Responding to the Threat of Smallpox Bioterrorism: An Ounce of Prevention Is Best Approach

April 18, 2002 • Policy Analysis No. 434

The threat of direct terrorist attack against the United States proved to be real. And the subsequent anthrax cases point to the possibility of a future bioterrorist attack, including use of the deadly smallpox virus. The nature of terrorism is such that it is impossible to accurately predict the probability of such an attack, but the potential consequences are catastrophic. Therefore, it is a serious threat that deserves serious attention.

The current ring containment strategy (administering smallpox vaccinations only after an outbreak in the hope of containing the spread of the virus) favored by the federal government may be appropriate for dealing with a natural outbreak of smallpox, but it is likely to be woefully inadequate for countering a direct attack by a thinking enemy intent on inflicting infection, death, and panic.

A better approach than leaving the entire population at risk and responding to a smallpox attack after the fact would be to take preventive measures. The current stockpile of smallpox vaccine can be effectively diluted to create a more abundant supply, which–along with a newly discovered stockpile and additional vaccine already ordered and scheduled to be delivered by the end of 2002–should be made available to the public. Even if only a small fraction of the population were vaccinated, a community immunity effect, which would lower the rate of transmission of a disease as well as significantly increase the chances of success of a ring containment strategy, would be produced. As a result, the chances of a successful attack would be lowered, and that could have a deterrent effect and might even prevent such an attack.

If the paramount obligation of the federal government is to protect the United States and its population, then an ounce of prevention in the form of a population partially vaccinated against smallpox will be more effective–both in deterring and in responding to a potential attack–than leaving the American public unprotected and completely at risk, hoping that a pound of cure will work after the fact.

About the Authors