U.S. Public Health Service

The last known case of smallpox occurred in 1978. Virtually no one has been vaccinated in the United States since 1972.

I live in Tallahassee, Florida, not far from the state Supreme Court Building. During last year’s election fiasco, it was surrounded by TV satellite hook-ups and reporters doing live broadcasts, and we in Tallahassee took to calling it “ground zero.” I drove my two young daughters by so they could see a piece of history.

September 11 left us all with a new ground zero. But events were not done with Florida. Soon after the attacks in New York and Washington, the FBI established a Florida connection. With its flight schools and its anonymous, everybody’s-from-somewhere-else apartment complexes, our state was found to be the staging area. And now, a few weeks later, Robert Stevens is dead, seven other people in Boca Raton have tested positive for anthrax, and we’re all starting to realize that from now on ground zero might be anywhere. Everyone is skittish. Hourly, it seems, we have to decide again whether we’re being cautious or alarmist. Should we fly or not? What do we say to our kids? What should we believe? What should we fear?

I fear smallpox. I’m not too keen on flying, and anthrax has everybody worried right now, but it’s smallpox that really scares me.

Anthrax is awful, but smallpox is worse. Unlike anthrax, it’s contagious, very contagious. “It spreads like wildfire,” says Peter Katona, a consultant to Los Angeles on bioterrorism and assistant professor of medicine at UCLA. “There are cases where people were walking down the street a hundred yards away, outside a building, and they got it.”

It’s also deadly. Smallpox has killed more people than any other disease in history, including bubonic plague. At least 300 million people died of smallpox in the 20th century alone. Even with modern medical care, smallpox kills about a third of the unvaccinated people it strikes. There are no mild cases. Survivors are left scarred, and sometimes blind or with deformed bones. But one of the great victories of 20th century science was the eradication of smallpox. The last known case occurred in 1978. The hitch is that once the disease was wiped out, routine vaccinations stopped. Virtually no one has been vaccinated in the United States since 1972, and most of us who were vaccinated back in the ’60s could now contract the disease because immunity does not persist permanently. It’s estimated that only 10 to 15 percent of the U.S. population has residual immunity. In June 1999, experts meeting at the Centers for Disease Control and Prevention in Atlanta unanimously agreed that, followed by anthrax, smallpox was the greatest bioterrorist threat to the United States.

It is some comfort that Secretary Tommy Thompson recently named Dr. D.A. Henderson to chair the Health and Human Services advisory council on bioterrorism. Henderson is the Johns Hopkins researcher who led the World Health Organization’s successful campaign to eradicate smallpox, and no one understands smallpox better than he does. For many years, he has been writing about the real and immediate dangers posed by bioterrorism. He has argued for the stockpiling of drugs and vaccines, the training and mobilization of health workers, the education of the public, and the need to build an international consensus against the use of biological weapons. “We are ill-prepared to deal with a terrorist attack that employs biological weapons,” Henderson declared in a 1998 article in the journal Emerging Infectious Diseases. “The specter of biological weapons use is an ugly one, every bit as grim and foreboding as that of a nuclear winter.”

Regarding smallpox specifically, Henderson warned: “If some modest volume of virus were to be released (perhaps by exploding a light bulb containing virus in a Washington subway), the event would go unnoticed until the first cases with rash began to appear 9 or 10 days later.” Because hardly any doctors have ever seen smallpox, and so few laboratories can test for it, several more days might go by before the first diagnosis was made. If only 100 people were originally infected, Henderson wrote, tens of thousands, including many unsuspecting hospital personnel, could have been exposed by the time the epidemic was identified. Hospital isolation wards and our national stores of vaccine would at that point be sorely tested.

This scenario had me quaking, and yet there was a sentence in his article that seemed to contain an oversight that set me thinking down some new and troubling channels. Reminding us that his Washington subway scenario was still speculative, Henderson emphasized that neither smallpox, anthrax nor the plague “has so far effectively been deployed as a biological weapon, and thus no real world events exist to provide likely scenarios.”

First of all, I thought about the recent anthrax outbreaks and was somewhat comforted. The attacks, while deadly, so far have been pretty limited in scope. But then my mind turned again to smallpox, and I recalled the effects of smallpox on America’s native population during the first centuries of European settlement. I thought about Fort Pitt, Lord Jeffrey Amherst and the tribes of the Ohio River Valley.

In the early 1760s, immediately following the French and Indian War, Ottawa Chief Pontiac pulled together a coalition of tribes intent on driving the British from the Great Lakes region. Angered by the British refusal to distribute (as the French had) gun powder and ammunition for hunting, and by the British plan to seize Indian lands, Pontiac’s warriors began to attack British troops and settlers in the spring of 1763.

At about the same time, smallpox broke out among the soldiers and civilians inside Fort Pitt, the site of present-day Pittsburgh. During May and June, nine forts fell to the Indians, leaving only Fort Detroit and Fort Pitt in British hands. On June 24, a small delegation of Delaware Indians brought news of the British losses to Fort Pitt and advised Simeon Ecuyer, captain of the fort, to surrender. Having already been notified by a messenger from Fort Detroit that Col. Henry Bouquet was on his way with reinforcements, Ecuyer attempted to buy time by putting the Delaware off. He sent them away with “two Blankets and a Handkerchief out of the Small Pox Hospital.”

His ruse apparently worked. For the next year, smallpox, resulting at least in part from these “gifts,” spread down the Ohio, devastating Mingo, Delaware, Wyandot and Shawnee villages. Eventually the epidemics traveled down the Mississippi, affecting Creek, Choctaw and Chickasaw Indians in what is now Mississippi and Alabama as well as some native people in the American Southwest.

