Military Smallpox Vaccinations Planned
Bush to Order Pentagon Action, but Safety Concerns Delay Civilian Inoculations

By Bradley Graham and Mike Allen
Washington Post Staff Writers
Friday, November 15, 2002; Page A16

Senior administration officials said yesterday they expect President Bush will order the inoculation of hundreds of thousands of U.S. troops against smallpox but delay action on vaccinating civilians to review safety concerns.

An administration official said that although Bush has not made a final decision, his top advisers have endorsed the plan, which was recommended by the Pentagon. An announcement could come within days but certainly within two weeks, the official said.

"The military is most likely to come into contact with the disease," the official said. "The odds of exposure are highest abroad, and it wouldn't need to be use of it by an enemy. It could be during inspection and confiscation of weapons stocks."

Questions of whether and how to proceed with vaccinating U.S. troops and civilians have confronted Bush for weeks. Driving the argument for a renewed national effort to protect Americans against smallpox have been heightened concerns about biological warfare and intelligence reports about covert stocks of the smallpox pathogen in at least four nations -- Iraq, North Korea, Russia and France.

But worries about the vaccine's safety have prompted Bush to hesitate over approving the resumption of routine vaccinations, which stopped in the United States in 1972. Use of the vaccine has led to serious -- and occasionally fatal -- complications in a small percentage of recipients.

"This decision hasn't been easy because this isn't a benign vaccine," another administration official said.

Officials said the White House sees serious risks to ordering civilian vaccination, especially with the oldest and youngest vaccine recipients. "The arguments are much more complex than with the military," an official said. "With civilians, you have to consider the possibility of vaccinating people after the fact."

Because soldiers are generally younger and healthier than the general population, Bush is said to have fewer reservations about authorizing the Pentagon to proceed with its inoculation program.

"With the military, you have fewer risky cases. And you also have extensive health and medical records that make it easier to screen out anybody who might be vulnerable to adverse effects from the vaccine," an official said.

Pentagon officials have developed a plan for inoculating as many as 500,000 troops out of the 1.4 million soldiers on active duty. The first shots are earmarked for medical specialists and other emergency support troops. Next in line would be troops designated for deployment in the Middle East and other areas in which the risk of combat is considered high, defense officials said.

Defense Secretary Donald H. Rumsfeld strongly favors the inoculation program, considering it critical to ensuring the protection of U.S. forces, according to aides. Given the prospect of a war with Iraq as early as next year, Pentagon officials are eager to begin the vaccinations. Although there is no conclusive evidence that Iraq would be willing to use smallpox in a war with the United States, there are no reliable devices for detecting the release of the virus, so delaying inoculations until after an attack is not much of an option, officials said.

Senior federal health officials also have urged making the vaccine available in stages to U.S. civilians, beginning with about 500,000 people who work in hospital emergency rooms, then inoculating an estimated 10 million other health care workers, police, firefighters and paramedics. Ultimately, the vaccine would be offered to the public on a voluntary basis.

But the probability that some people would die of the vaccine's side effects has remained a major stumbling block for Bush and some senior advisers, officials said. The vaccine has caused lift-threatening complications for 15 out of every 1 million people who have been inoculated for the first time.

Smallpox is one of the deadliest and most contagious diseases in history, killing about 3 out of 10 people who contract it. But the World Health Organization declared the disease eradicated in 1980.

The Department of Health and Human Services, which is responsible for maintaining U.S. vaccine stockpiles, has set aside for the military about 1 million of the 2.7 million doses licensed for use by the Food and Drug Administration.

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