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By Judd Gregg
Sunday, October 6, 2002; Page B07

With a mortality rate of more than 30 percent, smallpox was one of the world's most feared diseases until a collaborative global vaccination program eradicated it in the 1970s. Smallpox no longer occurs naturally, and today it can be found only in laboratories in the United States and Russia.

Or so we believe. With the fall of the Soviet Union, some intelligence officials are concerned that samples of the virus may have found their way to other countries, including Iraq. This is of grave concern to our nation and the world.

Highly contagious and easily dispersed in the air, smallpox virus can be a deadly weapon in terrorist hands. Congress and the administration have responded to this potential threat by authorizing the purchase of approximately 300 million doses of smallpox vaccine, enough for every man, woman and child in America. To date, nearly 100 million doses have been delivered, with the remainder expected by early next year.

The administration has developed a plan to respond in the event of an outbreak of the disease. Recently, the Centers for Disease Control and Prevention (CDC) released their Smallpox Response Plan and Guidelines, which call for vaccinating the entire U.S. population against smallpox within 10 days of an outbreak of the disease. The plan correctly presumes that an outbreak of smallpox would be an intentional attack on the United States and that we would have to move quickly in coordination with the states to implement nationwide vaccinations. Also under development is a plan to inoculate tens of thousands of health care workers who would likely be the first to treat an outbreak.

The administration and the CDC should be commended for their work on the plan, which addresses every aspect from logistics to parking. It is a significant improvement on the CDC's initial smallpox response guidelines providing for a strategy of "ring vaccination" under which vaccinations would begin with those closest to an exposure and then expand outward. The CDC also appropriately does not require mandatory smallpox vaccinations. The vaccine can have very serious, sometimes fatal side effects, particularly for pregnant women and those with weakened immune systems.

But while the strategy adopted by the CDC is an important step forward, it falls short of what is necessary to adequately protect and defend against a possible smallpox attack. I am concerned that even America's highly advanced health care infrastructure would not -- in the panic and confusion that would surely follow a smallpox attack -- be able to effectively respond to and vaccinate 288 million people within 10 days.

Moreover, even if we were able to do so, the vaccine must be given within four days of exposure to be effective. Because initial symptoms of the disease are flu-like and may go undetected or undiagnosed for up to two weeks, the disease could spread and kill thousands before the first vaccinations were administered.

Rather than leaving the entire population at risk and responding to a smallpox attack after the fact, we should take additional, preventive measures that complement the CDC's response plan. Once the smallpox vaccine has been licensed by the Food and Drug Administration as safe and effective, it should be made available to every person in America. While there are known health risks associated with the vaccine, individuals, after consultation with their doctors or health providers, should be allowed to make voluntary, informed choices for themselves and their families. Additionally, the federal government, which has the primary obligation to protect its citizens, should make the vaccine available to the public at nominal or no cost. I suspect that many people will take advantage of this option if it is made available to them, both for themselves and for their children.

In a system that values personal liberty and freedom, the decision to be vaccinated against smallpox should be made by individuals and their doctors -- not the federal government. The more who are vaccinated against smallpox, the lower the rate of transmission, and the greater likelihood that such an outbreak could be contained. The fewer people who are susceptible to the disease, the less likely an enemy will be to use it against us.

The writer is a Republican senator from New Hampshire and ranking member of the Committee on Health, Education, Labor and Pensions.