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Smallpox Scenarios

Remember the old joke about the doctor who tells the patient there's bad news, and then the very bad news? Well, the bad news is that America faces the real possibility that terrorists will unleash killer germs, like smallpox, on civilians. The very bad news is that Washington is stuck on a response that would result in the most people dying.

At least that's the conclusion of a paper soon to be published in the Proceedings of the National Academy of Sciences. It's the latest in a growing body of work from academics and health professionals criticizing the government's plan for dealing with a smallpox outbreak. The more we look around, the harder it is to find anyone who thinks the bureaucrats' plan makes one iota of sense.

That plan denies the public prior access to a vaccine. A government wunderpanel, the Advisory Committee on Immunization Practices, recently recommended sticking with a policy known as ring vaccination. Under this bit of brilliance, we'd wait until after an outbreak and then send in doctors to isolate the infected and immunize anyone who'd had contact with them. Health and Human Services Secretary Tommy Thompson so far seems willing to adopt this plan, with a few modifications.

We'd like to suggest that before the Secretary throws in with the public health priesthood, he first run his eyes over that upcoming PNAS paper by Edward H. Kaplan of Yale, and David L. Craft and Lawrence M. Wein of MIT. Their work claims to be the first to make a detailed comparison of vaccination scenarios.

Assuming an outbreak infecting 1,000 people in a large city, ring vaccination would result in 367,000 Americans falling ill and 110,000 deaths. It would also take a full year to extinguish the outbreak.

The paper also examined other scenarios the government is considering, such as mass vaccinating (instead of ring vaccinating) after an outbreak. It found that if authorities vaccinated as soon as an outbreak occurred, 560 people would die. If they first tried ring vaccination and then switched to mass vaccination after 33 days, 4,680 would die. As the authors put it (we assume without irony): "The cost of waiting . . . is very high."

The best scenario? It happens to be the one that would also allow Americans to choose for themselves. According to the Kaplan paper, if 40% of the population were previously vaccinated, the number of deaths after an attack drops to 440 (assuming mass vaccination after an attack as well). Prior vaccinations would also give the public health community more time to screen people most at risk for potential vaccine side effects.

Mr. Thompson is expected to make some decisions on smallpox guidelines in the coming weeks. His advisers seem focused solely on the risks of giving citizens access to a mass vaccination program prior to an outbreak. We'd redirect Mr. Thompson to the potential consequences of denying such access. Not only would he be denying Americans preventive medicine, he may well be setting the stage for an outbreak of significant proportions.

Updated July 10, 2002



     

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