Field hospital in Cuba, Spanish-American War

Yellow Jack Vaccine: Victory without Clinical Trial

In its reconnaissance on medical-themed films, Movies on Chatham dug deep in time to pluck a 1938 movie out of obsolescence. Uncovering this gem of a movie, Yellow Jack (Seitz, 1938) — apart from its value in portraying an event in the history of  medicine — allows us to learn about Walter Reed as a person, not just the name of a military hospital in Bethesda, Maryland (“About Us – Walter Reed”, 2019).

Map of Cuba showing Spanish-American War battle sites
Map of Cuba showing Spanish-American War battle sites

Yellow Jack tells the story of a group of doctors and scientists, Dr. Reed among them, who travel to Cuba after the Spanish-American War1,2 hoping to find a cure for “yellow fever,” a hemorrhagic virus that is ravaging the population there.

From archived materials at the Claude Moore Health Sciences Library at the University of Virginia (“U.S. Army Yellow Fever Commission”, 2019) we learn that

In May of 1900, [U.S. Army Surgeon General] George Miller Sternberg appointed four men to serve on the new U.S. Army Yellow Fever Commission. The head of the Commission was Major Walter Reed, a career military officer who was widely recognized as one of the leading bacteriologists in the army.

They decided to use human subjects in their experiments because yellow fever was not known to affect any other species. Human experimentation was not a new idea in 1900, but different from most other studies of the time, the subjects in Cuba were volunteers. The volunteers were given full information about the experiments and signed informed consent agreements, which may be the first use in history (“U.S. Army Yellow Fever Commission”, 2019).

Yellow Jack’s Positive Reception

Jack Benny
Jack Benny

As a measure of Yellow Jack’s positive reception by movie audiences, it earned the attention of comedian Jack Benny in particular. While entertaining on The Jack Benny Program in October 1938, Benny had listeners laughing with its parody of Yellow Jack (The Jack Benny Program: “Yellow Jack”, 1938):

Don Wilson: (OVER THE P.A. SYSTEM) “Calling all stegomyias!! Calling all stegomyias!! Report to the base hospital at once. Bring your stingers. That is all!”
[Now called aedes, stegomyia is the scientific name of the mosquito that transmits yellow fever; “Medical definition of stegomyia”, n.d.].   . . . .

Jack Benny: ‘All I need is one man who will gamble with death.’ . . . .

Mary Livingstone: ‘Good morning Dr. Benny. There’s a group of soldiers outside and there’s a volunteer among them.’

(SOUND: SOLDIERS MARCHING)

Jack Benny: ‘What’s the group of soldiers for?’

Mary Livingstone: ‘They’re dragging the volunteer!’ [The “volunteer” being dragged in to be purposely bitten by a stegomyia mosquito.]

Of course, Benny benefited from performing during an era when there was free rein on such humor. Dominating our current discourse are topics of identity politics and morality in which the issue of using humans as “volunteers” for medical experimentation brings a minefield of ethics discussion.

A Personal Experience with a Clinical Trial

Lucy Cota, researcher at Movies on Chatham, has long suffered from insomnia. From Winter to Spring of 2018, she participated in an intense study conducted by Atlanta’s Northside Hospital Sleep Clinic. She and all participants in this study received monetary compensation for their time, energy, and efforts.

The study involved tedious logging of sleep/awake time over several months, and having blood drawn repeatedly over multiple nights in the sleep lab. One night was particular rough on Lucy when technicians drew blood a total of eight times.

Saying that she was their best participant ever, praising her reliability, punctuality, and dedication, the Sleep Clinic invited her to take part in a new sleep study. She politely declined because of her need for a respite from the rigorous constraints the study had imposed on her daily life.

Advancing the field of medicine toward ultimately finding a cure, is thought to be the main reason people subject themselves to medical experimentation and clinical trials. Lucy persisted through the course of that study in hopes of helping to end her own and others’ cases of severe insomnia.

Yet, as Akhil Mehra, MD discovered during her research on Dr. Walter Reed’s yellow fever experiments, there are a host of other reasons. Those reasons would include a strong need for money, free and improved healthcare than would otherwise be available, “free check-ups, psychosocial support, or receiving a potentially life-saving drug” (Mehra, 2009).

