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FreeRepublic , LLC PO BOX 9771 FRESNO, CA 93794
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Posted on 04/15/2003 10:03:12 PM PDT by woofie
In separate articles, today's authors argue the cases for and against smallpox vaccination, as the government urges inoculations for medical personnel and emergency response workers amid terrorism concerns
TODAY'S BYLINE: Zelicoff is a physician and senior scientist at the Center for National Security and Arms Control at Sandia National Laboratories in Albuquerque. Nelson is an emergency room physician in Santa Fe and active in efforts to clean up nuclear weapon contamination from the Cold War.
By Alan Zelicoff
Smallpox was eliminated as a naturally occurring disease in the late 1970s after a massive vaccination effort directed by the World Health Organization.
Since then, the smallpox virus has been confined to the laboratory (two official WHO repositories exist, one in the United States and one in Russia), and the few cases of smallpox that have occurred since 1977 resulted from laboratory accidents.
Routine vaccination was discontinued worldwide in 1980, and few people alive today remember the horrific destruction from smallpox outbreaks. In the 20th century, more than half a billion people died from smallpox, making it by far the largest infectious disease killer known.
Throughout the 1980s, interest in smallpox waned; even basic research into the distinctive characteristics of the organism dwindled to nothing. But in the early 1990s, shortly after the fall of the Soviet Union, several former biological weapons scientists revealed that huge amounts of smallpox were made and hidden, to be used in the event of conflict with the United States or as a hedge against invasion from mainland China.
Initially these claims were discounted by Western biological weapons experts; after all, smallpox was known to transmit only directly from person to person, and the possibility of a smallpox weapon - disseminated perhaps from an airplane or missile - was dismissed.
But in the middle of last year, the Monterey Institute of California uncovered a secret Soviet-era report documenting an outbreak of smallpox in an isolated region of what is now present-day Kazahkstan that could have only come about as a result of testing of a smallpox weapon on Renaissance Island - recently identified as the Soviet Union's outdoor biological weapons test site in one corner of the Aral Sea.
The island, now abandoned, was the scene of an "aerosol" test of smallpox in July 1971 (ironically when the Soviet Union itself was leading the international community's efforts to eradicate the disease in the wild). The test sent a tiny plume of smallpox - 400 grams - more than 20 miles downwind, infecting at least one crew member aboard a research vessel south of the island. That crew member, a young biologist, returned to her home port of Aralsk, prompting an epidemic that resulted in a quarantine of the entire town of 50,000 for weeks. Several people died.
Smallpox as a weapon was a reality, although known at the time only to the Soviet leadership. It was made, and clandestinely stored, by the ton, and none of it resides in the Russian "official" smallpox collection.
Why should we care about this ancient history? First, those of us old enough to remember being vaccinated as children are no longer immune. The vaccine's effect wears off after 10 to 20 years (at most).
Second, The New York Times has reported that the same smallpox experts who helped develop the Soviet weapon in the 1970s worked closely with the Iraqi government, at least up until 1991. It appears likely that some of the expertise for formulating smallpox into a weapon was acquired by Iraq.
Third, sophisticated modeling of the effects on a aerosol spray of smallpox over a large American city demonstrates that many hundreds of thousands of people would die in a few weeks, unless a substantial portion of the population is vaccinated ahead of time.
All of the models also demonstrate that the people who should be vaccinated now are those we will depend on in the case of smallpox catastrophe - physicians, nurses, police and fire personnel, and other critical infrastructure workers.
For all of these reasons, in mid-2002 the Bush administration adopted a plan for vaccinating approximately 1 million people, shortly after the information on the Soviet experiment with weaponized smallpox was published.
Yet, the plan has failed; as of last week, only about 30,000 American civilian health care professionals and others had been vaccinated. It hasn't been for lack of trying. Public health departments around the country - including our own here in New Mexico - have made strenuous efforts to educate the medical community about the importance of vaccination in light of the terrorist threat.
Yet, most of the medical community has resisted - for political rather than scientific reasons.
Yet, the vaccination experience to date has been excellent; there have been no deaths directly attributable to the vaccine (despite recent reports of heart attack in three people with established risk factors for coronary disease). Compared with previous statistics compiled when tens of millions of people were vaccinated against smallpox in the United States, there have been no surprises.
