Bush's Smallpox Boondoggle

Health experts predict that if 10 million Americans are vaccinated against smallpox, 20 will die outright from the vaccine alone. What gets neglected is the 60-million-plus Americans with weakened immune systems who will be put at risk by widespread vaccination.

The national smallpox vaccination plan rolled out with a whimper last week. Part of the Bush administration's effort to stave off a bioterrorism attack, the vaccination plan was to begin with a strong start in the state of Connecticut by vaccinating 20 or more first-line medical responders who would then fan out and vaccinate thousands of other doctors, nurses, and emergency room personnel around the state. In the coming weeks, other states will join in and inoculate 500,000 first-line medical personnel in all major medical centers in the country against smallpox. Eventually 10 million more healthcare workers, firefighters, police, and emergency medical personnel will receive the vaccine.

But in Connecticut, only four people showed up to get the shot, and 3 of those were administrative personnel -- the state epidemiologist and 2 administrators at the University of Connecticut's Health Center. The numbers willing to volunteer for the shots had been dwindling all week, as hospital associations, nursing unions, and other professional groups balked at the risk of the smallpox vaccine itself and raised important questions about the true potential for a smallpox terrorist attack. At last count, more than 80 hospitals around the nation, including major teaching hospitals and medical centers in urban areas, have opted out of the vaccination program.

What's going on here?

The smallpox vaccine is made from a live virus, vaccinia or cow pox, which is a cousin of smallpox. It can cause illness in a significant number of vaccine recipients. Experts estimate that about 1,000 out of every every 1 million who receive the vaccine will experience serious side effects, about 40 of those will be life-threatening illnesses, and 1 or 2 of those people will die from it. So, of the 10 million expected to get the shots, 10,000 are expected to get sick, 400 will be threatened with death, and 20 are expected to die outright.

But, as critics have pointed out, this is a gross underestimate of the risks. People who are vaccinated carry an open wound in their arm, which sheds the live vaccinia virus for up to three weeks. Certain people who come in close contact with them can become quite ill. At particular risk are infants under a year old, pregnant women, elderly people, folks with eczema and skin disorders (who can absorb the disease through breaks in their skin -- an estimated 7 to 20 percent of the general population has had such skin disorders) and, most ominously, people with lowered immune system response.

There are an estimated 60 million people in the U.S. today living with weakened immune systems, and most of them are suffering from HIV/AIDS or undergoing a medical treatment that didn't exist 35 years ago when smallpox vaccinations were routine. People with AIDS, cancer patients undergoing chemotherapy or radiation treatments, burn patients, and organ donor recipients would all be put at an unacceptably high risk of death if their nurses and doctors are vaccinated for smallpox.

It's a peculiar form of torture to ask a medical person who has dedicated his or her life to saving other peoples' lives to risk killing patients because of vague fears of a bioterrorist attack. Doctors and nurses, in particular, have a good sense of the potential threat various diseases pose to their patients. As William Schaffner, head of preventive medicine at Vanderbilt University Medical Center in Nashville, said: "The thing that stops you from doing this is the complexity of the smallpox vaccine, which is not a safe vaccine. There's a real disease that kills people unnecessarily: the flu. Mr. President, I would love to see you endorse a national flu vaccine campaign with the same vigor." Medical centers around the country, however, have had to deal with recent flu vaccine shortages. Smallpox is simply not high on their list of concerns.