Source: Wall Street Journal, September 9, 2002.

REVIEW & OUTLOOK

Big Threat, Little Prevention

Since his earliest political days, President Bush has stressed the words "choice," "freedom" and "personal responsibility." We're about to find out how strongly he believes in those principles for Americans who want to protect themselves from bioterror.

In particular, Mr. Bush now has to decide if he'll accept Secretary of Health and Human Services Tommy Thompson recent recommendation to limit smallpox vaccination to emergency workers. What's odd is that Mr. Thompson is proposing only limited vaccination at the same time he's admitting that smallpox is a clear and present public health threat. His prevention proposal doesn't match his understandable worry, and Vice President Dick Cheney also sounded the same mixed messages yesterday on NBC's "Meet the Press."

Within six weeks of September 11, Mr. Thompson had requested $500 million from Congress to stockpile smallpox vaccine. Not long after, he announced that the U.S. would not destroy its remaining repositories of smallpox, for fear we wouldn't have the tools necessary to counter a "future outbreak."

Mr. Thompson's concern is such that last week he even chose to ignore the recommendations of an expert advisory panel that would have limited the vaccine to a scant 20,000 emergency workers. His plan to the President calls for inoculating as many as 500,000 hospital and emergency personnel. "My gut tells me you have to assume the worst right now with bioterrorism," he said, adding that there was speculation that North Korea, Iraq and other hostile nations might have the virus.

We'd feel better still if, having acknowledged this danger, Mr. Thompson's gut also told him the public should be allowed to decide for itself whether to be vaccinated. There's no question that's what people want: 3 out of 5 Americans say they are willing to be immunized right now.

There's also no question about what could happen if those vaccinations are denied. The health community has admitted it isn't prepared for an outbreak. Many doctors have never even seen smallpox, and medical studies continue to show that an attack -- even with emergency response -- would mean hundreds, potentially thousands, of deaths. Fatalities, horrible on their own, are just one consequence of inaction. This summer the White House Council of Economic Advisers briefed the advisory panel that an epidemic would shut down transportation and commerce, leading to severe economic damage.

There was some recent cause for cheer, when an article in the New England Journal of Medicine suggested the immunity conferred by smallpox vaccine might be longer than previously thought. That's good news for graying Baby Boomers but means little to the 100 million Americans born since 1972, who have never been vaccinated.

Parents of some of those young people are beginning to band together to lobby lawmakers for the vaccine. Congress is also waking up. Pennsylvania Senator Arlen Specter now says the federal government's role is to buy the vaccine, not to decide who gets it. And the Senate's only doctor, Tennessee's Bill Frist, has written that "Every American should have the opportunity to make an informed individual choice, to evaluate those risks, plus those benefits, to receive that smallpox vaccine."