Administration Ponders Scale of Smallpox Vaccinations

The Bush Administration is pondering how many Americans should be preemptively vaccinated for smallpox in order to limit the impact of a potential bio-terrorism attack on the United States.

In an interview on Fox News on September 28, Health and Human Services Secretary Tommy Thompson said the administration would soon decide how many Americans, or which sectors of the population, such as health care and emergency workers, should be vaccinated against a disease that has been considered extinct from the natural environment for 25 years.

"This is a difficult decision because a smallpox vaccine has got some side effects," said Thompson. "And two individuals out of every million people that are vaccinated will probably die."

"About 18 individuals [out of a million] will have some sort of serious complications, an inflammation of the brain, maybe an individual infection in the eye, or something like this caused by the vaccine," said Thompson. "The President is certainly looking at all of the alternatives."

Smallpox is a highly contagious disease that kills 30% of its victims.

On September 23, the Centers for Disease Control (CDC) released a new national plan for responding to a smallpox-based bio-terrorism attack. The plan was not formulated in response to any specific threat but was inspired by the general post-September 11 awareness of U.S. vulnerability to terrorist attacks and by the potentially devastating consequences of an attack in which the smallpox virus is the terrorists’ weapon of choice.

Escalating Response

CDC officials say that the United States currently has enough vaccine in stock to inoculate, under traditional dosage standards, 155 million people. The same amount of vaccine could be diluted, if necessary, and used in an emergency to inoculate the entire U.S. population of 280 million. By the end of this year, however, Thompson said, there will be enough vaccine available to give everyone the recommended dosage to ensure immunity.

Dr. Walter Orenstein, director of CDC’s National Immunization Program, said that the CDC is awaiting a decision from the Bush Administration on what segment of the population to preemptively vaccinate. "We are awaiting the policy decision with regard to that and will implement whatever decision is made," he said. He said that he expected any vaccination program to be "voluntary."

According to the CDC, if terrorists released smallpox in aerosol form in a public place it could spread from person to person for two weeks before public health authorities detected the attack. Although the United States and Russia are the only two nations known to possess the virus, it cannot be ruled out that another government or a terrorist group has secured some of it. Biological warfare experts have questioned the security of the Vector Institute in Siberia, where Russia keeps its smallpox stockpile.

The last naturally occurring case of smallpox was reported in Somalia in 1977. In 1980, the World Health Organization declared the disease eradicated.

The United States ceased regular vaccination against smallpox in 1972. Older Americans inoculated before that may have since lost their immunity. "The immune status of those who were vaccinated more than 27 years ago is not clear," a panel of medical experts reported in 1999 in the Journal of the American Medical Association. "The duration of immunity, based on the experience of naturally exposed susceptible persons, has never been satisfactorily measured."

On NBC’s "Meet the Press" on September 8, Vice President Dick Cheney raised the possibility that Iraq might have a stock of the virus. "One of the real concerns about Saddam Hussein, as well, is his biological weapons capability, the fact that he may, at some point, try to use smallpox, anthrax, plague, some other kind of biological agent against other nations, possibly including even the United States," said Cheney.

On August 15, Israel announced that it would vaccinate health care workers and other "first responders" against smallpox.

If there is a smallpox attack on the United States, the CDC-pending the new policy decision from the administration-envisions an escalating response. First, they would vaccinate everyone who touched an infected person or was in close quarters with such a person. If that failed to contain the outbreak, they would vaccinate everyone within a certain region, perhaps escalating all the way to nationwide vaccination. The scope of the vaccination would depend on the nature of the outbreak.

An outbreak of weaponized smallpox has occurred once in history. In 1971, a Soviet field test of smallpox spread too far and killed three people in the port city of Aralsk on the Aral Sea. In order to contain the outbreak in that remote area, authorities had to quarantine hundreds and inoculate 50,000 people, according to a report from the Monterey Institute of International Studies.