Doubtless there will be some deaths, but if the chance of a terrorist using smallpox as a weapon is only one in 1,000 over the next decade, all of the scientific studies agree that the correct strategy is to vaccinate now. Such a policy might even deter the use of smallpox.
In public meetings, some physicians state they are refusing vaccination as a protest against the war in Iraq. Given that some individuals have chosen to get vaccinated I wonder what these physicians will do if a rare person develops a complication and seeks medical care at an emergency room or physician's office? Will they refuse to see them? What if smallpox does get used? Will unvaccinated physicians decline to take care of smallpox victims? It is hard to imagine a less ethical stance.
Critics of vaccination, including some in the medical community, say the risk of smallpox is "theoretical" and vaccination is "extremely dangerous" and a "hysterical" response.
But these physicians are wrong on all counts. While they are certainly entitled to their own opinions, they are not entitled to their own version of the facts.
The threat of smallpox is real, and the vaccine - while hardly perfect - is a potent defense against the disease. It is also our only defense.
*** By Miles Nelson
The Bush administration has initiated a national policy to immunize all willing Americans against the smallpox virus. This is a mistake.
Smallpox was once a terrible killer, which was eradicated in 1980 by the World Health Organization. However, two samples of the smallpox virus were spared (one at the Vector Laboratory in Russia and one at the Centers for Disease Control in Atlanta), and since that time the virus has been made into biological weapons.
This is the rationale for the immunization of the entire country, although both the former Soviet Union and the United States are signatories of the Biological and Toxic Weapons Convention, which calls for the destruction of all stockpiles of biological weapons.
There are grave concerns regarding the immunization of the entire country.
The smallpox vaccine is a living virus similar to, but distinct from, the smallpox virus. It is not safe for everyone, and serious side effects exist.
These side effects can result in death and long-term disability. People with certain skin disorders, such as eczema, are at higher risk. People with chronic diseases such as cancer and HIV are particularly high risk, as are pregnant women.
Previously unknown fatal cardiac disease is being attributed to the limited first round of smallpox immunizations. According to the CDC, up to 25 percent of the U.S. population should not receive the vaccine as they would suffer an alarmingly high rate of complications.
Not only are the people who receive the vaccine at risk, but so too are others because the live virus from which the vaccine is derived is shed from the inoculation site for up to three weeks.
Data from the 1960s show us that with a national smallpox vaccination program there is likely to be at least 300,000 serious and 15,000 life-threatening reactions to the vaccine. In fact, the numbers today are liable to be higher because of more skin disorders and chronic disease in the population.
In the last century, when smallpox existed in the wild, the risk of vaccination was acceptable in the face of potentially contracting the disease. To be sure, the horror of a biological weapons attack here in the United States is incomprehensible, and reasonable steps should be taken to protect citizens. However, an all-out immunization of the entire country is not the way.
A better approach is to vaccinate a small group of key health care providers: This is a sufficient first step as the vaccine can be administered to the population after exposure to the disease and still be effective. The New Mexico Department of Health has adopted just such a rational policy.
Many health care workers strongly disagree with the strategy adopted by the Bush administration and are refusing to accept the vaccination. Many hospitals have declined to participate. In the case of an outbreak, those of us who staff the emergency departments of hospitals will ultimately be on the front line of fighting this disease and administering medical aid to patients.
However, in my emergency department, I am not aware of a single physician or nurse who has agreed to be vaccinated. We are just like you: We are concerned with the safety of our patients, family and friends. As health care workers, we understand that while the risk from smallpox is theoretical at best, the danger from this vaccine to our patients and loved ones is real and significant.
If administered nationwide, people will suffer and die from a vaccine to protect us from a disease that hasn't existed for more than two decades.
At this time, the real danger from smallpox is not the potential for death and injury from the disease. The real danger is the climate of fear that has been created. Since the tragic and criminal events of Sept. 11, 2001, this country has been changed. We have been changed by our grief and by our sense of vulnerability. We look to our leaders for inspiration and hope, and instead we find ever-changing terror alerts and fear-mongering.
What has made America great is our optimism and can-do attitude, but now we find ourselves afraid to travel and stocking up on duct tape and plastic sheeting. More than smallpox vaccinations, we need an inoculation against the virus of fear.
I urge you to consider logically the risks of this vaccine to yourself and loved ones before you agree to be inoculated. Do not let irrational panic drive you to the wrong decision.
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