mericans
feeling vulnerable to a potential smallpox attack by terrorists can breathe
a little easier, thanks to two encouraging developments last week. New
experimental results showed that the federal government's small stockpile of
smallpox vaccine could be enlarged fivefold through dilution without losing
much effectiveness, providing enough medicine to protect some 77 million
Americans. At the same time, officials revealed that a drug company had a
large additional supply of vaccine some 85 million doses left over from
decades ago that might also be expandable through dilution. The combined
result may mean that the government could quickly marshal enough smallpox
vaccine now to protect most of the country should the need arise.
On top of that, the federal government has contracted with drug companies
to deliver by the end of this year 209 million doses of a second-generation
vaccine made by more modern techniques. Clearly, the days when the nation's
280 million residents were virtually defenseless against a scourge that
spreads easily and kills some 30 percent of its victims are over. The only
question now is how best to use the vaccine.
Government officials consider the risk of a smallpox attack quite low
because the only known stocks of the virus are held at guarded sites in the
United States and Russia. But there are persistent rumors of clandestine
stocks that terrorists might be able to tap. So officials consider it
prudent to be ready for the worst.
The current plan, fashioned by the Centers for Disease Control and
Prevention, calls for holding the vaccine in reserve until after an attack
occurs and then rushing it to the scene. Health authorities would identify
and isolate infected individuals and quickly vaccinate all those who had
come in contact with them, a process that could prevent the spread of
disease.
That approach has worked well in containing natural outbreaks in the
past. The main drawback is that the virus might move too fast to keep it
contained, particularly if attacks were launched simultaneously on multiple
cities.
The current generation of smallpox vaccines is undeniably riskier than
other vaccines commonly taken by the public. It can be expected to kill one
or two people among every million vaccinated and cause serious side effects
in hundreds of others. If the entire population was vaccinated, there could
be a few hundred deaths and tens of thousands of adverse reactions. That
makes it extremely difficult for health authorities to recommend mass
vaccination absent compelling proof that an attack is likely.
But there seems to be no reason why the vaccine should not be available
to those who want it. People who fear the side effects and think that the
likelihood of an attack is remote could shun the vaccine. Those willing to
accept the risks should be able to get the vaccination, as Americans did
routinely back in the days when smallpox was still rampant in the world.
If enough people took that option, the likelihood that terrorists would
resort to smallpox would diminish. This is a case in which the government
should provide the best possible estimate of the risk of attack and the risk
of vaccination and let informed members of the public choose their own
medicine.