Continuing To Do Nothing About Smallpox

September 13, 2002 • Commentary

Health and Human Services Secretary Tommy Thompson recently said that a smallpox attack was likely: “We have to assume, with what’s going on in the world, that it’s going to come.” So while the Israeli government has begun inoculating more than 15,000 security and rescue workers in preparation for a possible U.S. war against Iraq (the Israeli government said it would inoculate the entire population within a week if the United States attacks Iraq), the U.S. government is still debating what to do. That’s not good enough.

The administration seems intent on waging war against Iraq — a country that possesses chemical and biological weapons, and some experts believe might have obtained the deadly smallpox virus. Smallpox is the most devastating of all infectious diseases, having killed more people than any other disease in history and in the 20th century killed three times more people than all the wars combined. The administration has also been touting the need for a Department of Homeland Security to protect against potential future terrorist attacks (including bioterrorism). Thus, it is stupefying that the federal government’s response to the threat of a smallpox attack seems to be to have another meeting.

The first responsibility of the federal government is to protect the citizenry. If the United States is about to embark on a war against Iraq (however imprudent that action might be), which might put the general population at risk to a possible smallpox attack, and the government has a stockpile of smallpox vaccine, then certainly the government shouldn’t be “doing nothing.” Yet that is what the administration seems to be doing.

The lame excuse being proffered by one government official is that people with various skin problems, including eczema, which is common in the baby boom generation, are more likely to suffer adverse effects. But if a smallpox attack is likely, what about the adverse effects of untold thousands of people dying from smallpox because no one is vaccinated?

The bottom line is that an unvaccinated population is 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), individuals should be allowed to make a voluntary, informed decision (in consultation with a doctor) to understand, manage, and mitigate those risks. In all likelihood, those who are most at risk to the vaccine would make the decision to opt out and not be vaccinated, thereby reducing the number of potential deaths and side effects due to the vaccine.

And concerns about people with various skin problems suffering adverse effects can be addressed by the use of a semi‐​permeable membrane dressing that prevents viral shedding. A self‐​quarantine is another option.

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 ring containment 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.

But leaving the population at risk to a smallpox attack when the administration is moving the United States closer to a war against Iraq, which carries with it the real risk of a potential smallpox attack, is simply irresponsible. And it begs the question of whether it makes any sense to attack a small country halfway around the world that has weapons of mass destruction (including possibly the deadly smallpox virus) which might be used in retaliation against the American people.

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