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

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The threat of direct terrorist attack againstthe United States proved to be real. And the subsequentanthrax cases point to the possibility ofa future bioterrorist attack, including use of thedeadly smallpox virus. The nature of terrorism issuch that it is impossible to accurately predictthe probability of such an attack, but the potentialconsequences are catastrophic. Therefore, itis a serious threat that deserves serious attention.

The current ring containment strategy(administering smallpox vaccinations only afteran outbreak in the hope of containing the spreadof the virus) favored by the federal governmentmay be appropriate for dealing with a naturaloutbreak of smallpox, but it is likely to be woefullyinadequate for countering a direct attack bya thinking enemy intent on inflicting infection,death, and panic.

A better approach than leaving the entire populationat risk and responding to a smallpox attackafter the fact would be to take preventive measures.The current stockpile of smallpox vaccine can beeffectively diluted to create a more abundant supply,which--along with a newly discovered stockpileand additional vaccine already ordered and scheduledto be delivered by the end of 2002--should bemade available to the public. Even if only a smallfraction of the population were vaccinated, a communityimmunity effect, which would lower therate of transmission of a disease as well as significantlyincrease the chances of success of a ring containmentstrategy, would be produced. As a result,the chances of a successful attack would be lowered,and that could have a deterrent effect and mighteven prevent such an attack.

If the paramount obligation of the federalgovernment is to protect the United States andits population, then an ounce of prevention inthe form of a population partially vaccinatedagainst smallpox will be more effective--both indeterring and in responding to a potentialattack--than leaving the American public unprotectedand completely at risk, hoping that apound of cure will work after the fact.