Mischaracterization of a Misadventure = Misinformation

Authors of “The Yellow Fever Vaccine Misadventure of 1942” respond to a tweet by Candace Owens.

Exactly 80 years ago today, war with Japan was imminent. The US Naval fleet at Pearl Harbor had been attacked; the Japanese surrounded Shanghai, and the Germans already had a foothold in Africa. The yellow fever vaccination campaign, initiated in 1941, was expedited after 7 December to immunize the military against one of the greatest disease threats in the tropics—yellow fever.

Yellow fever had destroyed Napoleon’s attempt to subjugate Haiti in 1801-2 resulting in more than 50,00 deaths.1 Yellow fever (and malaria) had killed more than 25,000 French and American workers during the construction of the Panama Canal (1881-1914). The fact that yellow fever was not present in Asia was not clear until well after WWII when knowledge of the virus and its mosquito vector became better understood. However, Aedes aegypti was known to exist in Asia (Figure 1).

We recall these events not only because it is the anniversary of Pearl Harbor Day, but because of another unfortunate event that occurred shortly thereafter—a misadventure that had nothing to do with the vaccine itself.2 The unfortunate event was  contamination of a single lot of the 17D yellow fever vaccine. The single lot came from pooled New York donors.3

The editorial board at the Journal of Public Health Management and Practice asked us to clarify this matter because a recent tweet on social media had “cited” our paper as part of vaccine misinformation that has become common on social media during the days of COVID.

“Remember that time our government rushed to force vaccinate our military against yellow fever and accidently infected 330,000 military personnel with hepatitis B because they ignored the reactions so many people were having post-injection?”

What actually happened was the following: The military and independent civilian authorities didn’t ignore post-injection reactions. Indeed, scrupulous surveillance allowed for early identification of the emerging hepatitis epidemic which became apparent over the early post-vaccination months. Nor was the vaccine forced or rushed. Testing has been thorough, including 1.3 million people at risk of yellow fever in Brazil in 1937-38. The 17D vaccine received licensing approval in 1938, with more than 850 million doses having been distributed since. The vaccine is well tolerated, up to 100% effective and affordable, and it can provide lifelong protection with a single vaccination. Serious side effects are rare. In 1951, Theiler was awarded the Nobel Prize in Physiology or Medicine for “discoveries concerning yellow fever and how to combat it,” the first and only time that the prize has been awarded for a vaccine.4 The American decision was prudent given the knowledge the experts had and the logic of where future conflicts might take place.

Today, yellow fever continues to be endemic in subSaharan Africa and tropical South America (oddly, despite the presence of Aedes, the disease has never appeared in Asia with the exception of rare imported cases via air travel.)5 But on the cusp of World War II, no one knew whether it might explode in future conflicts in Africa, Asia, and the Americas. Today, the absence of the disease in Asia is still a mystery.6

References

  1. Marr JS, Cathey JT. The 1802 Saint-Domingue yellow fever epidemic and the Louisiana Purchase. J Public Health Manag Pract JPHMP. 2013 Feb;19(1):77–82.
  2. Marr JS, Cathey JT. The Yellow Fever Vaccine Misadventure of 1942. J Public Health Manag Pract [Internet]. 2017 Dec [cited 2021 Nov 13];23(6):651–7. Available from: https://journals.lww.com/jphmp/Abstract/2017/11000/The_Yellow_Fever_Vaccine_Misadventure_of_1942.18.aspx
  3. Thomas RE, Lorenzetti DL, Spragins W. Mortality and morbidity among military personnel and civilians during the 1930s and World War II from transmission of hepatitis during yellow fever vaccination: systematic review. Am J Public Health. 2013 Mar;103(3):e16-29.
  4. Elvidge S. Developing the 17D yellow fever vaccine. Nat Res [Internet]. 2020 Sep 28 [cited 2021 Nov 13]; Available from: https://www.nature.com/articles/d42859-020-00012-9
  5. Kuno G. The Absence of Yellow Fever in Asia: History, Hypotheses, Vector Dispersal, Possibility of YF in Asia, and Other Enigmas. Viruses [Internet]. 2020 Dec [cited 2021 Jan 27];12(12):1349. Available from: https://www.mdpi.com/1999-4915/12/12/1349
  6. Cathey JT, Marr JS. Yellow fever, Asia and the East African slave trade. Trans R Soc Trop Med Hyg. 2014 May;108(5):252–7.

Author Profile

John S. Marr and John T. Cathey
Dr. John S. Marr is an American physician, epidemiologist, and author. His professional life has concerned outbreaks of infectious disease and thus his subsequent writing career has focused on that topic, particularly historical epidemics. Marr graduated from Yale and received an MD from New York Medical College. He then completed an MPH degree from the Harvard School of Public Health. Marr is a board-certified (internal medicine, preventive medicine, occupational medicine) physician and a Louisiana State University Fellow in Tropical Medicine.

John T. Cathey is formerly Senior Editor, Annals of Saudi Medicine, and now retired.