When Smallpox Struck
During The Revolutionary War
By Tina Rosenberg
Editorial Observer

The year 2001 is not the first time in history that war and fear of disease and bioterror have gripped Americans at home.
The country was born amid all three. Smallpox killed at least 130,000 North Americans during the Revolutionary War, writes the historian Elizabeth Anne Fenn in her new book on the epidemic, "Pox Americana."
The jumpy American populace of that era stayed out of crowded places and sought to avoid trips to major cities. The mail was suspect ó Gen. George Washington decreed that letters from Boston had to be dipped in vinegar to kill any germs. Americans also worried about terrorism. In 1763, the British had deliberately infected Indians threatening the safety of Fort Pitt. There was evidence during the war, taken seriously by General Washington, that the British were deliberately spreading smallpox to American troops.
The Americans, then as now, appealed to international public opinion. "Lord Cornwallis' attempts to spread the smallpox among the inhabitants in the vicinity of York . . . must render him contemptible in the eyes of every civilized nation," said The Pennsylvania Gazette.
The world described by Ms. Fenn is far removed from ours, but the experience of smallpox during the Revolutionary War bears relevant warnings. The factors that created a virulent epidemic then are even more present today.
Smallpox was particularly devastating in the Colonies because the disease was not endemic here. Unlike Europe, America did not have large numbers of people who had survived childhood smallpox and therefore were immune for life. To create immunity, Americans turned to variolation, in which smallpox was inserted through the skin. No one knows why variolation works, but it produces a mild form of smallpox with a fatality rate of only 1 percent instead of 30 percent. This inoculation, however, was available mainly to those who were rich enough to pay a doctor.
Outside of health workers and a few others who might have to confront smallpox, no one in the world today has been vaccinated recently enough to provide complete immunity, as the vaccine is fully active for only about 10 years. American vaccination stopped in 1972, and the practice ended globally after the disease was declared eradicated in 1980. Nor are there many people who had the disease as children. If a suicide terrorist in the throes of fever and pustules staggered onto the subway or left an infected blanket, the virus would find a congenial host in anyone it met.
Those infected, moreover, could spread infection around the globe. Colonial America found that the dislocations of war spread disease. Armies on the march, populations fleeing the conflict and demobilized soldiers all helped propel smallpox through a sparsely populated land. Today the population is larger and closer together. As smallpox sufferers take 10 days to show symptoms, they can travel by air and put at risk countries that lack the United States' current stockpile of 15 million doses of vaccine ó a number that will swell to 300 million within a year.
Three years ago, the World Health Organization polled nations on their vaccine stocks and counted 90 million doses worldwide, although the potency of some is in question. Which countries have the vaccine is secret, but they are probably wealthy ones, and there would be considerable political resistance to sharing precious vaccine with other nations if an outbreak occurred. The W.H.O. itself controls 500,000 doses, but this would be quickly used up in a major epidemic.
The vaccine imbalance would echo another characteristic of smallpox in Colonial America ó the poor suffered more. The variolation available to the rich ended up making things worse for those who could not afford to buy immunity. Normally smallpox sufferers become contagious just at the point when they feel too ill to be in public. But people undergoing variolation felt well enough to be out and about ó while fully contagious. Nations with no vaccine stocks and a poor public health system would likely suffer more from smallpox than the intended targets of bioterrorism.


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