Safety of Smallpox Vaccine among Military Recipients Questioned

Meryl Nass, MD

Journal of the American Medical Association (JAMA). 2003 ;290:2123-4.
November 3, 2003

The government’s hasty and ill-advised smallpox vaccination policy for US civilians was roundly rejected by scientists and the public alike. Scientists agreed that public concerns about the vaccine’s adverse effects were valid. Military personnel, however, were given no choice–500,000 were inoculated. Surely their reactions to the vaccine are not appreciably different from what civilians might have experienced–unless it is claimed they are of a different species.

An exchange of letters in The Journal of the American Medical Society (see below) by Dr. Meryl Nass, a board member of the Alliance for Human Research Protection, and Drs Grabenstein and Winkenwerder et al, revolves around the veracity of the military claims about the safety of the smallpox vaccine.

Dr. Nass disputes the claim by Dr. Grabenstein that the adverse event rates following smallpox vaccine were derived from active surveillance of 500,000 soldiers. Active surveillance means after you give a drug or vaccine you go back periodically and ask the recipients if they are okay or having any symptoms. It is expensive and time-consuming, and you then need to look into which symptoms might be vaccine-related. It would have cost many millions to do active surveillance on 500,000 soldiers–it is simply never done with such large groups. Since Dr. Grabenstein is a PhD pharmacoepidemiologist there’s no question that he knows the difference between active and passive surveillance.

Dr. Nass is contacted by sick soldiers every day, she can, therefore, vouch for the fact there has been no active surveillance, and when they got sick, they heard only denials the vaccine might have any relationship to their illness.

Dr. Nass’ response to Dr. Grabenstein’s published letter follows.  Safety of the Smallpox Vaccine Among Military Recipients:

To the Editor: Dr Halsell and colleagues [1] reported that myopericarditis occurred at a rate of 1 per 12,819 primary vaccinees in the US military. Similarly, Drs Grabenstein and Winkenwerder [2] found that between 0.5% and 3.0% of military vaccine recipients needed short-term sick leave. Both groups of authors concluded that adverse events occurred at rates below historical rates, and that a mass vaccination program could be carried out safely. In both reports, however, vaccine complications were derived using passive rather than active surveillance. Therefore, the very favorable comparison of military adverse effect rates to historical rates is misleading.

Furthermore, claims that no deaths were associated with the military vaccination program and that no women developed myopericarditis are incorrect. Two military deaths have in fact been reported to be associated with smallpox vaccination. [3-4] One occurred in a previously healthy 22-year-old female reservist who died 1 month after receiving both anthrax and smallpox vaccines. According to the autopsy report, this was associated with pericarditis.

Similarly, the rate of myopericarditis found by the US Centers for Disease Control and Prevention (CDC) in civilians under active surveillance was more than 7 times higher than the military rate: 1 in 1725 vaccinees, of whom 71% were women. [5] Furthermore, the CDC reports that 2 women are now known to have developed dilated cardiomyopathy following smallpox vaccination. [6] The total number of serious adverse events among civilians from January 24 through June 20, 2003, is 71, or a rate of 1 in 500 smallpox vaccinations. [6] These events included 5 myocardial infarctions and 1 stroke.

The letter by Dr Nass, as originally submitted to THE JOURNAL, was previously posted at – ED.

1. Halsell JS, Riddle JR, Atwood JE, et al. Myopericarditis following smallpox vaccination among vaccinia-naive US military personnel. JAMA. 2003;289:3283-3289. ABSTRACT/FULL TEXT
2. Grabenstein JD, Winkenwerder W Jr. US military smallpox vaccination program experience. JAMA. 2003;289:3278-3282. ABSTRACT/FULL TEXT
3. Roos R. Military smallpox vaccinee dies of heart attack; ACIP considers options. March 28, 2003. Available at: Accessibility verified September 26, 2003.
4. Meincke P. Soldier dies after smallpox vaccination [transcript]. Chicago local news. ABC television. April 9, 2003. Available at: Accessibility verified September 26, 2003.
5. Centers for Disease Control and Prevention. Update: cardiac-related events during the civilian smallpox vaccination program – United States, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:492-496. MEDLINE
6. Centers for Disease Control and Prevention. Update: cardiac and other adverse events following civilian smallpox vaccination – United States, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:639-642. MEDLINE
Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.


Meryl Nass, M.D. is board certified in Internal Medicine, and practices at Mount Desert Island Hospital in Bar Harbor, Maine. She cares for hospitalized patients, and has a clinic where she treat patients with Fibromyalgia, Chronic Fatigue Syndrome, Gulf War Syndrome, Multiple Chemical Sensitivity and related disorders.

She has studied biological warfare and bioterrorism since 1989. In 1992 Dr. Nass identified the use of anthrax as a biological weapon in Rhodesia (now Zimbabwe) between 1978 and 1980, during a civil war between the white minority and black majority. Only areas populated by blacks were affected. As Rhodesia was then an apartheid nation, it was possible to confine the effects of the epidemic to areas where only black people lived and worked. The epidemic was part of a strategy of low intensity warfare, designed to wreak economic havoc by killing cattle needed for ploughing. At least 182 people were also killed.

Dr. Nass has worked to prevent biological warfare by creating ways of investigating suspect epidemics. A report she coauthored was presented to the 1996 international Biological Weapons Convention Review Conference in Geneva.

In 1998 Dr. Nass found that the anthrax vaccine being given to hundreds of thousands of military service-members was making many of them sick, and has since helped publicize the reactions and treated many affected individuals. She has pointed out the serious flaws in relying on vaccines as a panacea for the threat of biological warfare, as they are a medical Maginot Line. This was pointed out by the Congressional Committee on Government Reform in its 2000 report, Unproven Force Protection.

Dr. Nass volunteers to answer medical questions related to biodefense vaccines, host the website, advocate for better vaccines and drugs for bioterrorism, and continues to write academic and popular articles on anthrax, bioterrorism and biodefense vaccines in her spare time. Dr. Nass has provided five testimonies at the request of four Congressional committees on these topics since 1999.