Smallpox Scare Offers Lessons About COVID-19 Vaccine Uptake

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If smallpox reemerges, it could be devastating with its 30% fatality rate and an ability to spread comparable to the Delta variant of COVID-19.

The recent story of finding previously unknown smallpox vials at the bottom of a deep freezer in Pennsylvania should serve as a reminder of the need for the strictest research precautions when handling dangerous pathogens and the dangers of any virus research program, especially gain of function research. The laboratory worker who made the discovery wore gloves and a face mask. So far there was no evidence of exposure. Unfortunately, no country's laboratories or research facilities are 100% safe.

Kevin Kavanagh, MD

Kevin Kavanagh, MD

By the 1950’s smallpox was eliminated in North America and Europe. This occurrence exemplifies the important role of vaccines in controlling infectious disease. Herd immunity for smallpox was not achieved without vaccination. George Washington mandated smallpox vaccinations for his troops. The modern vaccine is much safer. Unlike the SARS-CoV-2 vaccine, the smallpox vaccine was widely accepted by the United States public, even with a fatality rate of 2.5 per million vaccinations. Because of the rate of complications smallpox vaccinations were no longer recommended in 1972 and the disease was soon declared eradicated.

However, if smallpox reemerges, it could be devastating with its 30% fatality rate and an ability to spread comparable to the Delta variant. Almost all of our population was vaccinated to smallpox in the 1950s but currently few individuals born after 1972 are immune to this disease.

The most important difference between the most recent smallpox accident and the emergence of SARS-CoV-2, is that of transparency. How SARS-CoV-2 entered the human population is still hotly debated, and the possibility of a laboratory accident cannot be discounted.

Unfortunately, the vaccine hesitancy movement has placed us all at high risk for infectious disease. Those who are against mandatory vaccinations of frontline workers need to take a page from history and follow the lead of the Continental Army where an estimated 90% of the deaths were from infectious disease. After smallpox mandates were enacted in 1777, “the isolated infections that sprung up among Continental regulars during the southern campaign failed to incapacitate a single regiment.” With SARS-CoV-2 we are significantly weakening our nation by not abiding by public health advice and widely embracing vaccinations.

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