- The Washington Times - Wednesday, February 26, 2003

President Bush's plan to protect Americans against a terrorist attack through a phased-in mass vaccination has come to a virtual standstill due to unexpectedly stiff resistance from health care workers. We had hoped that such smallpox refusniks numbered only a small fraction of the national total, and thus posed merely a minor threat to public health preparedness. Unfortunately, that is not the case.
According to recent reports, about 4,200 individuals have been vaccinated less than 1 percent of the administration's target for this first phase and about 495,000 short of where the administration hoped to be at this point, a month after the campaign began. Several factors appear to be responsible for this standoff. Some health care unions have advised their members not to take the vaccine until the federal government commits significantly to a compensation fund. Some health professionals are reluctant to place themselves or their patients at risk from adverse effects of an inoculation in the absence of an imminent threat. Also, senior administration officials have not pushed smallpox vaccinations with the requisite urgency. When they have done so, it has seemingly been with the wrong sense of proportionality placing too much emphasis on the small risk of adverse effects from inoculation, and too little emphasis on the catastrophic effects of a smallpox attack on an unvaccinated population.
Those risks have been well-documented, but they are worth repeating. Historically speaking, the smallpox virus has killed one of every three unvaccinated individuals it infected. Those who survived were often horribly scarred, and quick inoculation remains the only proven way to prevent such effects.
In the event of a smallpox attack, those infected would have only a three-day window in which to be vaccinated against the virus without adverse effects. That is, individuals showing the initial flu-like symptoms of a smallpox infection (if they show any symptoms at all) will have merely 72 hours during the panic, confusion and travel restrictions of a smallpox attack in which to find a doctor able to make the proper diagnosis and correctly apply the smallpox vaccine. It's an invitation to a dance with death reminiscent of Europe's plague era.
While the chances of a smallpox attack will only grow with time, the risks of vaccination will continue to shrink, as practitioners gain greater experience with the vaccine and become more familiar with its adverse effects. Those feared reactions may have been overstated only five of the more than 100,000 members of the armed services who have been vaccinated have experienced serious reactions, none fatal. So far, no civilians have reported serious reactions to the smallpox vaccine.
So what can be done to resolve this standoff? The administration, from Heath and Human Services Secretary Tommy Thompson on downward, must put their shoulders and outstretched arms fully into the matter. Mr. Bush was successfully inoculated late last year, and New York City Mayor Michael Bloomberg was inoculated last week. It's reasonable to expect other prominent elected officials, including D.C. Mayor Tony Williams (who yesterday told us he will get inoculated), to lead by example and to be vaccinated against smallpox in as public a manner as possible.
The administration may also want to consider more coercive measures to ensure that the public is adequately prepared against a smallpox attack, such as seeking statutory authority to federally enforce the health policy. Of course, even under such authority, private citizens would always have the right not to be vaccinated.
Mr. Bush should also permit private citizens to get vaccinated, if they chose to do so. Currently, private citizens are not permitted to get vaccinated. Citizens are as much targets for the virus as health professionals they have the right to defend themselves in the best manner they see fit, and they should also be given the means.
Given how problematic basic smallpox preparations have become, we can only hope that it does not take an outbreak to end the standoff.


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