By Melinda T. Willis

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"For the last six months, administration officials have been secretly briefed about which nations are likely to possess covert stocks of smallpox, and what should be done about it," said ABCNEWS correspondent Martha Raddatz.

According to U.S. officials, North Korea, Russia, Iraq and France have stored the deadly virus. Because of the possibility of war, Iraq is seen as the biggest threat.

This revelation has awakened fresh fears that the virus could be used as a biological weapon against the United States if it fell into the hands of terrorist groups like al Qaeda, and brings the much-debated issue of mass vaccination into sharper focus.

Yet despite the possibility of increased risk of widespread smallpox infection, many doctors and health organizations firmly maintain their concerns about the dangers associated with the only way to prevent infection: the smallpox vaccine.

Among the organizations in opposition to a mass vaccination program are the American Academy of Pediatrics and the American Academy of Family Physicians, who support the government's current approach to smallpox prevention, known as ring vaccination.

Under the ring vaccination strategy, only those who have been infected or come into contact with an infected person receive the vaccine.

Not for Everyone

It is the risk of serious and even fatal complications associated with the smallpox vaccine that gives so many physicians reason for concern at the idea that it could be given to everyone.

"The smallpox vaccine is not benign. It has serious inherent risks involved," said Dr. Carolyn Eaton, a family physician from Palacios, Texas.

Among those risks are allergic reactions to the vaccine and spread of vaccine virus to others who have not been inoculated. Those with compromised immunity — such as those with HIV or leukemia — and those with skin conditions like eczema are at greatest risk of having severe reactions.

Additionally, an estimated one in 500,000 — or about 300 people — are expected to die as a direct result of being vaccinated. That is a risk that many feel is too great to take when there is no specific threat of infection.

"Would we be killing all these people because of a government-conjured bogeyman?" wondered Dr. Michael Good, a family physician from Middletown, Conn.

And despite more definitive tone of today's report, the actual risks remain unclear. "The intelligence agencies have very little info that would tell them that al Qaeda possesses smallpox. In fact, the U.S. thinks that is unlikely," said Raddatz.

Eliminating the Potential for Disaster

Weighing heavily on the other side of the issue is the number of deaths that could result from a smallpox attack on a vulnerable population if no preventive action is taken.

"If a smallpox attack were launched against us, the deaths would likely total millions," said Dr. Joseph Lipinski, assistant professor of medicine at the University of Pittsburgh. "The health system would be overwhelmed, panic would ensue and our financial system and economy would lie in ruins."

Mass vaccination, he feels, is the best way to ensure that the sting of a biological attack on the United States is never felt.

"This is one of the easiest public health decisions ever," said Lipinski. "It is difficult for me to understand those who object to it."

With a conscientiously applied program of mass vaccination, administered perhaps in a similar fashion as the flu vaccine, some feel that those at risk for serious complications could be screened and adverse events minimized.

Waiting for Possible Policy Change

It remains to be seen whether this new evidence will propel the Bush administration closer to changing the current vaccination strategy. The president's decision is expected next week, well after Election Day and a U.N. vote on a resolution on Iraq.

And physicians are all too aware of the difficult decisions government officials face when weighing the benefits and risks of mass vaccination.

"Until case one of smallpox, the hew and cry will be for the 'victims' of the vaccination program," said Dr. Michael Allswede, chief of the special emergency medical response system at the University of Pittsburgh. "After the first case, the charge will be that the program was not aggressive enough."