Smallpox worries are overblown, experts say



In spite of the Bush administration's call for smallpox vaccines to be made available, health officials and medical experts say that without imminent threat of an outbreak, widespread vaccination would be a mistake.
President Bush's revaccination last weekend signaled a first step in immunization plans for millions of U.S. military service men and women, and selected health care workers nationwide. The administration has deemed smallpox a potential biological terrorist threat.

Pat Libby, director of the National Association of County and City Health Officials, said the focus on smallpox, a disease the last documented appearance of which was in 1978, is misguided.

"If you put all of your energy and resources into smallpox," he said, "what's going to happen if some agent other than smallpox is used?"

Libby, who served as chief administrator for Thurston County Health and Social Services until August 2002, said the focus on smallpox "is detracting from our ability to prepare for other possible threats."

Dr. Diana Yu, Thurston County Health Department's medical director, agrees.

"The biggest thing smallpox can do right now is cause panic," she said. "There are things much more clearly on the horizon right now."

Chief among them is influenza.

"That is a clear threat," said Yu. "Four thousand people die from it every year in the U.S., and we have a vaccine for it that works and won't give you the flu. So if people want to do something now, I suggest they get their influenza shots."

She said her office has been fielding phone calls from concerned residents who want to know where they can go to get their smallpox vaccinations.

"The disease exists only in laboratories at the moment, and no vaccines are available here right now," she said.

An initial phase of the federal immunization plan calls for only selected health care workers to receive a smallpox vaccination. Those workers would be selected from a pool of volunteers who have been screened for health risks. There is no timeline for that initial phase, let alone subsequent preparations for mass immunization.

"My own hope," said Dr. Yu, "is that we do stage one and then stop right there."

Libby concurred. While visiting Olympia for the holidays, on break from his new job in Washington, D.C., he stopped in at the Thurston County Health Department offices and weighed in on current public health issues.

"We need to really study and learn from the first phase before continuing on to the next," he said.

"Unless the threat level changes, I definitely do not recommend it (mass immunization)," he said.

While administration officials have not recommended vaccinating the public, they have said the vaccine would be made available to those who insist on having it, possibly as early as next year.

Five articles slated to be published in The New England Journal of Medicine on Jan. 30 also advocate caution in going forward while the threat of a smallpox attack appears low.

The articles -- online at -- include one by the RAND Center for Domestic and International Health Security, which weighed the relative risks and benefits of immunizing a majority of Americans, of immunizing most of America's 10 million health care workers, or of not vaccinating anyone until an actual outbreak of smallpox occurred.

RAND scientists concluded that health care workers should be vaccinated now, but that it would be too dangerous to institute a mass vaccination plan unless threats of an attack are imminent.

Yu said the list of health care workers volunteering for immunization is growing, but that the screening process has just begun.

In addition, she said, a regional team hired through a federal bioterrorism grant is now in place to handle emergencies in Thurston, Mason, Grays Harbor, Lewis and Pacific counties. The team, made up of an epidemiologist, epidemiological nurse, environmental health worker, administrator and program manager is devising a series of plans to coordinate health and emergency workers in the area in case of a bioterrorist strike.

"When all this hullabaloo over smallpox dies down," Yu said, "We'll still have this team here that can help in any health emergency."

Smallpox facts

- Smallpox has not occurred naturally since 1978.

- The U.S. stopped vaccinating its citizens in 1972.

- Vaccines given in the first three days after exposure (before symptoms appear) can still be effective in warding off the disease.


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