Smallpox vaccinations: the risks and the benefits.

Introduction H ealth officials have long feared the use of biological weapons against the U.S. population, but since the September 11 and anthrax attacks, preparation for the possibility of bioterrorism has gained greater urgency. Smallpox is considered one of the most dangerous potential biological weapons because it is easily transmitted, few people carry full immunity to the virus, and there is no effective cure.Worldwide smallpox eradication through vaccination programs was declared by the World Health Organization in 1980, virtually eliminating the possibility of a “natural” outbreak. Officially, small quantities of smallpox virus exist in secure and authorized facilities in the United States and Russia. Recent news reports have linked smallpox weapon capability to Iraq and Afghanistan. Currently, the State Department and Centers for Disease Control and Prevention (CDC) consider the possibility of a smallpox attack to be low. However, the credibility of this threat could change with new intelligence and rapidly evolving world events. Since 2001, American scientists, policymakers, and the public have debated whether smallpox vaccinations should be offered to Americans in preparation for a smallpox attack. On December 13, 2002, the Bush administration announced that it would begin vaccinating approximately one million military personnel and emergency public health professionals in January 2003.Voluntary vaccinations would be offered to the public beginning in 2004, although individuals who wish to be vaccinated earlier may have access to the vaccine. According to a Robert Wood Johnson/ Harvard School of Public Health poll on America’s Response to Biological Terrorism, conducted in the fall of 2002, public concern The Commonwealth Fund is a private foundation supporting independent research on health and social issues.The views presented here are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.