- The Washington Times - Saturday, October 5, 2002

In preparation for a potential biological weapons attack involving smallpox, the federal government recently issued detailed logistical guidelines to states on how to handle the requisite mass-vaccination campaign. It's laudable that preparations are being made for such a terrifying scenario. However, the nature of such an attack, coupled with the government's dubious ability to follow its own guidelines under attack conditions, makes it clear that the better plan would be to allow Americans an informed choice about taking voluntary, pre-emptive smallpox vaccinations.
It is not clear that the government has the ability to deliver massive amounts of vaccine in a timely manner. "To do a mass vaccination in 10 days would be a total nightmare," Donald Leung, editor of the Journal of Allergy and Clinical Immunology, told The Washington Post.
Those days could be critical, since it is not certain how soon the smallpox vaccine will need to be administered to an exposed individual in order to prevent the disease. The window is thought to be between three and five days after exposure. Even if a vaccination program is running at optimum levels, it is far from certain whether those exposed will be vaccinated in time, especially given the crowded emergency rooms and restrictions on travel expected during a smallpox attack. Offering Americans pre-attack vaccinations would seem to be a far better option.
There's no doubt that smallpox vaccinations can be harmful even fatal. Statistically speaking, about one of every million Americans so inoculated will perish from associated complications, and about one of every 20 will be sickened. (By comparison, one's risk of being hit by lightning is about one in 600,000.) There is also concern that some individuals with unknowingly compromised immune systems, namely, those with undiagnosed HIV infections, will agree to be vaccinated without realizing that they are in a higher risk category for adverse consequences from the vaccine.
Unfortunately, there is simply no known way to avoid those risks. Many federal authorities probably fear a repeat of the swine flu fiasco of 1976, when, fearing that a powerful strain of influenza would sweep the country, a mass-vaccination program was ordered. While millions of Americans were being inoculated, hundreds were diagnosed with the neurological disorder Guillain-Barre Syndrome (GBS), and approximately 25 died a possible side-effect of the vaccine.
Yet, the federal government continues to make flu shots available. In fact, the CDC's recommendations for the prevention and control of influenza issued last April from the Advisory Committee on Immunization Practices could have been written for smallpox vaccinations. It read, in part: "The potential benefits of influenza vaccination in preventing serious illness, hospitalization, and death greatly outweigh the possible risks for developing vaccine-associated GBS."
It is not absolutely clear that the potential costs of smallpox vaccinations will outweigh the benefits (after all, no one can say that there will be an attack), but it is certain that the consequences of a smallpox attack would be terrible. The smallpox-causing variola virus will kill about one of every three unvaccinated Americans exposed to it. Many more will be horribly scarred.
Indications are that there will be enough smallpox vaccine available for every American by the end of this year. At that point, each American should be given the chance to make his and her own informed choice between the risks of a pre-emptive smallpox vaccination and the catastrophic consequences of a smallpox attack.

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