The 1918 Smallpox Outbreak: Logistical Challenges Faced by the American Inoculation Campaign in Manila

Abstract

This article discusses characteristics and causes of the reemergence of the smallpox epidemic in 1918, Manila. After the introduction of systematic vaccination by the American government in 1905, mortality and morbidity rates caused by smallpox were greatly reduced in Manila. However, in 1918, a surge in mortality and morbidity caused by smallpox was experienced by the city of Manila. This resurgence revealed problems in the bureaucracy’s inoculation campaigns, resulting from logistical issues concerning vaccine supplies and manpower. The article examines the logistical problems regarding vaccination campaigns conducted before and during 1918. These problems involved a lack of vaccine supplies which failed to cover the entire population of Manila, which was crucial for a city whose immunity against smallpox began to wane. Manpower was another major issue in the execution of vaccination campaigns. The low wages given to officers and workers of the health bureaucracy led to unfulfilled vacancies. The bureaucracy’s manpower was overstretched when the smallpox outbreak occurred coinciding with a fire in the San Lazaro district. Vaccination efforts by the bureau were interrupted because the bureaucracy’s healthcare workers needed to attend to fire victims and thus were unable to perform vaccination. The combination of these logistical factors resulted in a weak revaccination effort by the health bureaucracy prior and during 1918 which failed to proactively prevent the outbreak of smallpox in that year.