Ecuyer and others at Fort Pitt apparently hatched the smallpox plan on their own, but the commander-in-chief of British forces in North America, Lord Jeffrey Amherst, certainly would have approved. He was corresponding with Bouquet at the same time, asking “Could it not be contrived to send the Small Pox among those disaffected tribes of Indians? We must on this occasion use every stratagem in our power to reduce them.” We must, he wrote, “put a most Effectual Stop to their very being.” Amherst’s directives apparently arrived at Fort Pitt with Bouquet after the fact, but his paper trail and his rhetoric have linked him historically to this act of bioterrorism.

The European settlement of America offers a real-world scenario of what smallpox can do to an unprotected population. Measles, cholera, influenza, cannons and repeating rifles all played a role in the conquering of America, but none of them was more devastating than smallpox. Smallpox epidemics often killed as much as half of the affected Indian population. Sometimes it was worse. Epidemics, quite likely of smallpox, reduced the population of the Winnebago in Wisconsin from about 20,000 to 600 between 1634 and 1670. A smallpox epidemic from 1781 to 1783 is said to have killed as many as 3,000 of the 5,000 Ojibwa south of Lake Superior. In the winter of 1837-1838, a steamboat passenger with smallpox took the disease up the Missouri River. The resulting epidemic killed about 17,000 Plains Indians.

Of course, these numbers only bolster Henderson’s arguments and should lead us all to demand a more effective defense against bioterrorism. As Henderson has said, we must improve our intelligence about who might possess the smallpox virus. Supposedly samples of it are stored only in the Centers for Disease Control in Atlanta and a like facility in Russia. But that facility, in Novosibirsk, is no longer considered secure. Henderson says a colleague who visited in the autumn of 1997 found it half-empty and “protected by a handful of guards who had not been paid in months.” U.S. intelligence suspects that the Russians, North Koreans and Iraqis have hidden the virus for military use. Iran, Iraq, Pakistan and Osama bin Laden’s al-Qaeda network have all tried to obtain it.

Intelligence is important, Henderson says, but because prevention is so difficult and “detection or interdiction of those intending to use biological weapons is next to impossible,” medical workers in emergency rooms and “specialists in infectious diseases ... constitute the first line of defense.” These medical personnel need more training to help them diagnose smallpox, more beds and better staffing to treat the sick, more labs equipped to confirm their diagnoses and, especially, available vaccine to help contain an epidemic.

In 1972 a relatively mild outbreak in Yugoslavia prompted that country to seal its borders and vaccinate 20 million people. The United States has only about 15 million doses of smallpox vaccine on hand. Secretary Thompson is currently seeking funding to get 300 million new doses, but they wouldn’t be available before the end of next year at the earliest.

The implications of these numbers, and of Henderson’s warnings, are staggering, as is the history of the encounter between Europeans and Native Americans. And yet I am compelled to return to the Fort Pitt example and examine it from a political as well as a scientific standpoint. I believe we also need to look at Lord Jeffrey Amherst’s attitudes and his rhetoric if we are to learn all the lessons we should from Fort Pitt.

At first, we might be tempted to see Amherst only as a kind of 18th century Osama bin Laden (with Captain Ecuyer perhaps as his Mohammed Atta). Lord Jeffrey sat safely in New York, trying to avoid culpability while doing the strategic planning and ideological work of his holy war. “Total Extirpation,” he said, “was scarce Attonement for the Bloody and Inhuman deeds” of the Indians. His language is dehumanizing, genocidal and lit with religious fervor. It is the language of a terrorist.

But Amherst was a British soldier, a white settler in America, and we cannot in good conscience completely separate ourselves from his words or Captain Ecuyer’s deeds. U.S. troops, in fact, apparently emulated Fort Pitt’s example by providing their own infected blankets to Plains Indians during the 19th century. We cannot deny that our history includes the bioterrorism and genocide these men practiced in the name of Manifest Destiny.

But some have tried. Amherst College, for instance, claims on its Web site that “it’s the town of Amherst, not the college, that is named for the British general” and that “Amherst College was named in honor of the town.” But until the 1970s, Amherst College’s official china depicted a mounted Englishman with a sword chasing Indians on foot, and the school’s fight song still opens with the lines: “Oh, Lord Jeffrey Amherst was a soldier of the king / And he came from across the sea / To the Frenchmen and the Indians he didn’t do a thing.”

Lynne Cheney, wife of the vice president and former chairwoman of the National Endowment for the Humanities, said recently that in the present climate we must emphasize American history, not multiculturalism. “To say that it is more important now [to teach habits of tolerance, knowledge and awareness of other cultures],” she explained, “implies that the events of September 11 were our fault, that it was our failure to understand Islam that led to so many deaths and so much destruction.”

This kind of thinking is exactly what leads us to read our own history selectively and blindly. It leads us to think we have all the answers, to believe that none of the complaints of a terrorist could ever be valid, to assert that we are protecting democracy and not oil when we prop up royal families and repressive regimes in the Middle East. And it leads us into our own distinctly American version of Lord Jeffrey’s and bin Laden’s dehumanizing rhetoric, a rhetoric that puts God on the side of the cowboys who will “smoke them out of their holes” and bring ’em back “dead or alive.”

Ned Stuckey-Frenchteaches in the English Department at Florida State University. He is working on a book about his 10 years as a trade union organizer in a Boston hospital.

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