Here’s how the Bush administration expects to handle a domestic smallpox outbreak:
First, hospitalize the patient. Second, use a “surveillance and containment” process to identify his recent contacts and hinder the virus’ spread outside the immediate area. Third, ship in smallpox vaccinations from federal storage facilities and immunize those who may have been infected.
This policy makes perfect sense — if the disease emerges in, say, Sedona, Arizona or Bozeman, Montana.
But what if a “patient zero” enters a medical center in Chicago, Philadelphia, or San Francisco? Worse yet, what if 19 terrorist “smallpox martyrs” avoid hospitals and instead ride subways and roam through shopping malls and university libraries deliberately hacking and sneezing on thousands of innocent Americans?
In this age of global terrorism, federal officials approach this issue as cautiously as country doctors. This is both dangerously naive and potentially counterproductive.
Health and Human Services Secretary Tommy Thompson has asked Congress for $509 million to purchase 250 million doses of smallpox vaccine for late 2002 delivery atop the 15.4 million available units. Unfortunately, Thompson drove his needle into a brick wall with plans to stockpile these inoculations and await the unthinkable. Rather than gather dust until chaos erupts, smallpox vaccines urgently should be brought to Americans through private doctors, public clinics and nurses at schools and workplaces.
Like climbing out of bed every morning, smallpox vaccines offer risks and rewards. They could sicken or even kill those with AIDS or other immunodeficiencies. Fetuses and those with eczema and cancer are among the 40 per-million-people who history suggests the vaccine would harm more than help.
Smallpox shots, however, would protect 999,960 per-million-people from a highly contagious disease that normally kills about 300,000 per-million-stricken. Survivors suffer severe rashes that often yield permanent facial scars. Americans under age 30 are 100 percent vulnerable since smallpox vaccinations ended in 1972 as the microbe approached extinction in 1980. Those who were inoculated may retain limited smallpox resistance.
Extensive vaccinations also can benefit the non-injected.
“If a lot of people in an area get inoculated, the rate of transmission of the disease in the area gets lowered, even for those who are not themselves immune,” says Dr. Gilbert Ross, M.D., medical director of the American Council on Science and Health in Manhattan. What he calls “community immunity,” is “like interfering with an avalanche high up on a mountain rather than trying to stand in the way three-quarters of the way down the mountain.”
A well-vaccinated populace also would be unattractive to bioterrorists, although they already may have thought about it. Smallpox samples officially exist only at the Biohazard Level-4 Laboratory at Atlanta’s Centers for Disease Control and at Russia’s Vektor Institute in Novosibirsk, Siberia. Vektor’s scientists earn a whopping $1,260 annually, London’s Daily Telegraph revealed November 6. Their services and smallpox samples may have been sold on the black market. Says its director, Dr. Lev Sandakhchiyev: “Everything is possible in today’s world.” In Iraq, meanwhile, U.N. weapons inspectors some years ago found containers labeled “smallpox” in Arabic.
Americans wish to respond individually to these pluses and minuses. According to a November 13 Associated Press poll, 61 percent of adults would get vaccinated if permitted. The 30 percent who would not could enjoy some comfort that “community immunity” partially would protect them, much as stone houses sometimes shield nearby wooden homes from passing fires.
Letting individuals calmly exercise this option is smarter than passively awaiting an emergency, then ordering Americans to drop everything, dash to local hospitals and queue up for hours or even days for vaccinations.
Scarier still, widespread panic could carry the virus beyond the city limits. To prevent this, the CDC drafted the Emergency Health Powers Act, a model statute HHS urges states to adopt. Under the proposal, officials “could treat, vaccinate and quarantine individuals on a compulsory basis when there is a threat to the public health,” the National Law Journal’s Marcia Coyle reported November 5. “States would have broad emergency powers to confiscate property and facilities, from subways to drug companies.”
Rather than prescribe this unnecessary overdose of command and control, the Bush administration should work with the pharmaceutical industry to arrange prompt, universal access to the smallpox vaccine. For once, let’s watch syringes make Americans smile.