December 29, 2002

SOME OBSERVATIONS ON SMALLPOX PREPAREDNESS:

The other thing we can do is to prepare for the worst-case scenario — simultaneous releases of aerosolized smallpox virus at major airports or sports stadiums, for instance. The success of the smallpox eradication campaign has made the public-health community confident that it could quickly contain and stop several, even dozens of, smallpox outbreaks if the virus were introduced here. The real question is: Could we meet the challenge if we had thousands or tens of thousands of primary cases? Not with the current plan. It is important to reassure the public by providing a plan to vaccinate the entire country within days if such an outbreak occurred. Many feel that is impossible. Yet it is no more impossible than having the entire country vote in one day.

There is no part of the vaccination process that is so complicated that it would preclude reaching everyone in the United States within three days if the risk of contagion is high. It does mean getting needed supplies in place and training volunteers, National Guard and public health workers how to vaccinate with bifurcated needles, a simple procedure that can be quickly learned. It also means strengthening the public health infrastructure throughout the country, decentralizing the job to every county, shipping vaccine nationwide overnight if the threat proves real and holding clinics in every high school. And it is critical that this be done. A plan to vaccinate the population over a matter of weeks is simply inadequate.

He’s more optimistic about “ring vaccination” than this excerpt makes it sound, though he admits doubts about whether it could work in mass-exposure cases. And he’s certainly right that many problems would be solved if we could develop a safer vaccine. To that I would add the prospect of antiviral drugs: if smallpox could be treated with something that would prevent most deaths, it would be nearly as good as vaccination.