Staying the Devouring Monster: Smallpox Vaccine and Bioterror Preparedness

The havoc of the plague had been far more rapid: but the plague had visited our shores only once or twice within living memory; and the smallpox was always present, filling the church-yards with corpses, tormenting with constant fears all whom it had not yet stricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover.
-Macaulay, Thomas Babington. History of England, chapter XX. London; 1848

The small pox, so fatal and so general amongst us, is here rendered entirely harmless by the invention of ingrafting, which is the term they give it. There is a set of old women who make it their business to perform the operation every autumn….The old woman comes with a nutshell full of the matter of the best sort of smallpox, and asks what veins you please to have opened. She immediately rips open that you offer to her with a large needle…and puts into the vein as much venom as can lie upon the head of her needle, and after binds up the little wound with a hollow bit of shell.
-Montagu, Mary Wortley. Letter to Sara Chiswell, 1717. [Reprinted in Letters of Lady Mary Wortley Montagu, letter 31. 1779.]

Medicine has never before produced any single improvement of such utility. You have erased from the calendar of human afflictions one of its greatest.
-Thomas Jefferson, letter to Edward Jenner, 1801.

Smallpox and smallpox vaccine. The greatest scourge of mankind and the greatest medical intervention to ever be introduced. Smallpox, with its thirty percent mortality rate, is the only infectious disease to have been completely eradicated from nature, and now it only exists (we hope) in laboratories in the United States and Siberia. There's a good chance, however, that it also exists in laboratories in the Middle East, namely in Iraq, where it could have been developed for use as a weapon. The threat of a bioterrorist attack with smallpox is a very real one. The need for a good defense against it is equally real and pressing.

This week, the CDC released its smallpox vaccine guidelines for state and local health departments in the event of a bioterrorist attack. The guidelines give detailed instructions and advice for setting up mass vaccination clinics should they be needed. They give guidance on who to quarantine and when. There are patient information sheets about the vaccine and patient questionnaires to be administered before vaccination. What the guidelines don't have are recommendations for educating the average physician on how to respond if he should find a case in his exam room. And what is missing is any suggestions on how to handle the panic that would surely ensue. And, what has been missing for the past year is any attempt to educate the public about the disease or the vaccine so that an informed debate about pre-attack voluntary mass vaccination could take place. The underlying assumption of the CDC has been that the American public is incapable of understanding the risks to themselves and others of mass vaccination.

Article Author: Sydney Smith

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