Do you have a scar on your arm and you aren’t sure why it is there?
Is it from the smallpox vaccine?
Recognizing Old Vaccine Scars
Classically, there are two vaccines that can leave a scar – the ones that protect us against smallpox and tuberculosis.
“BCG scar is a surrogate marker of vaccination and an important index in the vaccination program.”
Dhanawade et al on Scar formation and tuberculin conversion following BCG vaccination in infants: A prospective cohort study
And there are a few easy ways to tell if you have a smallpox scar.
When were you born? Remember, the smallpox vaccine hasn’t been used in the United States since the early 1970s and its use stopped everywhere in 1986.
And where were you born?
The BCG (bacille Calmette-Guerin) vaccine, on the other hand, is still in use in many countries, and is given at birth to prevent tuberculosis disease, including meningitis and disseminated tuberculosis. It isn’t routinely used in the United States though “because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity.”
In general though:
the BCG vaccine scar has a raised center
the smallpox vaccine scar is depressed, with lines that radiate to the edges
Complicating matters is the fact that you can have multiple scars from each vaccine…
“In 1972, the National Advisory Committee on Immunization in Canada recommended that routine immunization of infants for smallpox be stopped. Very few Canadians born after 1972 have been immunized against smallpox. Those, like me, who were immunized prior to that date have little or no immunity left. Nothing, but a small scar as testimony to a grand global achievement.”
And we have known it for a long time. In Leicester, for example, it was known that folks weren’t vaccinated were much more likely to die of smallpox than those who were. In fact, the fatality rate in Leicester in the late 19th century and early 20th century was 1 to 2% for those who were vaccinated. What was it for folks who were unvaccinated? It was 8 to 12%!
And like many other diseases, if they did get sick, those who were vaccinated against smallpox often got a very mild case, especially as compared to those who were unvaccinated. We can see that even now thanks to photographs taken by Dr. Allan Warner, the Resident Medical Officer to the Isolation Hospital in Leicester.
Dr. Warner’s photos have been published time and again, but they can originally be found in the New Sydenham Society’s Atlas of 1904.
There are many photos and many stories from the time that were testament to the fact that vaccines work.
“A boy, aged 14 years, unvaccinated, sickened with small pox on April 14th. He was removed to hospital on April 18th, where he had a severe confluent attack. The father consented to his wife and three children being vaccinated, stating that personally he would not be vaccinated, but would be a “test,” to see if there was anything in it.
Ten days later his daughter, aged three years, developed a small-pox eruption she had less than one hundred spots and never appeared ill. No other person in the house suffered from small-pox except the father, vaccinated in infancy, his eruption appearing fourteen days after the son had been removed to hospital. A photograph of the father and daughter, taken on the twelfth day of the father’s eruption, may be seen in Plate VI. [see below] and requires no comment.”
And there are also stories of folks skipping vaccines already. Remember, the anti-vaccine movement is even older than the first vaccines. It started with variolation. By the time these photos were taken, anti-vaccine folks had already marched on Leicester. A march that didn’t turn folks away from getting vaccinated.
For those who think getting smallpox was all about poor nutrition and hygiene, how do you explain these photos? Why such different outcomes for people in the same family, if it wasn’t their vaccine?
Mostly though, parents in North Texas do a good job of getting their kids vaccinated and protected.
The Plano Smallpox Outbreak of 1895
Of course, that’s not what’s keeping smallpox away.
Routine smallpox vaccination, which was typically given when children were about 12 months old, ended in 1972 in the United States. And smallpox was declared eradicated in 1980.
“Today, Preston Lakes is a quiet, manicured neighborhood in an affluent area of Plano. Almost 120 years ago, it was the site of one of Plano’s darkest hours.”
Plano Smallpox Outbreak of 1895
Driving around Plano now, it is hard to imagine that this city once battled smallpox.
While that is probably true of any modern city, the curious thing is that the area in and around Plano wasn’t settled until the early 1840’s, at which time an effective smallpox vaccine had been available for over 40 years.
