| Home > Resources > Leadership > Executive Summary > Case Studies Case Study Lessons from 2 Smallpox Outbreaks: 1894 Milwaukee, 1947 New York The very different outcomes of two U.S. smallpox outbreaks—one in Milwaukee in 1894 and the other in New York in 1947—make clear that public cooperation during an outbreak limits suffering and death and that public resistance does not.
Milwaukee's 1894 public health response contributed greatly to the spread of smallpox and ultimately to the duration of the outbreak. During that time, Milwaukee had an active anti-vaccination movement that touted the dangers of vaccination—and many in the medical community agreed. Mixed messages were conveyed to residents on whether to be vaccinated, which prolonged the epidemic.
Disparities in how different segments of society were treated during the outbreak also fueled the epidemic. Wealthier smallpox patients were placed under quarantine and encouraged to care for their afflicted loved ones in the comfort of their own homes. Patients of foreign descent and limited economic means, however, were forcibly (and, if deemed necessary, violently) removed from their homes and transported to an isolation hospital considered to be substandard. The use of force coupled with the inequitable response fueled anger and resentment among immigrant populations, who believed that the city's double-standard health policies underscored a lack of understanding and compassion for victims. In protest, residents rioted for a month. The end result: 1,079 afflicted and 244 dead during a prolonged outbreak.
In contrast, New York's public health response in 1947 resulted in a swift and mild outbreak. Smallpox had not made an appearance in New York in more than a generation, and since the threat was perceived to be minimal, the public in 1947 was largely unvaccinated.
At the onset of the outbreak, New York leaders mounted a public health outreach campaign centered around information flow and equitable treatment of citizens. Press conferences were held each day to update the public on events and to deliver clear messages about what individuals needed to do to get the community through the crisis. A mass vaccination program was launched and was ultimately a key factor in stemming the spread of disease. With the full endorsement of civic officials and the medical community, and backed by a vital public health infrastructure, smallpox vaccine was administered free in every precinct and school throughout the city. The mayor was publicly vaccinated, and citizens stood in lines that snaked through neighborhoods, patiently waiting to receive vaccine. Although health officials were legally authorized to vaccinate people or move patients to hospitals forcibly, coercive measures were unneeded; the public fully complied with public heath directives. The end result: 6,350,000 vaccinated in 4 weeks (5 million in the first 2 weeks, alone), 12 cases, and 2 dead. Reference Based on Leavitt JW. 2003. Public Resistance or Cooperation? A Tale of Smallpox in Two Cities. Biosecurity and Bioterrorism. 1(3):185-92. |
