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Dear "Silent Lion"

Let me address each comment you make.

It was a close call but I think the CDC made the right choice on this one:

(1) If there is an instance of bioterrorism, they can get the vaccine out in a hurry. It supposedly is still effective within the first few days after exposure.

As a practicing physician in the community, let me respond to this load of malarky. I have already written several articles on this website which outline the scenario of attack.
The "push-packs" will not be used until the initial casualties are identified. Remember how those initial cases of anthax DIED in Florida? Well, the fact is that the initial cases of smallpox and the secondarily infected patients will be guaranteed to suffer illness or perish under a real biological attack. Vaccination after exposure will not prevent all citizens from harm. Vaccination prior to exposure will certainly prevent illness.
Currently, we can not get routine tetanus vaccines from the two companies who make the vaccine to the entire country's populace. Yet, you request that we wait while a non-existant push-pack system "save us"?
What makes you think that some phantom federal agency is prepared with this response? It is inappropriate for the federal gov't to limit delivery of essential medical services. YOU ARE NOT THE PHYSICIAN MAKING THIS DECISION. I AM!

(2) If someone tries to use an altered virus as a bioterror weapon, there's no guarantee that the standard vaccine will protect against it.

Do you have any evidence to support this scenario as an existing and plausible threat? The Soviet Union's stockpile of smallpox was not sufficiently engineered to make this claim stick. You have no data to support your assessment. If you do, I publicly challenge you to post that information so I can review it.

(3) Though the chances of adverse reactions are slim, when you give the vaccine to the entire US population, the estimate is that there would be several hundred deaths. If the bad guys can scare us into inflicting that kind of damage on ourselves, we're letting them win.

There is real faulty logic here. The epidemiologic data which you parrot is based upon old stockpiles and older vaccine production techniques not used today. Even so, I was immunized with that vaccine and have the scar to prove it. I am pleased to have that scar because it means that I will survive an attack. UNFORTUNATELY, OUR CHILDREN WILL NOT! Are you a physician or parent?
We are not requesting mandated vaccination. I am requesting that CDC release anthrax and smallpox immunization for voluntary immunization by those Americans who want it. After all, if this really a free market economy, why is the US government in the position of WITHHOLDING KNOWN and PROVEN VACCINE from the US populace?

RELEASE THE G** D*** VACCINE!!!!

Yes this is war. We need to work together, make smart decisions, and trust the concensus. Voluntary vaccinations of part of the population will be ineffective, and produce widespread panic that may result in the indiscriminate use of bold and CAPITALIZATION in internet posts.

The facts are they've stockpiled enough vaccine for everyone if it's needed, but every vaccine, even flu vaccines have side effects. People die if we try to vaccinate a population of 280 million. If we hold off vaccinating, we risk casualties if a bioterrorist attacks. If we vaccinate now, the terrorists forced us to inflict casualties on ourselves.

I am a parent, in my judgement, my government made the right call here.

Care to comment on any of the following?

Dr. James Koopman (U of Michigan). Science, volume 296, number 31, May 2002.
"Smallpox is a barely contagious and very slow-spreading infection."

From AP, June 16. Dr. Paul Offit, chief of infectious diseases at Children's Hospital in Philadelphia:
"I would not give that [smallpox] vaccine to my children now."

Dr. Anthony Fauci, chief of infectious diseases at the National Institutes of Health.
"Fauci...told scientists and health officials the [smallpox] vaccine is one of the least safe around, although clearly a lifesaver if smallpox makes a comeback."

YOU ARE NOT THE PHYSICIAN MAKING THIS DECISION. I AM!

But do understand--you won't make the decision for those who don't want the vaccine.

As a practicing physician in the community,

With all due respect, unless you are an epidemiologist or similar infectious disease specialist, your professional credentials go only so far.

It is inappropriate for the federal gov't to limit delivery of essential medical services. YOU ARE NOT THE PHYSICIAN MAKING THIS DECISION. I AM!

Quite obviously, there are others in the medical profession who don't regard smallpox vaccination as an essential medical service.

Do you have any evidence to support this scenario as an existing and plausible threat? The Soviet Union's stockpile of smallpox was not sufficiently engineered to make this claim stick.

So far as you know, and safe to say that Biopreparat doesn't send a full accounting of its activities to American physicians.

You have no data to support your assessment.

Other than anecdotal evidence to the contrary, neither do you.

If you do, I publicly challenge you to post that information so I can review it.

Right. And you'll also want a pair of E-passes for the rides at USAMRIID?

Bones (Orthopod, I presume?)...I agree with you. Having problems just getting DT to patients with minor scratches and bites. Tetanus in short supply and literally rationed in many health care systems. BTW, that scar of yours may not be so comforting...As far as I know, nobody has CHECKED antibody levels to smallpox in a large sample of previously immunized adults...Those immunized may not have sufficient antibodies from those vaccinations in the the early days. Of course obtaining this SCIENTIFIC information would would be something USEFUL the CDC could do! I am just ill about their glib, speculative pronouncements about national smallpox readiness. My only comfort is that some of the current antivirals (cidofovir, tenofovir etc.) just might be effective in shortening the viral replication and shedding phases and we can use supportive care to stabilize patients. But again...Are we prepared with sufficient antivirals to help large numbers of patients. This is very frustrating!

You are right that the CDC are deluding themselves if they think they can successfully stop a Smallpox outbreak begun by determined terrorists using the 'ring vaccination' protocol, without hundreds or perhaps thousands of deaths. That method may have worked in the campaign to eliminate Smallpox, but it would be very inefficient against a simultaneous outbreak occurring in dozens of areas all over the country. The terrorists would probably use a covert release method, such as spreading freeze-dried Smallpox particles at a railway, airport or bus station. Before the primary victims start showing serious symptoms the virus would be in 40 or more towns and cities around the country and probably also abroad. This conclusion is supported by a study which was actually done by the US military on this dispersal method in a bus station using spores from a harmless Bacillus species.

The idea that epidemiologists could trace everyone who might have been infected and vaccinate their communities in time to stop a disaster is wishful thinking. The only way to prevent a successful Smallpox attack would be mass vaccination in advance. Unfortunately, if al Qaeda don't have Smallpox then we would look rather silly using mass vaccination, since we would loose about 180 people according to the accepted Smallpox vaccination risk assessments. The only problem is, are there enough doses of Smallpox vaccine to do 97% of the US population? If there aren't then it would be better to keep them for 'ring vaccination', instead of just giving them to people who want them.