“On May 6, 1895, Plano City Council called an emergency meeting, establishing a strict quarantine “to protect our citizens from this loathsome disease.” Anyone within the area between what is now Spring Creek Parkway, Park Boulevard, Coit and Preston Roads was forbidden to leave. An armed guard patrolled the border.”
Plano Smallpox Outbreak of 1895
Farwick Collinsworth, whose family owned large portions of what is now West Plano, lost his 11-year-old granddaughter in the smallpox outbreak.
Next, his wife and two sons died.
Then two more grandchildren and a nephew.
All together, at least 15 people died in the smallpox outbreak of 1895 in Plano, Texas.
“In 1806 the first smallpox inoculations were administered in San Antonio de Béxar. After initial resistance to the experiment, the townspeople came to accept the procedure, and the threat of smallpox was lessened for a time.”
Texas State Historical Association Public Health
While the Plano outbreak is certainly sad, it is truly tragic that smallpox was already a vaccine-preventable disease at this time.
History of Smallpox in Texas
Still, as late as 1900, 894 people died of smallpox in the United States. Globally, at least 300 million people died of smallpox during the 20th century.
So why weren’t folks vaccinated against smallpox in the late 19th century in North Texas?
While some people talking about issues with vaccine availability, remember that this is just after almost 100,000 people participated in the Leicester Demonstration March of 1885 to protest the smallpox vaccine.
While Leicester is quite a ways from Plano, a little bit closer to home we had the Laredo Smallpox Riot.
“When he realized that Laredoans were not fully embracing the quarantine program, especially the mandatory inoculation, he asked the governor to send in Texas Rangers. A contingent of rangers under Captain J.H. Rogers arrived on March 19, 1899, and began enforcing the health official’s orders more vigorously than some of the city’s residents thought proper. Milling protestors pelted rangers and health workers with harsh words and harder rocks, leading to a couple of minor injuries.
The next day, when the rangers got word that someone had telephoned a local hardware store to order 2,000 rounds of buckshot, the officers began a house-to-house search of the part of town where the order had come from. The situation soon deteriorated into a riot, with the rangers killing two citizens and wounding 10 others. It took cavalry from nearby Fort McIntosh to restore order.
The inoculation and fumigation program continued, and by May 1, Dr. Blunt lifted the quarantine in the border city.”
Frontier Medicine: Texas Doctors Overcome Disease and Despair
It maybe shouldn’t be surprising that the last smallpox outbreak in the United States was in Texas – in 1949. Eight people got sick, and one person, Lillian Barber, died.
But Texas wasn’t at the center of the anti-vaccine fight against protecting kids against smallpox. In Utah (the McMillan bill), Minnesota, and California, laws were passed banning mandatory vaccination for attending school. While the governors of Utah and California vetoed their bills, in Utah, legislators overcame the veto.
What came next?
Outbreaks of smallpox.
In 1906, AMA President William J. Mayo, a Minnesota physician, charged that his state’s “inability to enforce vaccination” had unleashed a smallpox epidemic, infecting 28,000 of the state’s citizens – “all due to a small but vociferous band of antivaccination agitators.”
Pox: An American History
That was over a hundred years ago.
What comes next?
Will we let today’s “vociferous band of antivaccination agitators” guide vaccine policy and put our kids at risk for vaccine-preventable diseases, as they push the same old anti-vaccine propaganda and fight against vaccine mandates, which are only necessary because they scare parents away from vaccinating and protecting their kids?
Let’s hope not.
What to Know About the Plano Smallpox Outbreak of 1895
Fifteen people died in Plano, Texas in 1895, even though a smallpox vaccine was available at the time that could have prevented this and most other smallpox outbreaks and epidemics. Tragically, the fight against its use mirrors much of what we see in today’s anti-vaccine movement.
And if you had to rank vaccines from safest to most dangerous, then yes, you could say that the original smallpox vaccine, the one with the most side effects, is the most dangerous.
Fortunately, that very same smallpox vaccine helped eradicate smallpox and few of us need to even think about getting a smallpox vaccine. It is still given to some folks in the military though and is available if necessary.
