Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D.
Friday, Dec. 20, 2002

In our July 4, 2002, column on the smallpox threat, we wrote, "Don't procrastinate; Vaccinate."

We noted that, for any given individual, the risk of not vaccinating against smallpox could be greater than the risk of vaccination, depending on personal medical conditions, location, travel patterns and myriad other factors. We cautioned, however, that immunization for the general public should be voluntary and informed.

We therefore strongly support President's Bush latest proposal, with a few exceptions noted below.

However, since the threat of bioterrorism is scary enough, we first want to correct some widespread media disinformation.

Although generally supportive of the president's vaccination plans, many news reports falsely claim that the smallpox vaccine is the world's "most dangerous vaccine." For example, a Dec. 14 Reuters story by Maggie Fox, Health and Science Correspondent, calls the DryVax form of smallpox vaccine "the most dangerous vaccine existing." A Dec. 13 Associated Press article claims "Smallpox vaccine is more dangerous than any other."

These and other news stories are a media myth and seem to be spreading faster than a computer virus.

For example, the Hepatitis B vaccine has more complications than the smallpox vaccine. Yes, this is the Hepatitis B vaccine that is now required by some grade schools, even though grade school children are not at significant risk for Hepatitis B infection.

As Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS), points out: "Children are routinely required to take vaccines against diseases much less serious than smallpox despite comparable side effects. For example, statistical projections estimate the number of deaths associated with administration of 300 million does of the smallpox vaccine would be 350 deaths. And yet there were 440 deaths associated with only 20 million doses of hepatitis B vaccine as of 1998." This death rate is more than 10 times higher than the smallpox rate.

For another example, we believe that the anthrax vaccine is much more dangerous than smallpox immunization. But because only the military use the anthrax vaccine, and because the military hasn't released complication data, civilian scientific analysis isn't possible.

So, what should be done to improve the president's plan?

The recommendations made in a Dec. 13 AAPS press release urge the president to speed up the timetable.

"We applaud the President's recognition that advance, voluntary, immunizations is the right decision," said Dr. Orient. "But it could be a fatal error to wait until 2004 to make the vaccine available to the general public."

The specific reasons why were spelled out previously, in a September 2002 AAPS proposal:

"Prudent medicine as well as public policy tells us the logical alternative is to make immunizations available, with full disclosure and informed consent, to those who want them. This will allow much more effective screening of those who are at a high risk of complications from the vaccine, and allow people who are more likely to be exposed – to voluntarily be inoculated."

Other reasons include:

For about two weeks following inoculation, vaccinated individuals can spread the live virus (called vaccinia) used in the vaccine. Vaccinated persons need to avoid people more vulnerable to complications, an impossible task during emergency mass inoculations.

Immunized volunteers are needed now to produce vaccinia immune globulin (VIG) for treating others later.

In addition, we also suggest manufacturing of smaller vaccination kits to avoid spoilage and waste (current kits provide 100 doses that must be refrigerated after opening and used within a month) and educating the public regarding next-generation vaccines.

Educating the public will take some time, even before a smallpox attack. Doing so now will help prevent chaos and panic later.

But perhaps the greatest argument in favor of vaccinating now is the fact that the capability exists. On Dec. 13, the Centers for Disease Control and Prevention (CDC) proclaimed, "The United States currently has sufficient quantities of the vaccine to vaccinate every single person in the country in an emergency."

Therefore, we see no reason to wait as late as 2004 before you are allowed the opportunity to educate and protect yourself and your family, in consultation with your personal physician.

In sum: It is time for "Super Smallpox Sundays" in 2003 – just as it was time for "Sabin Oral Sundays" to protect against poliomyelitis in 1957.

The president made a difficult but wise decision. Reporters shouldn't muddy the water with bad information.

Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a former president of the Association of American Physicians and Surgeons.

Contact Drs. Glueck and Cihak by e-mail.

Read more on this subject in related Hot Topics:
Bioterrorism
Bush Administration
George W. Bush

Editor's note:
"Scourge: The Once and Future Threat of Smallpox"
"Living Terrors: Surviving the Coming Bioterrorist Catastrophe"