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As a disease, smallpox was eliminated as a natural threat in 1980. As a weapon of bioterrorism, smallpox - and the fear it engenders - has returned. An intentional outbreak at the hands of Al Qaeda agents or by Saddam Hussein's forces could spread quickly. Public officials say one-third of those exposed will die. But massive vaccinations - considered the only effective treatment - carry major risks, too.

President George W. Bush is expected to outline a major smallpox prevention plan that could include provisions for massive vaccinations. Though expectations have emerged about the plan's details, the Centers for Disease Control spokesman Von Roebuck cautions that nothing is official. "We don't have a final decison," he says.

According to published reports, the plan's first stage involves vaccinations for 500,000 military personnel and a half-million more civilian medical workers. Next in line: up to 10 million "first responders," such as police, emergency service personnel, and healthcare staff. Finally, the vaccine, along with warnings of its health risks, would be offered to anyone who wanted it sometime in 2004.

But the math involved in a such a large vaccination plan illustrates the risks of precautionary measures. Consider this scenario: a vaccination of 100 million Americans might kill more than 100 people, send at least 4,000 to the hospital, and cause mild to moderate illness in another 100,000. Initial trials have proved sobering. One-third of 200 young adults who recently received the vaccine missed at least one day of work or school and 75 developed high fevers.

As part of the sweeping new homeland security laws passed last month, drug companies avoid liability for producing the smallpox vaccine.

Even as the federal government finalizes its plan, the CDC is providing direction to state and local health officials for responding to a smallpox emergency. The CDC also reports that there is a detailed nationwide smallpox response plan designed to quickly vaccinate people and contain a smallpox outbreak and that there is enough smallpox vaccine to vaccinate everyone who would want it in the event of an emergency.