The story was about a plan to vaccinate many more people, including hospital workers. At the time, there was a worry about terrorist attacks using smallpox.
“Here’s another way to do it. We can make the vaccine. Make sure we understand who’s going to get it, who’s going to be giving it. Then wait, wait for there to be one case of documented smallpox somewhere on the face of this earth and then we can move into vaccinating people, large numbers of people.”
Paul Offit, MD
Not everyone was on board with the plan though. Dr. Offit, for one, didn’t think that it was a good idea to start vaccinating people for a threat that we didn’t know would appear, especially since the older smallpox vaccine had more side effects than other, more modern vaccines.
Again, that doesn’t mean that the smallpox vaccine is dangerous.
Smallpox is dangerous and deadly. If there is a risk that you could get smallpox, then you would much rather have the smallpox vaccine, even with its side effect profile.
And fortunately, a new attenuated smallpox vaccine, Imvamune, is also available and has less side effects. Two other smallpox vaccines, ACAM2000 and APSV, which are similar to the original DryVax vaccine that was used in the US, are also still being used until Imvamune is formally approved by the FDA.
Still, while quarantines are helpful to control disease outbreaks, they clearly aren’t enough. That’s evident by the way that vaccines were used in Leicester to control smallpox, even though some folks say it was all due to quarantines. It wasn’t.
Well, he’s not the only scientist to take a wrong turn later in life, although he certainly did precede the modern ones that we often think about, such as:
Dr. Linus Pauling – after winning two unshared Nobel prizes, he later pushed the idea that high doses of vitamins and other nutrients could treat disease, especially megadoses of vitamin C
Dr. Benjamin Spock – at the end of his career, he pushed a vegan lifestyle for all children
Like Pauling and Spock, Wallace’s legacy has a dark side – his lost causes for which “he became a passionate advocate,” including spiritualism, support of land nationalization, and an objection to compulsory smallpox vaccination.
Alfred Russel Wallace on Vaccination
Not surprisingly, Wallace once worked as a teacher in Leicester, England, which has been described as a “a stronghold of anti-vaccination” and a “Mecca of the anti-vaccinationists.”
“For a man admired by Charles Darwin, Sir Charles Lyell, Joseph Dalton Hooker, and Charles Sanders Peirce as one of the keenest minds of the Victorian age, Wallace’s public conversion to the anti-vaccination camp was a coup d’état for the various English anti-vaccination leagues and it gave them a new scientific foothold in the public debates over the utility of vaccination.”
Martin Fichman Resister’s logic
His time in Leicester likely didn’t influence Wallace though, as it was still a “well-vaccinated town” when he was there in the 1840s. In fact, Wallace and his children were all vaccinated and it wasn’t until he was “recruited some time in 1884 to the antivaccination movement through the efforts of his fellow spiritualist William Tebb (1830–1917), a radical liberal who in 1880 had cofounded the London Society for the Abolition of Compulsory Vaccination.”
How was he converted to becoming anti-vaccine? Interestingly, much like Dr. Bob describes reading the anti-vaccine book DPT: A Shot in the Dark, Wallace states that the book Papers on Vaccination made him have a change in “attitude towards vaccination.”
Like an antiquated version of dumpster diving in the VAERS database, Wallace misused a statistical analysis of life tables and mortalities to push his antivaccination ideas.
Similar to many modern anti-vaccine arguments, he also believed that:
only people living with poor sanitation and poor nutrition were at risk for smallpox, measles, whooping cough, yellow fever, diphtheria, and other “filth diseases”
getting vaccinated was more dangerous than having the disease
didn’t think the smallpox vaccine worked and “rejected vaccination as the cause of the rapid decline in the mortality from smallpox”
interpretive bias could be seen in reports put out by pro-vaccine scientists of the time
And similar to many modern anti-vaccine arguments, he also believed that many anti-vaccine arguments were “full of a great deal of trash and a great deal of very poor matter.”
What To Know About Alfred Russel Wallace
Alfred Russel Wallace played a big role in the antivaccination movement in the late 19th Century.