When Smallpox Failed

First there were just 20 sick people -- all in Oklahoma. Two weeks later, there were thousands, spread across many states. Three months after that, 1 million people in 25 states were dead.

Those were the results of "Dark Winter," a government-sponsored exercise conducted last summer, in which researchers simulated a smallpox attack on Oklahoma City.

Since then, of course, fears of such an attack have grown far more urgent, and last week the Bush administration announced that it had awarded a $428 million contract for 155 million doses of smallpox vaccine. That amount, added to supplies on hand or on order, should be enough to protect every American against the deadly virus.

But war games are not reality, and history suggests that a real smallpox attack need not result in devastation.

In 1947, smallpox suddenly appeared in the United States, and the authorities responded with notable success. Then as now, hardly any physician had seen a case of smallpox. The last one in New York had been in 1939. Then as now, the great majority of New Yorkers had not been vaccinated recently enough to have immunity, and the city health department had only about 500,000 doses of vaccine.

On April 4, 1947, the city health commissioner disclosed that three cases had been found, evidently introduced by an American businessman who entered the city from Mexico on March 1. He died on March 10 at a downtown hospital where he and two others were initially misdiagnosed.

In the week after the commissioner's announcement, the number of cases rose to 12, and a second person died. By then, the disease had been in New York for six weeks and the mayor urged that all 7.5 million New Yorkers get vaccinations. Hospitals, clinics, police stations, company buildings and union halls were designated as free vaccination sites, and people flocked to them, where they often waited in line for hours.

A thousand physicians, nurses and others helped in the vaccination campaign, and teams of doctors and assistants fanned out to public and private schools to vaccinate every student. Within a month, 6.3 million people had been vaccinated. There were no additional cases of infection.

All this is reason for optimism. Today, the medical community is on the lookout and immediate diagnosis is likely. Yet in 1947, even with a five-week lag before the disease was discovered, its spread was minimal. Of course, if several infected people entered different parts of the city at the same time, the number of victims could be far greater. But since the vaccine offers protection if administered during the first several days after exposure, a prepared city could immunize almost everyone in time.

In 1947, the city responded rapidly, and enhanced communications and laboratory capabilities should make the response today even more effective, especially with some advance planning. The public needs reassurance that vaccine stocks will be available, and officials should designate vaccination sites, while establishing a registry of health care volunteers who could be called on to help.