- The Washington Times - Friday, December 13, 2002

The debate over smallpox vaccination as a precaution against bioterrorism pits those who say it is necessary for national security against those who are concerned about the vaccine's medical risks.
President Bush is expected to announce today that there will be immediate and mandatory smallpox vaccinations of 500,000 U.S. military troops, followed by voluntary immunizations of 500,000 Americans who work in hospitals and on special smallpox response teams.
The president was forced to weigh the risk of the live-virus vaccine against the theoretical risk of a terrorist attack with smallpox as a weapon in deciding whether to offer mass smallpox inoculations for the first time in the country in 30 years.
Mr. Bush is also expected to announce that the vaccinations will be offered to the general public as soon as large stockpiles are licensed. That phase is likely to begin early in 2004, although the federal government will not be encouraging average Americans to get the vaccine, which has more deadly side effects compared with any other vaccine in use in the country.
"The vaccine includes a risk for death, so the issue has to be seriously deliberated," White House spokesman Scott McClellan said in an interview Wednesday.
Studies from the 1960s show that 15 of every million first-time recipients of the vaccine suffer life-threatening complications and that one or two of them die.
Encephalitis, or brain swelling, is one of the vaccine's most severe side effects. It kills between 5 percent and 25 percent of affected victims, and an additional 25 percent have permanent neurological damage, according to data from the University of Minnesota.
A Heritage Foundation policy paper released Monday says that vaccinating the American public against smallpox is "no longer just a public health issue."
"It's becoming a national security matter," the paper said.
"Even a localized [smallpox] attack on non-immunized Americans could result in the deaths of a million or more Americans nationally," writes Michael Scardaville, policy analyst for homeland security with the foundation.
He cited the prospects of a war with Iraq and terrorist attacks by al Qaeda. One or both could release the smallpox virus as a bioterrorism weapon, he said.
Smallpox is believed to have been eradicated worldwide more than 20 years ago. No one knows the likelihood of the smallpox virus returning as a terror weapon.
Only two labs in Atlanta and Moscow are known to have the virus. But many disease and weapons specialists fear that it has been obtained by rogue nations such as Iraq or by terrorist groups. There's speculation that Iraqi leader Saddam Hussein will release the virus if his country is attacked by the United States and others.
Mr. Scardaville acknowledges that the vaccine "carries significant risks." He said experience with a smallpox vaccination program in this country before 1972 "indicates that one in every million first-time recipients is likely to die from complications."
Vaccinating the entire American population "could cost 300 lives," Mr. Scardaville said. He noted that estimates of how many would suffer serious complications from the vaccine but would not die range from a low of one in every 67,000 to a high of one in every 8,000.
But he argues that the benefits of the vaccine far outweigh the risks. Pre-emptive vaccination, he says, would reduce the spread of the disease if it is used as a biological weapon, improve health workers' ability to treat victims, reduce panic and deter some terrorists from using smallpox against U.S. targets.
In his report, Mr. Scardaville says the federal government should urge states to "vaccinate all first responders and public health officials essential to their state and local response plans."
He also says it "should carry through on plans to vaccinate essential military personnel immediately" and should make the vaccine "available to the general public for voluntary inoculations following a broad campaign of education."
A number of powerful medical organizations, including the American Medical Association, had opposed vaccinating the general population on the basis of a perceived threat of a smallpox attack.
They argued that, without a better assessment of the threat, the potential loss of life from the vaccine outweighs the benefits of inoculation. They also expressed fear that administering physicians who distribute the vaccine could face legal liability.
The AMA now says it can accept the recommendations Mr. Bush is expected to announce today. However, it insists that no American be vaccinated until "vital federal liability protections" are put in place.
Gordon Johndroe, spokesman for the Department of Homeland Security, said the legislation that created that department calls for liability coverage for the vaccine to take effect Jan. 24, 2003.
There has been no case of smallpox in the United States since 1949, and world health officials announced its global eradication in 1980.
D.A. Henderson, a federal bioterrorism adviser, who led the global eradication effort, told the Associated Press yesterday that he finds the planned level of use of the vaccine "troublesome." He and his associates had recommended a conservative vaccination program involving no more than 20,000 Americans.
Dr. Henderson, who heads the Center for Civilian Biodefense Studies at Johns Hopkins University School of Public Health, says it is crucial that the government keep detailed records of the vaccine's effects on the first million recipients before offering it to the broader population. The Bush administration says it intends to do that.

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