By Mimi Eisen, Historian
For most of 2020, people across the globe anticipated the development of a vaccine to safeguard against COVID-19. The arrival of Pfizer-BioNTech and Moderna’s mRNA vaccines at the end of the year signaled a new phase of the pandemic and an unprecedented scientific achievement, accomplished in record time. Scientists had developed a new type of vaccine that uses an mRNA blueprint, instead of a weak or inactivated virus, to teach cells how to make spike proteins and trigger an immune response to protect us from the live virus. Of course, vaccine development is not the ultimate goal — mass immunization is, and the efficacy of a vaccine is only as good as its widespread distribution. As millions of Americans now receive or await COVID-19 vaccinations, history provides a paragon of public health mobilization in the face of one of the world’s all-time deadliest infectious diseases.
The 3,000-year-old mummy of Ramesses V, king of Egypt, contains traces of smallpox pustules. The pharaoh likely succumbed to the virus, and remains one of its earliest-known victims. Source: Centers for Disease Control and Prevention
In late February 1947, American businessman Eugene Le Bar traveled by bus from Mexico City to New York City. He felt ill upon arrival on March 1st and, a few days later, had a 105-degree fever and a rash spreading on his hands and face. Doctors at two premier hospitals found themselves puzzled by Le Bar’s symptoms and unable to definitively diagnose or treat him. Nine days after stepping off the bus in New York, Le Bar died. Within weeks, doctors saw three more patients — two toddlers and an adult — with similar symptoms. Lab results revealed in early April that all four had smallpox, an incredibly infectious and deadly disease not seen in New York since before World War II.
Historians and virologists alike know well the infectiousness and lethality of the smallpox virus — for centuries, it devastated civilizations. Its most common form had an incubation period of 12 days, from infection to obvious symptoms, and a mortality rate of 30%. In the 20th century alone, smallpox claimed several hundred million lives worldwide and left millions more permanently impaired. It also, however, became the first and only infectious disease to be eliminated, a feat owed to a series of robust vaccination programs. The World Health Assembly declared smallpox eradicated in 1980, making history once more. But just decades earlier, the virus posed a sudden and severe threat to the most populous city in America.
The eradication of smallpox was a global undertaking. This chart outlines its elimination by continent over the course of three decades. Source: Centers for Disease Control and Prevention
New York City’s health commissioner in 1947 was Israel Weinstein, a bacteriologist, physician, and lifelong New Yorker. In the early 1900s, as a child growing up on the Lower East Side, he had seen communities ravaged by smallpox outbreaks. Weinstein was just months into his post as health commissioner when smallpox reappeared. Most New Yorkers had been inoculated against it by that time, but in some cases, vaccination did not yield lifelong immunity. Le Bar’s illness and death confirmed that — he had a years-old smallpox vaccination scar.
Dr. Israel Weinstein lends a hand on the ground, vaccinating his staff at the Department of Health against smallpox. Source: New York Times
Weinstein learned of these new smallpox cases two days before Easter Sunday, when thousands of New Yorkers planned to descend on Fifth Avenue for a parade. As they congregated to cheer on the parade—if history or science were any guide—the celebration could turn into a calamity. He immediately held a news conference, encouraging all New York City residents to get vaccinated or revaccinated right away. Though vaccines are far more safe and effective today than they were in 1947, even then the potential benefits of mass immunization easily outweighed the drawbacks of any individual side effects. But the public did not take to Weinstein’s message immediately. Over a million New Yorkers gathered in Manhattan for the Easter Sunday parade, which landed on an unusually warm and sunny day. That same weekend, only a few hundred sought out vaccination. Weinstein knew he would have to communicate clearly and consistently with city residents and officials to build trust, implement public health measures, iron out vaccine distribution logistics, and protect all under his charge.
A line curves around several blocks as thousands of residents await smallpox inoculation at a hospital in the Bronx. Source: New York Daily News Archive
With 7.8 million people living in the city, this was a particularly daunting task to take up. New York maintained a stockpile of 250,000 smallpox vaccines, but would need far more to immunize its population in such short order. Working with the city’s mayor, William O’Dwyer, Weinstein lifted hundreds of thousands of vaccine doses from Brooklyn’s naval medical supply depot, coordinated with military bases in California and Missouri to fly in hundreds of thousands more, and purchased millions from pharmaceutical companies. Weinstein and O’Dwyer facilitated free vaccination clinics around the city: at hospitals, fire stations, schools, and many more publicly accessible establishments. Department of Health posters proliferated with the campaign slogan, “Be Sure! Be Safe! Get Vaccinated!” Weinstein even held daily radio addresses to communicate the urgency and practicality of immunization, and organized a contact tracing program to reduce the spread of the virus.
A week after Easter Sunday, a second person died from smallpox and several new cases appeared. When this news broke, with continued support from Weinstein, O’Dwyer, and other city officials, millions of city residents began to cooperate. Consequently, a major vaccine shortage emerged in mid-April. O’Dwyer immediately called an emergency meeting with pharmaceutical manufacturer representatives and urged them to expedite delivery. It worked: over a million new doses arrived on April 17. For the rest of the month — which returned to characteristically cold and rainy weather — New Yorkers formed and endured long lines outside of vaccination clinics. Meanwhile, thousands of civilian volunteers joined health care professionals to help immunize their neighbors and quickly contain the smallpox outbreak. In under a month, New York City vaccinated 6,350,000 of its residents. A staggering five million doses were administered in the second half of April alone. By May, the city had achieved herd immunity and quelled the outbreak.
The final tallies of New York City’s 1947 smallpox outbreak show 12 infections across age groups and two deaths, beginning with Eugene Le Bar. Source: Life via American Journal of Public Health
In total, approximately a dozen people were infected, and only two died — including Le Bar, patient zero. With such low tallies, it is important to remember that most effective public health measures can often appear as overreactions: that means they have worked, averting disaster. Indeed, given the city’s population density and the virus’s mortality rate, many thousands more could have lost their lives without such clear messaging and mobilization. As we move through year two of the COVID-19 pandemic, it is obvious that scientific and political arenas have shifted considerably since 1947. Still, when faced with vaccinating a vulnerable population against a deadly virus, Weinstein’s words from 74 years ago ring true: “every effort must be made.”
