Smallpox Politics?

Great Debates
1

US Docs Urge Caution on Mass Smallpox Vaccination

SAN FRANCISCO (Reuters Health) - The American Medical Association’s (AMA) House of Delegates voted Tuesday to take a cautious approach to any national smallpox vaccination program, urging the federal government to wait for good science before ordering vaccinations for all Americans. Although many delegates argued for immediate endorsement of a universal vaccine program, AMA trustees Drs. John Nelson and Ronald Davis said that there are risks associated with universal vaccination. Nelson said the smallpox vaccine is associated with a number of side effects and ``vaccinating every American could result in as many as 300 deaths.’’

Source: http://dailynews.yahoo.com/h/nm/20011205/hl/smallpox_15.html
The doctors are apparently concerned about a one in a million death rate with the vaccination program.

Then again, with smallpox having a 30 percent death rate, computer simulation shows one hundred infected in a major eastern seaboard city would result in approximately 250,000 cases before it would be contained by no less than 100 million vaccinations. Gee, that means the doctors believe an epidemic claiming 75,100 lives is not worth the effort of mass vaccinations now, and the possible 300 lives lost. Then again, we haven’t discussed those who survived, crippled for life, nor mentioned the political and economic chaos (probably the greatest economic collapse in world history which we may never recover?) resulting from such an epidemic.

Strange that the media doesn’t bring this up, nor discuss blackpox which would also occur in the same epidemic.

Methinks their vote was more for self-protection against malpractice and prestige than any real idea that delaying vaccinations until after an epidemic has begun is the better route.

Thoughts?

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I don’t see a General Question here, but rather a debate.

Off to Great Debates.

DrMatrix - General Questions Moderator

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How could a smallpox epidemic begin? It’s a contained disease. The only reason smallpox vaccinations are even being talked about is the possibility of terrorists using it as a biological weapon.

IMHO, it would be a terrible thing to vaccinate against it. The odds are very unlikely that a terrorist would successfully use it, and justifying 1 in a million deaths is hard to do.

4

Smallpox lives officially in only two repositories on the planet. One repository is in the United States, in a freezer at the headquarters of the federal Centers for Disease Control and Prevention, in Atlanta – the C.D.C. The other official smallpox repository is in a freezer at a Russian virology institute called Vector, also known as the State Research Institute of Virology and Biotechnology, which is situated outside the city of Novosibirsk, in Siberia. Vector is a huge, financially troubled former virus-weapons-development facility – a kind of decayed Los Alamos of viruses – which is trying to convert to peaceful enterprises.

There is a growing suspicion among experts that the smallpox virus may also live unofficially in clandestine biowarfare laboratories in a number of countries around the world, including labs on military bases in Russia that are closed to outside observers. The Central Intelligence Agency has become deeply alarmed about smallpox. The United States government keeps a list of nations and groups that it suspects either have clandestine stocks of smallpox or seem to be trying to buy or steal the virus. The list is classified, but it is said to include Russia, China, India, Pakistan, Israel, North Korea, Iraq, Iran, and Cuba. The list may also include Osama bin Laden.

The AMA does not support mass vaccinations for smallpox. I personally believe decision is not based upon pragmatic prevention but internal politics and professional ego.

The US Government is now buying 300 million does of smallpox vaccine.

At this stage in the war on terrorism, which is more risky to lose, your ego or your life?

5

Vaccination decisions always involve comparing the risks and benefits. There’s rarely a clear-cut answer. The reason they stopped vaccinating against smallpox to begin with is for the same reason - that occasional death vs the fact that smallpox was all but eradicated.

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There’s already a small but significant opposition to vaccination in general. Largely irrational, I think, but existent nonetheless.

Now imagine a nation-wide vaccination program that causes more deaths than can be conveniently named on the evening news. “There were three more deaths today directly related to smallpox vaccinations; that brings the total to more than sixty nationwide…” This would inflame the anti-vaccination sentiment, which would decrease the number of routine vaccinations that are already administered, which decreases the general protection of the population against a lot of diseases that are still threats.

7

Of course to figure out if its worthwhile to vaccinate people, we have to estimate the odds of an outbreak, which is admittedly very hard.

Here’s a suggestion:

Make it voluntary, not mandatory. Many many people will choose to take a 1/1,000,000 chance of immediate suffering in return for peace of mind. If enough people are vaccinated, it will deter attacks in the first place and make any attack that does occur that much less effective.

8

This won’t work, IMHO. There are studies that show an unvaccinated population experience a raise in the onset of diseases that are being actively vaccinated for. In other words, vaccinating some people could in fact start the one thing we don’t want, and that would be a smallpox epidemic.

9

Did any of the studies you mentioned specifically address smallpox vaccinations? Can you cite any evidence that previous smallpox vaccinations caused an epidemic?

After all, the smallpox vaccine does not contain the live smallpox virus, but vaccinia virus, an orthopoxvirus that induces antibodies that also protect against smallpox. Perhaps a read of the CDC Vaccinia (Smallpox) Vaccine Recommendations of the Advisory Committee on Immunization Practices is in order: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5010a1.htm

10

What studies? Done by whom? When? Any published reports? Got a cite?

During the program to eliminate smallpox there was no report of immunization caused outbreaks that I ever read. The annual influenza immunization has never been reported to cause outbreaks of influenza in the US. We have decades of data on those, and similar immunization campaigns conducted in the US over the last half century.

While not entirely useless as a terror weapon, militarily the value of a smallpox weapon against the US is minimal. The US has the highest percentage of living prior recipients of the vaccine, the largest current stocks of vaccine, and the fastest response infrastructure to combat such an attack. Voluntary vaccination programs would be very useful in reducing the available vector population in large cities. By the end of the year, most of the vaccine doses needed to combat a mass attack will be available for distribution. In two years there will be enough to entirely vaccinate the nation.

The AMA wants everyone to hear up front about the three hundred who WILL DIE from a complete vaccination program. No one wanted to listen to them about the dozens who were going to be killed if everyone started popping antibiotics to avoid anthrax. Medical treatment is never risk free. Doctors kill hundreds of people every year. More people died from antibiotic interactions since October than died of anthrax. (Well, unless it was statistically unusual two months.)

The best evidence (and there is damned little evidence, by the way) is that even those who were vaccinated decades ago will have somewhat enhanced immune response to the disease. That is me, and a whole lot of other folks like me. The young are the most at risk, and I think should be put first. We should distribute, but not use enough doses to immunize our entire school aged population as a first preparation. (OK, wrong, doctors and nurses first, it only makes sense.) In the event that an attack is launched, such a ready dose system could protect our children in a matter of days, but would not cause any needless deaths.

Military forces should be immunized as a matter of course.

When supplies allow, rotation of stock and voluntary free immunization of all citizens should follow. Me, I am not worried, but will probably get one out of solidarity, what the hell, I didn’t die the last six times I was vaccinated.

With those public preventative measures taken it becomes ludicrous to maintain smallpox weapons for use against the US. The cost and danger to the using nation would be greater than the reasonable expectation of damage to the target. Perhaps a CIA study could help us vaccinate all the nations that are regarded as enemies of the nations currently thought to maintain the stocks of the virus. Then those nations can have their biowar, and no one else needs to come.

Tris

“For to win one hundred victories in one hundred battles is not the acme of skill. To subdue the enemy without fighting is the acme of skill.” ~ Sun-tzu ~