Pox Americana: The Great Smallpox Epidemic of 1775-82.

• Author: Franke-Ruta, Garance
• Position: George Washington's Bioterrorism Strategy: how we handled it last time

POX AMERICANA: The Great Smallpox Epidemic of 1775-82

by Elizabeth A. Fenn Hill and Wang, $25.00

IN 1995, I WAS OFFERED AN OPPORTUNITY to be vaccinated against smallpox. I was interning in a virology laboratory, and the scientists working in the hood two feet from where I spent my days culturing cells--the biological equivalent of making photocopies--worked with live vaccinia (cowpox) virus, a close relative of smallpox, and human immunodeficiency virus (HIV). Sometimes they would mix the live vaccinia with HIV proteins and vaccinate lab rats with the combination and study their immune responses. The possibility of human infection was remote, but high enough that the lab offered permanent workers vaccination or re-vaccination against vaccinia as a precaution. At the time, the fact that this also rendered them immune to smallpox was irrelevant. The last known case had occurred in 1978, and in 1980, public health officials had declared the disease officially eradicated worldwide.

I soon learned the vaccination would not be a simple procedure. It would most likely lead to a fever, flu-like symptoms, and an oozing sore on my arm that could take four weeks to heal. More importantly because it involved being infected with a small dose of a living organism--the procedure for so-called "live-virus" vaccines--I would become infectious. If I wasn't careful, I could transmit cowpox to any pregnant women or immune-suppressed people I shook hands with or hugged hello. Wearing a bandage on my arm for four weeks would reduce that risk, but not eliminate it.

I declined the offer. It seemed messy, complicated, and largely pointless. By the time my sore had healed, I would no longer even be working in the lab. Besides, I didn't want to inadvertently give anyone a case of cowpox.

By page 17 of Elizabeth Fenn's book on the great smallpox epidemic of 1775, I began to regret my decision. By page 74, with anthrax attacks on the rise, I sent out a panicky e-mail to my old boss to see if his lab still had any vaccine available. (They didn't.) And by the time I finished Pox Americana, rattled Homeland Security Chief Tom Ridge had ordered 300 million new doses of smallpox vaccine to protect the nation, which had abandoned universal inoculation in 1972. Since early October, four Americans have died of inhalation anthrax, more than 20 sites across my city have been contaminated, and my doorman--who spends afternoons sorting bulk mail from D.C.'s Brentwood facility for 271 apartments--spent ten miserable days dizzy and sick from taking Cipro. A bioterrorist attack with smallpox--vials of which U.S. intelligence believes may be in the hands of various rogue...