Last Updated

14 Aug 2003

Source: Washington Times, August 14, 2003

EDITORIAL/OP-ED

Overcautious approach to a killer

Earlier this week, the Institute of Medicine (IOM) issued its fourth report to Congress on the smallpox vaccination program. While the committee that produced it made a few worthwhile recommendations, it also took far too cautious an approach to preparing Americans against a potential attack.

The report argued that smallpox is only one of many threats to the public health, grouping it with others like "the insidious and growing threat of chronic diseases and their predisposing conditions (e.g. obesity.)" Pointing out that vaccinations are only one tool against smallpox, the report posited that inoculating the public is too dangerous to proceed except under strict clinical supervision.

Committee Chairman Brian Strom went even beyond those guarded recommendations, telling reporters that "it does not make sense to give a vaccine with substantial risks against a disease that does not exist — in fact, it could be considered unethical."

However, Dr. Strom is wrong on all those counts. The smallpox vaccine does not have substantial risks — it has almost, but not quite insignificant risks, estimated about one death per 15 million by Dr. William Bicknell, professor of International Health at Boston University's School of Public Health, and Kenneth Bloem, former CEO of Stanford University Hospital and Georgetown University Medical Center. Others have estimated a slightly higher risk, of one fatality in every 1 million individuals vaccinated, but that's still insignificant to one's risk of being hit by lightning (about 1 in 600,000). Nor can the risks of non-fatal but possibly serious side-effects — estimated at between 1 in 19,000 to 1 in 71,000 — be considered "substantial."

Meanwhile, there is a substantial risk that the smallpox-causing variola virus does exist, and is in the possession of either terrorists or states sponsoring terrorism. While the virus supposedly vanished in 1977 with the last human case, the former Soviet Union did weapons research on it throughout the following decade. Even if the virus itself did not fall into hostile hands when that state fell apart, some of the scientists skilled at working with it may well have gone to rogue states. Using the modern methods of molecular biology, biologists might even be able to build the virus from scratch, as others did last year with the polio virus.

Even in its natural state, smallpox is uniquely dangerous among potential biological agents. Few others are as contagious or as lethal. Since the virus is infectious before its characteristic rash appears, individuals carrying it will be spreading it to others before public health officials have any inkling that a catastrophe is happening. Once the virus strikes, it is expected to kill about one in three individuals exposed to it.

While the doctor's ideal of first doing no harm is entirely appropriate for a hospital, it's almost opposite of the homeland security officer's ideal of first preventing great harm. From a policy-making standpoint, not encouraging vaccinations against the virus is terribly shortsighted and possibly unethical.

Allowing willing Americans to be vaccinated against smallpox is reasonable, ethical and prudent. Following the too-cautious recommendations of the IOM's report too carefully could well cost America far too much.