Vaccines in the Time of War

You’ve probably heard about biological warfare. That is when a group or government uses a biological agent to make their enemy too sick to fight. In Colonial America, the British government used blankets contaminated with smallpox to try and decimate Native American communities with the disease. (Native Americans at the time had never been exposed to smallpox, so the disease would have spread like wildfire through their communities.) In the 1980s, members of a cult in Oregon spread Salmonella at different eateries in an attempt to make town officials sick. Their goal was to prevent those officials from acting against the interests of the cult. Most recently, concerns about weaponized anthrax have led to the mass-immunization of members of the military and preparations in case of a mass-release of the bacteria in the general population.

However, have you heard of the role of immunizations in winning wars or – at the very least – their use during wartime to protect civilians? During the Revolutionary War, George Washington ordered his troops to be inoculated for smallpox. Between 1775 and 1776, the City of Boston was sieged by the Continental Army, led by Washington. This coincided with a smallpox epidemic spreading through the city (and, eventually, the entire country). George Washington, a smallpox survivor himself, saw the disease as a threat to the readiness of his troops.

At the time, the smallpox vaccine was still about 25 years away from being developed by Jenner, so the next best thing was inoculation with smallpox in a controlled setting. Mortality from inoculation was much less than acquiring smallpox in the community. While some of the troops receiving the inoculation did get full-blown smallpox, and some died, the majority of troops became immune. It was those troops that Washington sent in to occupy Boston when the siege was over in order to make sure that the troops would not be made sick with the disease, or from one of the soldiers catching the disease and inadvertently bringing it back to the others.

In 1898, during the Spanish-American War, soldiers fighting in the Caribbean faced tropical diseases like malaria and yellow fever. A commission was created to look into these problems and, through the work of military researchers like Walter Reed and civilian physicians like Carlos Finlay, they developed strategies to deal with those diseases. First was mosquito abatement and eradication, and later was the yellow fever vaccine as well as antibiotic prophylaxis against malaria. (These efforts would also translate into the successful creation of the Panama Canal.)

War and social unrest have a way of allowing diseases to get out of control. The breakdown of public health and medical infrastructure keep sick people from getting help, so they end up being infectious in their own homes and neighborhoods. Without proper treatment, the outbreaks continue and spread. Without public health efforts to immunize, vaccine-preventable diseases emerge and also spread. If the violence hits critical infrastructures like potable water distribution or the electrical grid, the outbreaks grow even quicker.

Since 2015, a particularly violent war has been going on in Yemen, a country on the southern tip of the Arabian Peninsula. An ineffective government, combined with a separatist movement and extreme poverty, led to an intervention by foreign nations led by Saudi Arabia on one side and Iran on the other. Those two nations have been fighting a proxy war in Yemen through backing the opposing factions there. This has resulted in tens of thousands of deaths of belligerents and civilians. According to the World Health Organization, the destruction of health infrastructure has caused outbreaks of diseases like cholera, malnutrition and vaccine-preventable diseases like measles.

The United Nations International Children’s Emergency Fund (UNICEF) is funding mass vaccination campaigns in Yemen to prevent vaccine-preventable diseases from spreading. This has required continued surveillance to identify places in Yemen where vaccines are needed. Then negotiations with the warring factions to allow workers access to those places. And then actually going to those places, including some very remote locations.

Throughout history, war and disease have competed to injure and kill as many humans as possible. While we still have work to be done in preventing and countering the effects of both, we have some very safe and effective vaccines against things like measles. On the other hand, we don’t yet have a vaccine against war. Nevertheless, science, technology and human will can and must come together to ameliorate the effects of war, even if it takes traveling to the ends of the Earth with a refrigeration unit strapped to their back.


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Author: René F. Najera, DrPH

I am the editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia. All opinions expressed on these blog posts are not necessarily those of the College or any of my employers. Check out my professional profile on LinkedIn: Feel free to follow me on Twitter: @EpiRen