Skip to comments.A Risky Policy on Smallpox Vaccinations
Posted on 12/17/2001 9:36:40 AM PST by tellw
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If fears of an attack using smallpox turn out to be much ado about nothing, this approach will have saved Americans from the vaccine's side effects. But what if there is an attack? A fully unvaccinated population could face dangers that would not be easy to control with the crisis approach. But if Americans were given the choice beforehand, when such an attack came many probably would already be vaccinated.
As we saw with anthrax, the first few victims of a bioweapons attack are canaries in the mine. They are more likely to die than those infected later because their infections are advanced when discovered and because those caring for them are just learning how to diagnose, treat and prevent disease in a novel situation. If half the population, for example, chose to be vaccinated now, the number of human canaries would be reduced by half.
A partially vaccinated population would also be a great advantage if attackers released smallpox in more than one place at the same time. A terrorist organization that can release a biological weapon in one location can release it almost as easily in many places. As the number of outbreaks increased, the ability to control the spread by rushing vaccines to the affected areas would certainly decrease, perhaps precipitously.
For individual Americans, there are also issues of varying risk. The risk of being attacked by a bioterrorist may be greater in New York than in Des Moines. It has been greater for postal workers than for the general public and greater for some postal workers than others. Individuals can assess their own unique sets of risks, but if they are denied access to the vaccine, they can't act on those assessments.
When last in use, the smallpox vaccine caused about one death in every million people vaccinated. The risk of serious nonlethal complications was greater, around one in 10,000.
But these risks can be reduced substantially by assessing risk factors on a person-by-person basis. Pregnancy, for example, poses a risk of side effects for the fetus and increased risks for the mother. A woman who wants to become pregnant might choose to be vaccinated beforehand, so that if an attack did occur, she would not face the grim choice of risking the pregnancy-associated side effects or risking smallpox itself. People with compromised immune systems might also choose to be vaccinated when they could best control the conditions around them.
Ideally, a person who wishes to be vaccinated should also plan the vaccination for a time when he or she will not be in close contact with anyone who is pregnant or whose immune system is suppressed by disease or medications. In a crisis, there would be no time for this consideration.
Perhaps most important, voluntary vaccination could prevent a smallpox attack from occurring. Even if only part of the population were vaccinated, the bang for the terrorist's buck could be drastically curtailed, not only because a smaller number of people would be harmed but also because the spread of the outbreak would be more easily controlled; there would be fewer contagious people and fewer in dire need of immediate vaccination. Terrorists know this. Considering that biological weapons are relatively ineffective, it might not take much vaccination to deter their use.
Americans feel frustrated by terrorism because most can do little if anything to defend against it. Voluntary vaccination would give them some power to protect themselves while helping to deter an attack. Surely many Americans would like to have this choice.
Paul W. Ewald, a professor of biology at Amherst College, is the author of ``Evolution of Infectious Disease'' and ``Plague Time.''
Voluntary vaccinations would produce herd immunity and make a safer environment for those who would not or could not be vaccinated.
It's a no-brainer. People should have the option to choose these "risky" vaccinations.
So would I and I'll bet at least 50% of the population would, too.
Thank you for posting this very important article.
Everybody should have the option of having a vaccination. This is one of those situations where the whole herd has to be vulnerable so nobody feels independent of the threat.