This may very well just be a General Question, but taking probable evolution into account, here it is; still, this is primarily to fight some of my own ignorance, and I’d like some extra muscle to gang up on it. So, why recommend against (or stop short of reccomending for) vaccinating the general public against a highly contagious and likely highly lethal disease to which we have very little resistance? I know we don’t have the stockpiles of vaccine yet, but should have sufficient for general vaccination by the end of the year (per the same article). So, assuming we avoid getting smallpox misted through the bathrooms of a major hub airport between now and time of sufficient stocks…why not? Is the vaccine itself dangerous? Is the guaranteed expense of widescale vaccination such that it outweighs the possible worst-case expense of a third of infected folks dying and thus no longer paying taxes? What’s the Straight Dope here that such news items may gloss entirely past? Help me out here, because Ignorance is eyeing my milk money.
Remember, smallpox has been eradicated from the natural world, and the only places any of the stuff is supposed to still exist are in a couple of high-security labs in Moscow and Atlanta. So, there’s basically zero chance of a natural epidemic, and even the chance of a bioweapons terrorist attack with smallpox is probably small. And, to directly answer a question you asked, yes, the smallpox vaccine is dangerous. A certain percentage of people who take it will have “adverse reactions”, and some of them will even die.
Right now, the cost (in terms of dead people, not just dollars) hasn’t been judged to outweigh the benefits (in terms of a theoretical probability of saving lives) to justify mass vaccination. Currently, the best plan seems to be to stockpile the vaccine but not to give it out. If someone does attack, then a major vaccination program could be instituted, which if properly done could very likely contain any outbreak; at that point, the few people who would die from the vaccine itself rather than from the actual epidemic would become, to look at it rather cold-bloodedly, acceptable losses.
Here are some of the problems with a general vaccination:
-We don’t have enough vaccine
-Hundreds of people would die from side effects (primarily the elderly and the young)
-People who are immunocompromised couldn’t be vaccinated
and most of all:
-We don’t even know if anyone other than the U.S. or Russia even has a supply of smallpox.
The funny thing is; when I was doing my undergrad work as a Microbiologist, the big controversy at the time was whether or not to eliminate the two final stockpiles left (those in the US and those in the USSR). It would have been the first intentional extinction of a species by humans.
Personally, there is no way I would take the vaccine, despite the fact that I was amongst the last to be vaccinated the first time around. Moreover, I would advise others against vaccination. I don’t think there is a credible enough threat to initiate general vaccinations.
The calculus of death. The vaccine, like all vaccines, is somewhat inherantly dangerous – I’m not sure for this particular vaccine, but some finite but small percentage of people who get vaccinated will suffer side effects and/or death as a result. This is a guaranteed result. On the other hand, you don’t know if anyone (or Nature Her Own Bad Self) will release smallpox again, meaning that those people might die for nothing. On the gripping hand, if it’s released, a quick response to an infected area might be able to save the corpus of American taxpayers without putting everyone at the small, but definite, risk of the vaccine. The problem is incomplete information – no one knows for sure when / if a release might occur; if they did, those people could just be vaccinated and there would be no problem. As it is, there’s all these icky risk factors to think of. Personally, I’d take the vaccine if it was available and take my chances with the side effects, but I’m not beating down my physician’s door either.
This is all part of the “calculus of death” that is very often missing from discussions of medicine and medical procedure. The basic fact that is usually overlooked in public and media reports is that whenever you put something into or take something out of the human body, you cause additional risks to the human body. And you have to weigh those risks against the benefit of the putting in or taking out.
People here have already addressed the risks associated with smallpox vaccines. The same issues are at play in the dispute over mammographies. Do you find more cancers with mass mammography at a young age then you cause by the x-rays? Do you save more lives with biopsies of suspicious tumors than you lose due to side effects of those biopsies?
The same balancing tests apply to a whole mess of medical procedures.
I’m a big believer in immunizations, but the key is in the balance of benefit versus risk, as emphasized by Sua. The possiblity of benefit from a mass immunization program would be small and certainly not huge compared to a targetted program that unrolled after a known event. The risks of such a campaign are real and substantial. Some people would definitely die as a result of the vaccine for no sure benefit.
It would certainly seem to be prudent to vaccinate the “first line of defense.”
Since there will not be sufficient stocks for mass vaccinations for perhaps 6 months, it also would appear that we don’t have to make any final decision today.
At the conclusion of the “first line defenders” we should have better data as to the risks of mass vaccinations.
Also, in 6 months, will we have any better handle on the threat of/posed by a smallpox attack? Would further terrorist acts by Osama bin Laden & Al Queda tip the balance toward mass imunnnization, or ObL’s capture or other significant victory against Al Queda tip it against. Or even making to 9/11/02 without any further incidents.
Of course, even if ObL could get his hands of smallpox, would he not realize that a smallpox epidemic might cause just as much death & destruction to those peoples he claims to be fighting for, as to those people that he hates.
As a very healthy male in his 40’s I don’t know whether I would take the vaccine, or not. I view the health risks as virtually non-existent, [I survived the vaccine just fine back in 1956.] OTOH, there seems to be no evidence that any person or group [other than the US and Russian gov’ts] has the virus.
Just for general information’s sake, I’d like to put in a sketch of how smallpox was eradicated in the first place in areas where few people were vaccinated. The WHO quickly gave up the impossible task of vaccinating everyone in undeveloped countries; instead they went for a different strategy. When a smallpox case was reported, the victim would be isolated and every person he/she had come in contact with would be tracked down and vaccinated ASAP, which often mitigated or prevented the disease in those who had been exposed. They didn’t need to vaccinate everyone–just the ones in danger. It saved a lot of unnecessary labor and bad reactions, and worked remarkably well.
How well would that same quarantine-and-vaccinate-known-contacts strategy work today, though? I would think that the world’s quite a bit more quickly interconnected via air travel and such, which would make vector-management sort of a nightmare from an “artificial” breakout in a major city, yes?
Still, the death calculus makes a lot more sense now–hadn’t realized how comparatively high the side-effect level in the vaccine is.
I’d take the vaccine in a heartbeat. Sure, the risk of smallpos being released among the general public is small, but not small enough. If I take the vaccine, there’s a tiny risk that I might die. If I get smallpox, there’s a damn good chance that I will die horribly and painfully or be disfigured for life. If a smallpox epidemic did hit a major city, I have very little faith that the government would be able to contain it effectively.
Why not make it available on a voluntary basis? Tell people about the risks and side effects, and let people over the age of 18 decide for themselves. Parents could decide for their children. Let people choose which risk to assume.