, and whenever they discover the smallest Symptom of the smallpox, they are without delay to send the patient to the small-pox Hospital in Cambridge. --George Washington, March 25, 1776, General Orders, Library of Congress

Precautions like Washington's wartime orders were reflective of previous Colonial quarantine policies — smallpox crises led to the first public health laws in American history.

  • BBC History - Silent weapon: smallpox and biological warfare
  • The Columbian Exchange, Native Americans and the Land, Nature Transformed
  • PBS: Conquistadors

  • First Vaccination
    History of a Vaccine

    Inoculations against smallpox has a long history in folk practice. The young Emperor of China had smallpox scabs blown into his nostrils to protect against the disease. Inoculation, or "variolation," gave the patient, hopefully, a mild case of the disease and built up immunities.

    Inoculation in Western Europe owes a great deal to Lady Mary Wortley Montagu, who lost her famed beauty to the disease as an adult. When Lady Mary moved with her ambassador husband to Turkey in 1717 she observed a local custom:

    There is a set of old women, who make it their business to perform the operation, every autumn, in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox; they make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. She immediately rips open that you offer to her, with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much matter as can lie upon the head of her needle, and after that, binds up the little wound with a hollow bit of shell, and in this manner opens four or five veins.
    Montagu had her son inoculated in Turkey in 1717 and insisted that an English physician inoculate her daughter upon their return to England in 1721.

    The real breakthrough came in the late 1790s thanks to a cow named Blossom, a dairymaid named Sarah Nelmes, eight-year-old James Phipps, and Dr. Edward Jenner. Jenner had noted that milkmaids, among others, who caught the cowpox from their animals rarely sickened with smallpox and resolved to test cowpox as a protection against smallpox. Jenner took material from Sarah's cowpox and introduced it into scratches on James' arms. He thus invented "vaccination" — a word whose root comes from the Latin for cow. (See how vaccines are made.)

    The course of the vaccine was not smooth. There were noted protests from skeptics, like artist James Gillray's famous "The Cow-Pock, or, the Wonderful Effects of the New Inoculation," in which patients become bovine. But the royal family themselves submitted to vaccination and by 1840 variolation was forbidden, in 1853 vaccination mandated. Smallpox vaccination was the cause of Harvard physician Benjamin Waterhouse who began his campaign in 1800.

    The smallpox vaccine was never without dangers. Learn more about the contemporary vaccine here.

  • Lady Mary Wortley Montagu's letter
  • The Edward Jenner Museum
  • Edward Jenner and the Discovery of Vaccination
  • "To Slay the Devouring Monster: The Vaccination Experiments of Benjamin Waterhouse," Countway Medical Library, Harvard University
  • NOVA Online: Making Vaccines: Smallpox

  • Pro-vaccination Protest

    Even with Jenner's breakthrough smallpox remained deadly — killing at least three hundred million people in the 20th century. In 1958 the Soviet Union proposed that the world attempt to rid itself of smallpox. In that year there were still 280,000 cases in 63 different countries. A small campaign was started by the World Health Organization (WHO) the following year. By the mid-1960s it was clear that vaccination alone would not suffice and WHO began a ten-year program that combined vaccination with education. WHO also inaugurated a strategy of containment — reacting quickly to outbreaks to create a disease firebreak with isolation and vaccination.

    The last two cases of the two main strains of human smallpox were found in Bangladesh in 1975 and in Somalia in 1977. The World Health Organization declared the disease eradicated in May of 1980. The program is estimated to have cost $112 million. The organization's article "A Victory for All Mankind" ended with these words: "Now the chapter entitled 'smallpox' is closed — let us hope for ever." Smallpox stocks remained in 75 labs in several countries.

  • "Smallpox is Dead," WORLD HEALTH MAGAZINE, 1980
  • World Health Organization: Smallpox

  • Headline
    Soviet Bioweapons Program

    The Geneva Protocol, which prohibits the use of biological and chemical weapons, was written in 1925 as a reaction to the devastating use of chemical agents in World War I. Research on such weapons was not prohibited. In 1969 President Nixon did away with the U.S. biological weapons program, and asked the world to follow suit. And in 1972, the United Kingdom, the United States and the Soviet Union all signed the Biological Weapons Convention.

    The WHO eradication program requested that all but two tiny samples of the virus be killed off. These were locked away for possible future research — one at the Centers for Disease Control in Atlanta, and another at a similar lab outside of Moscow. Secretly, the Soviets continued research. Not much was known about the program for many years, although there were clues. In 1979 there was an unexplained anthrax outbreak in Sverdlovsk, which the USSR blamed on tainted meat.

    Then in 1989 a defecting Soviet biologist named Vladimir Pasechnik told British authorities that the USSR had biological weapons pointed at the U.S. Great Britain and the U.S. confront then Soviet leader Gorbachev and demand inspections.

    They begin their inspections in 1991 and made disturbing finds (detailed in the articles below.) In 1992 Dr. Kanatjan Alibekov defected to the United States, bringing with him details of a complex biological weapons program. The combined pressure of the inspections and defections led President Yeltsin to admit that the anthrax outbreak of a decade before was indeed the result of a military accident.

    Investigative journalists Richard Preston and Shannon Brownlee were reporting on the implications of the Soviet program in the late 1990s, long before the spectre of such attacks was heightened by September 11.

  • Richard Preston, "The Demon in the Freezer," THE NEW YORKER, July 12, 1999
  • Shannon Brownlee, "Clear and Present Danger," THE WASHINGTON POST, October 28, 2001
  • FRONTLINE: "Plague War Timeline"
  • World Health Organization, "Smallpox Eradication: Destruction of Variola virus Stocks," December 23, 2003

  • Soldier being vaccinated, AP
    Smallpox 2003

    On December 13, 2002, President Bush announced an ambitious smallpox vaccination plan. Smallpox Response Teams of health care and emergency workers would be created, and members vaccinated for the disease. The government also announced the restarting of vaccination for Department of Defense and certain overseas government personnel. The Centers for Disease Control (CDC) who will administer the program, assures visitors to its Web site that the government is not recommending vaccination for the general public at this time. However, "the United States currently has sufficient quantities of the vaccine to vaccinate every single person in the country in an emergency."

    On January 6, 2003, Ceci Connolly reported in THE WASHINGTON POST that the administration's smallpox vaccination program is lagging behind schedule. Two weeks after its start only 432 people out of the anticipated 10.5 million have been vaccinated. Many, according to Connolly, are refusing the vaccine because of fears of complications and liability questions.

    The administration's plan is expected to run into the millions of dollars. In 1980, WHO estimated the that before eradication smallpox protection cost the United States about $150 million a year, in 1980 prices.

    A recent study published in the NEW ENGLAND JOURNAL OF MEDICINE showed that many Americans fear bioterrorism and especially smallpox, but also have many misconceptions about the disease and the vaccine.

  • Robert J. Blendon,, "The Public and the Smallpox Threat," NEW ENGLAND JOURNAL OF MEDICINE, January 30, 2003
  • Ceci Connolly, "Liability Fears Grow on Inoculations," WASHINGTON POST, January 6, 2003
  • Ceci Connolly, "U.S. Hopes Incentives Will Push Vaccine Development," WASHINGTON POST, January 30, 2003
  • "Smallpox as a Biological Weapon, Medical and Public Health Management," JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, June 9, 1999
  • World Health Organization, "Smallpox Eradication: Destruction of Variola virus Stocks," December 23, 2003

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