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http://www.nytimes.com/2002/12/17/health/17CASE.html

A Distant, Troubling Echo From an Earlier Smallpox War

By MICHAEL POLLAK

he word went out: everyone in New York should get a smallpox vaccination. "It was just public knowledge," my mother recalled 55 years later. "It was in the newspapers. On the radio."

It was early April 1947. I was 6 months old. A month earlier, a man returning from Mexico had fallen ill and checked into the city's Willard Parker Hospital, where he died on March 10. By the time a smallpox diagnosis was confirmed, two other people were showing symptoms.

On April 5, Dr. Israel Weinstein, the director of public health, announced an outbreak. A few days later, after a second death, he urged all New Yorkers to be vaccinated, regardless of age and previous vaccinations.

Last week, the call for smallpox vaccinations was again sounded, though this program is more limited — for now. In its first phases, a million military personnel and civilian health care workers will be vaccinated. In 2004 the vaccine is expected to be available to the public, on a voluntary basis.

Back in 1947, the response — also voluntary — was overwhelming. Within two weeks of the discovery of a potential epidemic, five million people were vaccinated.

The emergency mentality from the recent war mobilization helped. People waited for hours in the rain. Private doctors, public and parochial schools, company and union clinics and 3,000 volunteers pitched in. Former air raid wardens kept the throngs calm. Shots were given in the 84 police precinct station houses. Newspapers ran pictures of city officials getting shots. "Among city residents vaccinated yesterday were 25 children, from babies of 2 months to adolescents of 13 years," at one center, The New York Times reported.

My father, a Navy officer, had worked with Filipino civilians on Leyte after the 1944 invasion; he and a lot of other recently returned veterans had seen the terrible disfigurement of smallpox up close. Mom took me from our Riverside Drive apartment to the pediatrician's office for the vaccination.

About 10 days later, I grew restless and irritable. A fever kept rising. I was admitted to the hospital, had convulsions and went into a coma. The diagnosis was vaccinial encephalitis, a brain inflammation linked to the vaccine. The doctors told my mother they didn't know whether I would live, or whether there would be neurological damage.

After days in intensive care, the fever broke, and I went home. I grew up with chronic tics, similar to the muscle spasms of convulsions, that I have to fight to this day. Their connection to my encephalitis cannot be proved, but, according to the Centers for Disease Control and Prevention, they are consistent with the neurological effects of the disease.

Smallpox vaccine, made from vaccinia, a cousin to smallpox, is among the most dangerous of vaccines. I was lucky. A 3-year-old girl in New Jersey died of vaccinial encephalitis in April 1947 after her shot. I graduated from Harvard and eventually became an editor at The Times.

By virtually any measure, the 1947 crash vaccination program was a huge success. Twelve cases of smallpox were reported, with two deaths. (A 1901-02 outbreak caused 1,959 cases and 410 deaths.) But the same spirit that allowed near-universal vaccinations did not extend to thorough reporting of side effects.

In a November 1947 article in The American Journal of Public Health, Dr. Weinstein minimized the problem. He noted 46 probable cases of encephalitis in New York City during the vaccination campaign, adding that many were probably unrelated to the vaccine, but he did not try to estimate the number of cases of vaccinial encephalitis, explaining that a diagnosis could be made "with certainty" only by microscopic examination of the brain tissue.

A University of Michigan medical team reported in March in the journal Effective Clinical Practice that the data presented from the 1947 campaign in New York were of limited value in judging the adverse effects of mass smallpox vaccinations "because of differences in disease classification and inconsistency in case-finding efforts." We will never know the collateral damage from the 1947 program.

The study noted that smallpox had a 30 percent death rate, but that a mass vaccination of 179 million people ages 1 to 65 could be expected to cause about 4,600 serious side effects and 285 deaths, even if it excluded those at risk for problems, like pregnant women and people with immune deficiencies. That is not a lot of illnesses compared with unchecked smallpox, but we don't face unchecked smallpox. We face the unknown. Smallpox vaccine fights smallpox; the truth fights terror.

If we are going to go to war against smallpox, and there is any perception that side effect statistics are being ignored or suppressed, it will serve as a powerful recruiting poster for those who fear vaccines. The victims of vaccination's collateral damage need to be counted.

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