CIA Director George Tenet has warned that if the United States attacks Iraq, Saddam Hussein would no longer be deterred from assisting Islamist terrorists in conducting attacks against the United States. Yet according to one person involved in the smallpox debate, “the decision is still sitting on his [the president’s] desk.” And the reason a decision hasn’t been made is because the bureaucracy is apparently still engaged in a debating society on the issue.
Vice President Cheney is said to be pressing for mass vaccination. Health and Human Services Secretary Tommy Thompson prefers voluntary vaccination, but wants to wait at least two years for an improved vaccine before making it available to the public. Meanwhile, the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention continues to push for limiting vaccinations to first responders and waiting for an actual outbreak to begin more widespread vaccination of the public.
The first responsibility of the federal government is to protect its citizenry and none of these plans is acceptable. There is enough smallpox vaccine in the stockpile (over 150 million doses with three times that by the end of the year) to begin voluntary vaccination now.
The most effective defense (and deterrent) against a smallpox attack is a well‐vaccinated population. A study by experts from Yale University and the Massachusetts Institute of Technology shows that vaccination of the U.S. population (even if only a fraction was vaccinated) before an attack worked best to reduce fatalities and the number of days to contain the outbreak when compared to all post‐attack responses (including mass vaccination).
There’s no known cure for smallpox. The vaccine is most effective if administered beforehand. Immediate vaccination is the only way to combat the virus after infection. The problem is that the first symptoms of smallpox usually appear 12–14 days after infection and the vaccine needs to be administered within 3–5 days of contracting the virus.
The bottom line is that an unvaccinated population is completely vulnerable and an attractive target. In a densely populated and highly mobile society, the intentional introduction of the smallpox virus into the population will outpace the ability of public health officials to inoculate against its spread. And in the inevitable post‐attack panic and confusion, the medical infrastructure would buckle under the weight of millions of people demanding immediate vaccination.
A better approach than leaving the population exposed and responding after an attack would be to take preventative measures now. Because there are known risks with the smallpox vaccination (in particular for those with weakened immune systems, pregnant women, and very young children), individuals should be allowed to make a voluntary, informed decision (in consultation with a doctor) to understand, manage, and mitigate those risks. Those who are most at risk to the vaccine could elect to opt out and not be vaccinated, thereby greatly reducing the number of potential deaths and side effects due to the vaccine.
Even if only a fraction of the population were vaccinated beforehand (various polls show that 50 percent or more of the public would like to be vaccinated), a “community immunity” effect would occur that lowers the rate of transmission of the disease and significantly increases the chances of success of a post‐attack vaccination strategy. As a result, the chances of a successful attack would be lowered, which could also have a deterrent effect and thus might prevent such an attack from occurring.
In its rush to engage in regime change in Iraq, the Bush administration is knowingly putting the public at grave risk — which is in and of itself a questionable policy — but doing nothing to protect it. Continuing to leave the U.S. population vulnerable, when an adequate stockpile of smallpox vaccine exists, seems foolish at best and irresponsible at worst. After Sept. 11, Americans deserve better from their government.