Life-saving Drug, Indeed!

In March 2019, Movies on Chatham watched and critiqued Facing Darkness (Rasco, 2017), a documentary produced by the international aid organization, Samaritan’s Purse. Christian evangelist Franklin Graham presides over Samaritan’s Purse and directs its world-wide humanitarian efforts — including its front-line engagement with the 2014 Ebola outbreak in Liberia, West Africa.

This effort included treatment of infected patients and coordinating efforts to contain the spread of the lethal virus. The movie highlights the ordeal that Dr. Kent Brantly of Samaritan’s Purse, and nurse Nancy Whitbol of Serving in Mission (SIM), endured when they both became infected with the dreaded disease.

The documentary ends with their miraculous survival because of a last-minute effort: administering an experimental vaccine that had never been tested on a human being.

A Gap in the Facing Darkness Story

Over the years of its film research, Movies on Chatham has spent many hours watching documentaries. One important take-away from that time invested is that documentaries rarely, if ever, tell the whole story.

The glaring gap in Facing Darkness is a deceased Sierra Leonean physician named Dr. Sheik Humarr Khan, whose life now serves as a beacon of light to those who learn about who he was, and what he did.

Dr. Khan, a virologist who specialized in hemorrhagic fever, is now hailed a hero by the Sierra Leone health ministry because of his valiant efforts in the trenches against Ebola. Like Brantly and Whitbol in the neighboring country Liberia, Khan persisted tirelessly to treat infected patients.

ebola deaths 2014
Ebola deaths 2014

Turning down opportunities to get safely out of Sierra Leone, he fully dedicated himself to patients, and to educating local doctors and nurses about Ebola. Always meticulous about protecting himself and colleagues from exposure, Khan nevertheless was infected with the virus in July 2014. Those who worked with him speculate that sheer exhaustion and tremendous stress caused a momentary slip up in his safety measures.

He may have absent-mindedly taken his goggles off to clear them of fog near an Ebola patient, or he may have inadvertently touched the bare skin of a colleague who later tested positive for Ebola. However the virus came to infect him, Khan’s life was in mortal danger.

That a high-profile, leading authority on the Ebola outbreak was deathly ill with the virus would have surely caused panic among locals. To avoid this, Khan traveled in biological isolation to the northern part of Sierra Leone to be treated by Doctors Without Borders (DWB).

In desperation to save Khan, the Sierra Leone government made phone calls all over the world to plead for help. They reached out to all of the following organizations:

  • the World Health Organization (WHO)
  • the US Centers for Disease Control and Prevention (CDC)
  • the Public Health Agency for Canada
  • the US Army
  • Doctors Without Borders (DWB) [the organization treating Dr. Khan]

Out of their discussions arose the fact that there were three vials of Zmapp, an experimental vaccine stored in a battery-powered freezer just steps away from Khan. Zmapp had shown promise in treating Ebola, but it had never been tested on a human.

The Decision to Take a High-Risk Step

Time was running out, and a decision had to be made. The passage below recounts the precarious situation (Hammer, 2015).

The drugs were a gift. “Everyone was on board for giving it to him, and I got off the phone thinking, ‘He’s got it,’” says one medical officer who participated in a conference call. There was some trepidation about giving Khan a drug that had never been tested on humans, but almost everybody, it seemed, believed that the potential benefits outweighed the risks. “Everybody agreed that it made sense that a very informed and important person, who had treated more patients with hemorrhagic fever than anyone else in the world, should be given the experimental drug,” says the medical officer. But the final decision was left to Khan’s primary caretakers: Doctors Without Borders and the World Health Organization.

When push came to shove, the decision makers of WHO and DWB hesitated, and ultimately decided not to give Khan the Zmapp. They got “cold feet,” thinking that it was extremely risky since it had never been tested on humans. Neither Khan nor his family were asked for their opinion on whether they wished to take the chance with the vaccine.

The Sierra Leone government had frantically tried to no avail to get him airlifted for treatment. At that point, Germany was the only country willing to accept an Ebola patient. Unfortunately, it was too late. Dr. Khan died of Ebola on July 29, 2014 (Hammer, 2015).

