- The Washington Times - Saturday, October 26, 2002

Despite resistance, federal policymakers appear to be moving toward allowing Americans to be vaccinated against smallpox. Last week, the Advisory Committee on Immunization Practices (ACIP), the primary source of advice on such matters to the Centers for Disease Control and Prevention, endorsed the idea of pre-attack vaccinations for more than 500,000 health care workers. It represents a fairly dramatic change of mind for the ACIP's experts, who had previously recommended providing the pre-vaccination option to only a few hundred health care workers in each state.

However, not all medical professionals agree with the ACIP's recommendations, much less the idea of voluntary mass vaccinations. They fear that the vaccine is too risky, both in terms of its potentially lethal side effects and its potential to infect vulnerable individuals. Given those adverse consequences, they fear that the public's confidence in other immunization and vaccination programs will be undermined. Instead, they suggest that a small-scale vaccination program would be acceptable until the dangers of vaccination can be assessed or an attack is imminent.

While it is true that such a program would be useful, it simply does not go far enough. As Donald Henderson, the Bush administration's principle adviser on the issue said recently, "The risk [of the reappearance of smallpox presumably through a non-natural event] as appraised is a small one. It is not zero, and that is the worrisome piece." No one knows when, or how, a smallpox attack would occur. Perhaps the only certain thing is that no warning will be given. For in addition to nuclear weapons, rogue nations like North Korea could be engineering terrible versions of smallpox. As Richard Preston, author of "The Hot Zone" pointed out in an op-ed in the New York Times last week, "Pox viruses are among the easiest viruses to engineer in the lab … . There is little doubt that Iraqi biologists know how to do it."

The idea that public confidence in public-health programs will be undermined by adverse reactions to the smallpox vaccine seems specious, given the planned public-education campaigns and the fact that vaccines will only be given to willing volunteers. True, some individuals will blame the government, but it would be easier to outlaw lawyers than to stop misguided lawsuits.

While there is no way around the small possibility that some vaccinated individuals will inadvertently infect immuno-compromised persons, those risks must be weighed against the consequences of a smallpox attack to the general population. In "Pox Americana: The Great Smallpox Epidemic of 1775-82," author Elizabeth A. Fenn pointed out that George Washington was faced with similar choices during the Revolutionary War his unvaccinated troops were highly vulnerable to smallpox, in contrast to most of the already inoculated redcoats he faced. Washington tried isolation, but eventually realized that, given smallpox's ubiquity and lethality, a mass vaccination of his soldiers was safest way to go.

While smallpox has not been seen for decades, it remains an ominous threat, and every American is a potential target. The ACIP was wise to change its recommendations. It is hoped that the administration understands that voluntary public vaccinations are necessary to preserve both public health and personal freedom.

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