Smallpox, Bubonic Plague, and MMR

Plague! Run for your life!

But wait: a plague doesn't necessarily mean the end of the world. We might feel less anxiety about such things if we appreciated the strides science has made and will continue to make in fighting some horrible-sounding scourges.

MMR and Chickenpox

The childhood diseases measles, mumps, and rubella can now be prevented with a safe and effective vaccine. More frightening than the diseases themselves in a way is the fact that some parents aren't having their kids vaccinated, thinking that children are more likely to die from vaccines than from diseases. That isn't true, and last week brought the further good news that the largest-ever study seeking a link between the MMR vaccine and autism found no connection.

Dr. Andrew Wakefield has been most responsible for pushing the MMR vaccine scare, but even the twelve co-authors of his original 1998 paper about vaccine risks in the Lancet disagree with him. His claim that separate measles, mumps, and rubella vaccinations should be given over the course of several months is denounced as scientifically groundless by the British Department of Health.

Meanwhile, some parents are being frightened away from the chickenpox vaccine, arguing that even a miniscule, hypothetical risk from the vaccine isn't an acceptable one, since chickenpox itself is harmless. If only that were true. Unfortunately, prior to the introduction of the chickenpox vaccine in 1995, some 4 million Americans got chickenpox each year, about 11,000 were hospitalized, and about a hundred died. It would be a tragic mistake if large numbers of parents continued to avoid the vaccine that stopped that carnage out of unfounded fear of side effects.

Bubonic Plague: The Black Death or Armpit-Swelling Nuisance?

New Yorkers remained admirably calm last week despite reports of two cases of bubonic plague, a disease that brought widespread death on an unprecedented scale to Europe seven centuries centuries ago. Fleas carrying the plague can still be found on some animal populations, including armadillos of the American southwest, and this causes about forty to fifty human cases of the plague annually, which can now be remedied with common antibiotics.

People once fled in terror from towns infected with "the Black Death." Those wealthy enough to seal themselves off from the general populace did so, a highly effective preventive measure and one particularly popular with royalty, who could conceal themselves in castles (indeed, the only royal claimed by the plague was the obscure Alfonso the Magnanimous, king of Aragorn and Sicily, in the mid-fifteenth century). But today, as ACSH's medical director Dr. Gilbert Ross explains to me, it is surprising even to hear that people with bubonic plague need to be kept in isolation, so easily can the disease be treated and its spread prevented though in advanced cases, victims' swollen lymph nodes, usually near the groin and armpits, can rupture, spewing contagious pus. Too, people sometimes contract a "pneumonic" form of bubonic plague, a pneumonia-like infection that is highly lethal and contagious.

The couple who came down with the disease in New York were likely bitten by fleas at their home in New Mexico, since fleas on the property were found to carry the plague germ. The male's condition was made likely made worse by his diabetes and other complications.

Prior to the New York cases, the closest bubonic plague had come to touching my life was the effect it had on the brother of a friend of mine. He lost his armpits to bubonic plague after touching an armadillo. That is, the swelling in his armpits never fully retreated, so the armpits didn't regain their normal concavity.

That's a problem, but losing one's armpits beats the Black Death.

Smallpoxalypse?

Smallpox is understandably causing more anxiety than childhood illnesses or bubonic plague, but it, too, can be indeed, largely has been beaten by science, which should be some comfort. The question is not How on Earth can smallpox be stopped? but a subtler one: Faced with the (currently hypothetical) prospect of a smallpox outbreak caused by terrorists, what would be the most effective response?

Bush is reportedly leaning toward making the vaccine available to the entire populace if people choose to take it (and Al Gore has been urging more aggressive preparations as well, for what it's worth). The Centers for Disease Control report that we already have enough vaccine to do it (see the CDC's official smallpox page for more information on the disease). With the CIA suggesting that North Korea, Iraq, Russia, and France may all possess smallpox, mass vaccination might appear to be the smart course of action.

However, as ACSH's Dr. Elizabeth Whelan noted in a recent debate, this vaccine does carry some real risks, including the likelihood of death for about one to three people of every million vaccinated.

That's why there's been great interest in a recent Emory study suggesting that vaccination of "first responders" (medical and rescue personnel likely to come in contact with smallpox during an outbreak) might be about as successful in containing an outbreak as vaccinating whole communities would be. The details of our actual smallpox response plans will soon be worked out on a state by state basis, based on CDC guidelines (with New York and New Jersey reportedly ahead of the curve in making preparations, spurred by their anthrax experiences a year ago).

Regardless of which plan is adopted, it should be remembered that each plan has risks and benefits but in all likelihood none leads to perfect safety, nor to annihilation. We should approach smallpox as one more problem to be minimized, not as an unstoppable doomsday scenario.

The Future Brings Options

In fact, it's easy to forget, while obsessing over the question of which vaccination plan to use, that science may soon provide us with other methods for combating the problem, such as better drugs for fighting the symptoms of smallpox, if an outbreak cannot be prevented. In a New York Press column I wrote one year ago, I argued that in a conflict between well-financed, high-tech American nerds and a bunch of terrorists who hide in desert caves, I would bet on the nerds in the long run. Bin Laden and his ilk may seem like James Bond villains, but we're the ones with lasers, robot drones, and the most innovative pharmaceutical companies on the planet.

For good or ill, we'll probably forego trying to culturally re-engineer the world to prevent groups like Al Qaeda from arising. Instead, we'll keep finding new technical fixes for the damage such groups do whether those technical fixes come in the form of new attack helicopters, new intelligence-gathering techniques, or better drugs. Eventually, I think, the populations from which such groups recruit followers will get tired of being the ones in the caves and will side with the folks who have lasers, robots, pharmaceuticals, and the freedom and science that made them all possible.

In the meantime, plagues whether caused by nature or by terrorists will remain one of the many problems in life that we ameliorate and cope with, even when we cannot eliminate every last risk.

November 21, 2002

I am amused by your statement "Eventually, I think, the populations from which such groups recruit followers will get tired of being the ones in the caves and will side with the folks who have lasers, robots, pharmaceuticals, and the freedom and science that made them all possible."

Let me say I have a Ph.D. in inorganic chemistry and consider myself a fairly well educated person, but I live in rural Appalachia and know a lot of people who are very poorly educated and have very little money or prospects. You are dead wrong, and there is no better example than Israel and the Palestinians. Israel has reached the limits of what you can do against violence, short of expulsion of the Palestinians, and they keep coming on and on and on.

A coal miner friend once told me, "When you have something to eat, and a place to lay down at night, the next thing you want is a sense of dignity." Notice this is ahead of sex, health care, and security. Unless the U.S. can allow the poor and distressed of the Earth to have their self-respect, the war will go on until we lose. The war is not likely to be high-tech and it won't overwhelm us, but it will go on and on and on until we change or give up, like the British Empire.

Wake up.

stbond