- The Washington Times - Thursday, October 14, 2004

The medic wielding the tiny smallpox vaccination needle jabbed my left arm a dozen times. Satisfied with his handiwork, he slapped a large butterfly bandage over the brand-new sore and gave me a stack of replacement bandages. I had to keep the vaccination covered, to aid healing. The last bandage came off three days before I flew to Iraq.

Once upon a time, the World Health Organization (WHO) thought smallpox would be eradicated. We no longer believe that fairytale, so military, emergency response and medical personnel now get smallpox vaccinations. Here’s why: Despots, crooks and madmen invoking the wrath of God value weapons that kill en masse. Bacteria and viruses fit that bill, and packed as bioweapons are much cheaper to produce than a nuclear bomb. Smallpox once killed millions of people, and now we fear it could do so again.

However, the United States stopped mass inoculations for smallpox in the 1970s. Most young Americans are unvaccinated. When I pressed one of the doctors about the possibility of “shedding” vaccine and infecting an unvaccinated child, he assured me the chance was infinitesimally small.

But he was also uncomfortable with the larger issue of societal vulnerability. “At some point we need to start inoculating everyone again,” he said. “It’s the smart thing to do.” One expert told me America probably has a high “herd immunity” against smallpox — a statistically significant population share retains enough immunity to blunt the disease’s spread.

Still, relying on herd immunity instead of human intelligence is a poor way to defend against smallpox, or for that matter, any disease, including the flu.

Our vaccine production system, however, is flimsy. Moreover, our ability to “surge” vaccine production (in case of a bioattack or pandemic) is even weaker.

Witness the sudden shortage of flu vaccine with flu season less than 60 days away. Two companies, Chiron Corp. and Aventis Pasteur, manufacture America’s flu vaccine. Last week, the British government shut down Chiron after regulators discovered bacterial contamination in its vaccines and other problems in manufacturing. The regulators were doing their job, but the shutdown knocked out half of America’s flu vaccine.

Flu vaccine preparation is a tough business, for many reasons. Despite advances in gene-splicing techniques, most flu vaccine is produced using chicken eggs as a culture medium.

It takes six months to produce vaccines, so manufacturers face several tricky decisions. To make an effective vaccine, some astute guesses are needed about the genetic characteristics of the flu strain: there are new flus every year. They must also predict vaccine demand. The Wall Street Journal reported several pharmaceutical companies quit the U.S. flu-vaccine market because the difficulty of forecasting demand. Companies cannot afford to be left with several million unused, unsold vaccine doses.

Flu vaccines aren’t the only problem — fragility is endemic to the entire vaccine industry. In 2002, the Government Accounting Office reported 26 companies made children’s (pediatric) vaccines in 1967. Now, only five are in the business. For some specific vaccines, there are only one or two suppliers.

Slender profit margins are one reason manufacturers avoid the pediatric vaccine market. Manufacturers also fear multimillion-dollar lawsuits filed for those who suffer negative reactions to vaccines, and negative reactions are a statistical certainty.

The flu vaccine shortage should jolt human intelligence. I don’t expect another Great Plague this winter, but the flu epidemic of 1918-1919 did kill well more than 20 million people. We must address this issue now.

The Centers for Disease Control and Prevention (CDC) says there are simply too few manufacturers. CDC Director Julie Gerberding argues the U.S. government may have to offer “incentives” to companies to produce vaccines. Those might include tax credits for investing in new manufacturing processes (e.g., cell culture), immunity from vaccine-related lawsuits or a guaranteed market for unused vaccines.

Austin Bay is a nationally syndicated columnist.

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