In contrast with Khan’s tragic circumstances are the events that Facing Darkness documented on Brantly and Whitbol. The stories of their work are almost identical. Like Khan, Brantly and Whitbol represented the best of humanity as they willingly stepped into the most dangerous of viral hot zones to compassionately treat patients infected with Ebola. The odds eventually caught up with all of them. Brantly and Whitbol got sick with Ebola in August 2014, about one month after Khan’s death.

Why the Difference in Treatment?

Facing Darkness describes in detail the frantic race against the clock to save the two American healthcare providers, which was not all that different from the attempts the Sierra Leone government made to save Dr. Khan. International phone calls, pleading for help, intense prayers. Then Brantly’s boss, Dr. Lance Plyler, found out about the vials of Zmapp that were stored in Sierra Leone — the very same vials that were withheld from Dr. Sheik Humarr Khan.

The whole world knows the rest of the story, which ends on a positive note with complete recoveries for both Brantly and  Whitbol at Emory University Hospital in Atlanta. While they received excellent care at Emory, it is a happy ending that wouldn’t have happened without the Zmapp vaccine they both received while still in Africa.

Those concerns cited by international aid organizations on giving an experimental vaccine to a human? They simply flew out the window as the three vials were rushed from Sierra Leone to Liberia and administered to both patients as each was near death.

Not to take away from rejoicing over Brantly’s and Whitbol’s survival, but questions arise. Why was Khan denied the Zmapp vaccine that had the potential to save his life? Why did international aid organizations change their minds about risk, and make the same three vials of Zmapp ready to avail for Brantly and Whitbol?

These are questions that spill over to several areas:

Religion

In Facing Darkness, Samaritan’s Purse expressed the strong belief that God intentionally caused a plane pressurization problem to delay the timeline of evacuating Brantly and Whitbol back to the USA, thus enabling Dr. Plyler to discover and then obtain the three vials of Zmapp from Sierra Leone at the last minute.

Franklin Graham described in detail his fervent prayer on his knees in his office for the recovery of the two healthcare providers, Dr. Kent Brantly and Nancy Whitbol. Did God choose to answer Franklin Graham’s prayers, but not the ones said on behalf of Dr. Khan, the native Sierra Leonean Muslim?

Medicine

Would Brantly and Whitbol, having already received Zmapp, have survived just as well in Africa as they did receiving superior care at Emory University Hospital?

Medical Ethics

Is there a protocol for international aid organizations to follow in this particular kind of situation, when demand for a vaccine is far greater than supply?  Exactly how do Doctors Without Borders and the World Health Organization justify denying Zmapp to Khan, but releasing it to Brantly and Whitbol?

Race

There are people who believe Khan was denied Zmapp simply because he was black. Brantly and Whitbol are both white. Is there truth to this accusation? (Quartey, 2014).

While the movie group discusses and debates these delicate issues, Movies on Chatham does not profess to have the knowledge or expertise to respond formally. However, our members have witnessed a range of suffering over the years among family and friends. To name a few: viral Illnesses, cancer, Parkinson’s disease, diabetes, multiple sclerosis, and what those in the medical profession consider the most dreaded disease of all, Lou Gehrig’s syndrome (ALS).

The general consensus is, if there is an elixir out there that has the potential to save loved ones’ lives, mountains should be moved at every possible to angle to get access to it, no matter how big or small the risk to the sick person. The will to live is a powerful one, and every possible chance should be given to nurture it.

Robert Montgomery, Virginia Bruce, and Lewis Stone - stars of "Yellow Jack"
Robert Montgomery, Virginia Bruce, and Lewis Stone – stars of “Yellow Jack”

In the case of yellow fever and the U.S. Army Yellow Fever Commission, not only did Dr. Walter Reed and his colleagues take enormous risks, but the volunteer subjects of their unique experiment with mosquitoes did too, no matter their motivation. In fact, in the early stages of the investigation, Johns Hopkins scientist Jesse Lazear lost his life to a case of yellow fever, very likely experimental in origin.

