EDITORIAL

Murder by Virus

To protect against bioterror, the U.S. should vaccinate health workers against smallpox.

For months, the Bush administration has debated a plan that would make smallpox vaccinations available to all Americans to prevent the devastation of a bioterror attack. But the dangerous side effects of the smallpox vaccine - life-threatening side effects in 15 of every 1 million people vaccinated - and the public health and legal dilemmas inherent in mass inoculations have given the White House pause.

Vaccinations are planned and preparations are moving ahead, and properly so, but President George W. Bush must decide soon who should receive them first and who should be discouraged from getting them. The best guidelines are those offered by a panel of vaccine experts from the Centers for Disease Control and Prevention. Bush should heed their counsel.

The panel favors offering the vaccine to the public on a voluntary basis, but only after up to 10 million health-care workers are immunized first, and after the vaccine has been licensed for general use. That seems sensible.

The most likely terror scenario involves an enemy sending a dozen or so people intentionally infected with smallpox, at the peak of the contagious phase, to a few airports in the United States. By circulating among travelers, they could spread the highly contagious, deadly virus - one in three who contract it die, with no cure available - to other parts of the country, where it would multiply rapidly. The first to come in contact with the infected would be emergency-room and other health-care workers.

Hospitals are to be stocked with enough vaccine to immunize those who have come in contact with the infected; the vaccine works if it's administered within four days of first exposure.

But the White House must precede any inoculation program with a massive public-information campaign. Conditions have changed considerably since the mass smallpox inoculations that went on from the 1950s to the early 1970s. The vaccine is most dangerous to those whose immune system has been weakened by such disorders as HIV/AIDS, hepatitis and therapies for cancer and organ transplants. It's also dangerous to those with such common skin disorders as eczema. There are massive potential legal and public-health repercussions from mass vaccinations.

The Pentagon plans to vaccinate half a million troops soon. Health-care workers should be offered the vaccine next. It will be made available to the general public by early 2004. Soldiers won't have any choice. But the rest of us will. And an informed choice is best.