EDITORIAL

Defending Against Smallpox

Health and Human Services Secretary Tommy Thompson is deciding this month how many health care and emergency workers should be vaccinated against smallpox, the deadly disease that has been eradicated from nature but that is a potential weapon of bioterrorism. A scientific advisory panel last month recommended a limited inoculation program for teams of first responders, some 10,000 to 20,000 individuals across the country. Officials now say that a broader program is under consideration that could involve as many as a half-million medical and emergency workers.

That possibility prompted questions to President Bush at his news conference last Monday: Why not make the vaccine available to any American who wants it? In response Mr. Bush sounded a proper note of caution. "If everybody received a vaccine there are some who, to whom that vaccine might be fatal," he said. "And I worry about that." That's a fair concern, one that should not be lightly put aside in planning for a threat that is one of many possible dangers and that also can be addressed by vaccinations after the fact if an attack should occur. The difficult balancing act here as in other areas of homeland defense is to weigh responsible preparations against both their costs and the likelihood that they really will be needed.

The first imperative is to make sure that enough vaccine is on hand to respond to any outbreak and that it can be delivered rapidly enough to wherever it might be needed. That task is not yet complete. More must be done to make sure public health officials can recognize and report any outbreak of smallpox or of other illnesses that might be deliberately spread and to make sure that beds and other facilities exist to treat any sudden surge of patients. There is common-sense appeal to vaccinating a substantial number of health care and emergency workers. Protect more of these workers against infection and gain more flexibility to respond to an outbreak, even one that is more widespread or chaotic than planners have anticipated.