A strategic smallpox plan
© St. Petersburg Times
published December 29, 2002
President Bush's smallpox vaccination plan is an important defense against bioterror. The prospect of terrorists unleashing the deadly virus is no longer unthinkable, and the people most vulnerable to attack need to be prepared. The president deserves credit for moving swiftly, and for taking a balanced approach to an initiative that carries tremendous risks.
Under the plan the president unveiled this month, a half-million U.S. military personnel will receive the vaccine. (Their commander in chief set an example by getting his vaccination.) Then the states will proceed with voluntary vaccination for up to 10-million emergency medical and public safety workers.
The plan makes strategic sense, targeting the people who need to be immunized prior to an attack. Troops and emergency workers need to be in a position to respond to any outbreak within days. These vaccinations will protect them and speed the public health response. But while President Bush made a convincing case for the vaccinations, he also was careful not to overstate the threat or understate the risks. The White House stressed that there was "no reason to believe" an attack was imminent. It also discouraged vaccination for the general public. These were the right messages to send. The nation's health care system is not yet in a position to vaccinate on a mass scale. The shots also pose serious risks to millions of Americans. The important thing now is to put a response plan in place, without causing alarm or prompting unnecessary vaccinations.
The success of the administration's smallpox plan will hinge largely on the efforts of individual states and the willingness of Americans to make informed decisions. U.S. doctors last routinely gave the vaccinations in 1972. Much of the planning involves the specifics of administering shots. People who suffer from skin disorders, depressed immune systems and other conditions are at risk and should be screened. Newly vaccinated people need to be educated about covering their sores to prevent infecting others. And states need to integrate their tracking data, so they can detect potential outbreaks, target their response and follow up to see whether vaccinations had any harmful effects.
The states have moved quickly, but they still need to create better operational plans and lines of communication if mass vaccination is suddenly needed in response to an outbreak. The federal government should add its assistance here. Given the mobility of the population, an outbreak in Montana could quickly spread to Florida. At the same time, the administration should continue to press Americans to consult their doctors. The decision on whether the vaccine is the right choice for everyone will be complex and difficult for many. The president's plan forces governments and individuals to start thinking these dilemmas through now rather than later.
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