Every single person involved in the experiments in Cuba in 1900 contributed to the fact that yellow fever is no longer a mortal threat to humans. The virus is mostly eradicated except for remote subtropical areas in Africa and South America. With that in mind, it is a comforting thought that Dr. Sheik Humarr Khan died so that Brantly and Whitbol might live to help push the field of medicine forward for the benefit of all people.

Footnotes

1 The Spanish–American War was the first U.S. war in which the motion picture camera played a role (Wikipedia contributors, 2019).

2 To pay the costs of the war, Congress passed an excise tax on long-distance phone service. At the time, it affected only wealthy Americans who owned telephones. However, the tax remained in place until 2006 — over 100 years (Reardon, 2006).

REFERENCES

About us – Walter Reed national military medical center. (2019). Walter Reed National Military Medical Center. Retrieved from https://www.wrnmmc.capmed.mil/About%20Us/SitePages/Home.aspx

Hammer, J. (2015, Jan 12). “I don’t know if I’m already infected.” The controversial death of Ebola’s unsung hero. Medium. Retrieved from https://medium.com/matter/did-sierra-leones-hero-doctor-have-to-die-1c1de004941e

Medical definition of stegomyia. (n.d.) Merriam-Webster Medical Dictionary. Retrieved from https://www.merriam-webster.com/medical/stegomyia

Mehra, A. (2009). Politics of participation: Walter Reed’s yellow-fever experiments. AMA Journal of Ethics, 11(4), 326-330. doi: 10.1001/virtualmentor.2009.11.4.mhst1-0904

NBC Blue. (1938). The Jack Benny program: “Yellow Jack” [RADIO BROADCAST]. Hollywood. Retrieved from https://www.youtube.com/watch?v=qfV3LV3EaLs&feature=youtu.be&t=1204

Quartey, K. (2014, Nov 26). Ebola’s racial disparity. Foreign Policy In Focus. Retrieved from https://fpif.org/ebolas-racial-disparity/

Rasco, A. (Director). (2017). Facing Darkness [MOTION PICTURE]. USA: Samaritan’s Purse.

Reardon, M. (2006, Aug 2). Telecom tax imposed in 1898 finally ends: Levied on wealthy Americans with phones in 1898 to help fund Spanish-American War, tax was discontinued Tuesday. CNET. Retrieved from https://www.cnet.com/news/telecom-tax-imposed-in-1898-finally-ends/

Seitz, G. (Director). (1938). Yellow Jack [MOTION PICTURE]. USA: MGM.

The Spanish-American War in motion pictures. (2010, Feb 19). Wayback Machine, US Library of Congress. Retrieved from https://www.loc.gov/collections/spanish-american-war-in-motion-pictures/about-this-collection/

The United States army yellow fever commission headed by Walter Reed. (2019). U.S. Army Yellow Fever Commission, University of Virginia Health Sciences. Retrieved from http://exhibits.hsl.virginia.edu/yellowfever/

Wikipedia contributors. (2019, April 10). Spanish–American War. In Wikipedia, The Free Encyclopedia. Retrieved from https://en.wikipedia.org/w/index.php?title=Spanish%E2%80%93American_War&oldid=891790433

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4 thoughts on “Yellow Jack Vaccine: Victory without Clinical Trial”

  1. As a close observer of Movies on Chatham (my PhD wife is the founder and editor and her two researchers, Mary and Lucy, are often at our house plotting the next movie presentation). They, in addition to the 14 or so women who meet monthly to observe, question, debate and ponder the messages these movies present, not only generate thoughtful discussion, but “female bonding” that might not have happened without Movies on Chatham. The discussions that occur are more than “that was a good or bad movie,” but engender a deeper questioning of the messages of the movie that challenges the viewers to assess the validity of what is being presented, and its value for influence.

  2. What a meticulously researched and compelling work was this.. Thank you, Mary. As the grandmother of a Type 1 diabetic, I was particularly moved by the dedication of these self-sacrificing doctors. Truly. May God bless the medical profession and all those in the field of research.

    1. Hi Milam! Thank you so much!! I’m also most inspired by the dedication of doctors, and am forever grateful for the one who operated on Charles for his cochlear implants, and the team of doctors who treat Catherine! They are a special breed! Thank you for taking the time to read and comment!

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