[piasa]

???

Your math is way off. There are roughly 280 million people in the US... with a rate of 1 death per million, that's 280 deaths.

It's actually going to be LESS than that, because the one per million figure is based on those million people NEVER having been vaccinated before. Why? The one per million figure is for PRIMARY vaccinations. So the figure would be much less than 280 deaths per 280 million people because people over 35 have been vaccinated at least once, and people who have served in the military since 1990 have been vaccinated at least once, and people who have travelled overseas or immigrated here since the 1986 have been vaccinated at least once... probably about 160 million people might not be vaccinated, which brings the possible deaths down to 160.

(That is a good deal better than the 30% death rate for naturally occuring smallpox, with a much higher death rate for weapon-type smallpox, which is a much more potent strain.)

Fatal complications for people who have been vaccinated before is 0.25 deaths/million... one-fourth that of primary vaccinations.

[JohnBovenmyer]

Vaccination related deaths were 1/million in 1st vaccinations, 1/4 million in repeat vaccinations and total complications were 1/13,000 in 1st vaccinations and 1/200,000 in repeat vaccinations for the 14M Americans vaccinated in 1968, according to the 1999 JAMA Consensus statement. High risk people were not routinely vaccinated, i.e. the immunocompromised and those with skin diseases such as atopic dermatitis (eczema). Eczema is even more common now and there are a lot more immunocompromised people. Vaccinating everyone in a city like San Francisco would produce results that only the Taliban could enjoy. Vaccinia virus can uncommonly be spread accidentally person-to-person and potentially cause complications in the unvaccinated.

The only proven treatment for the complication is vaccinia immune globulin (VIG) and the Consensus statement repeatedly states we have very little of that. It can be given as treatment for complications. It can also be given preventively, at the same time, when high risk people have to be vaccinated. It can only be made from the blood of recently vaccinated people. While we are increasing our vaccine stocks we also should be vaccinating enough people now to make enough VIG for the demand those stocks would produce. We should prudently do that whether we plan mass vaccinations or whether we just plan to keep the vaccine in reserve.