Bush set to order shots for smallpox

By Laurence McQuillan, USA TODAY

WASHINGTON — As early as Monday, President Bush is expected to order smallpox vaccinations for 500,000 U.S. military personnel and 510,000 civilian medical workers as a precaution against a biological attack by Iraqi agents or other terrorists, administration officials say.

Bush most likely will wait until next year before deciding whether the threat of a smallpox attack is serious enough to make the vaccine available immediately to all Americans, the officials say. (Related story: Smallpox vaccine carries a dose of risk)

The limited approach lets Bush address a potential threat but delays the tough decision on whether to try to safeguard the public with a vaccine that could claim lives. The initial inoculations offer Bush a chance to get better advice from doctors studying the side effects of the vaccine.

Vaccinations were discontinued in 1972, when smallpox was declared eradicated in the USA.

The first stage of inoculations will take weeks or months, partly to screen out pregnant women and others who should not get the vaccine because of risks to their health — for example, anyone with a compromised immune system, such as a person with HIV.

Out of 1 million new vaccinations, at least 15 people would be likely to develop life-threatening complications, and one or two could die. But in a smallpox outbreak, 30% of those infected would die. The vaccination site on the skin requires special care for at least two weeks, because the vaccine is made with a live virus that can spread to other parts of the body or to other people.

The same risks existed when the vaccine was widely used, but the risk of smallpox infection was greater then. The last known case in the world was in 1977. Those previously vaccinated may no longer be fully protected, but their risk of side effects is less.

Whether to resume vaccinating Americans has been debated since the rise of the terrorist threat. Advisers see peril for Bush whatever he decides — if some people die after being vaccinated and there is no attack, or if he decides against vaccinations and then a deliberate release of smallpox kills Americans.

As a possible war with Iraq looms, Bush's military advisers, including Defense Secretary Donald Rumsfeld, have been pressing for the inoculations. Most of the 1.4 million men and women in the military were born after vaccinations ended 30 years ago.

Administration officials say the inoculations would cover about 100 workers at each of the nation's 5,000 hospitals. Additional vaccines for up to 10 million medical and emergency personnel would be ordered if Bush decided the threat warranted it, they say.

There is some uncertainty about the effectiveness of the vaccine, which works on the old form of the smallpox virus. However, government experts do not think Iraq possesses a newer, vaccine-resistant form developed in the old Soviet Union.