An article in the San Francisco Chronicle of June 2, 2002, described the new policies regarding smallpox research being enacted by the Centers for Disease Control and Protection (CDC). The CDC is devoting one of its two maximum-containment laboratories to smallpox-only research for the foreseeable future. This is an extraordinary new policy and reflects the serious nature of the threat that the government thinks smallpox may have in the event of a terrorist attack using the smallpox virus as a weapon.

Scientists are researching into new vaccines and also into tests that may detect smallpox prior to symptoms manifesting and also into treatment options for both the disease and vaccine affects.

There are many challenges that researchers face. The government retained only 15 million does of the vaccine after the disease was declared eradicated in 1980. Since September 11, the United States has arranged to purchase 300 million doses of live smallpox vaccine from a British vaccine manufacturer and have been donated another 85 million doses of smallpox from a French vaccine manufacturer. Also, a study in April 2002 showed that the vaccine supply could probably be extended by diluting the full strength vaccine without any loss of affect.

However, the greater challenge lies in finding a vaccine that has less side effects than the ones previously used. Previous policies of compulsory smallpox vaccine in the USA, Europe and Asia produced very questionable immunity to the disease and also led to very serious side-effects in significant numbers of people.

In England, compulsory vaccination was introduced in 1852, yet in the period 1857 to 1859, a smallpox epidemic killed 14, 244 people. In 1863 to 1865, a second epidemic claimed 20,059 lives. In 1867, after even more stringent compulsory vaccination laws were enacted, 97.1% of the population were vaccinated, with those refusing being prosecuted. However, in 1872, a smallpox epidemic claimed 44,840. Between 1871-1880, during the period of compulsory vaccination, the death rate from smallpox leapt from 28 to 46 per 100,000 population.

Similar statistics indicating an increase in smallpox outbreaks and deaths AFTER introduction of compulsory vaccination programs can be found in Japan, Germany, Philippines and other countries. In each of these countries, incidence of smallpox was actually declining prior to introduction of the vaccine. The problem is that the vaccination has been made from a live virus, which makes it much more volatile, and leading to secondary contagion. This has led members of Congress to ask for development of a safer, killed vaccine. However, new research into a new vaccine could take 5-10 years, too long for many who consider a terrorist attack with smallpox a realistic possibility. Also, in the absence of naturally occurring smallpox disease, there is no way to establish whether a new vaccine would work.

So, how much risk is there from smallpox and its possible use as a terrorist weapon? After the 2nd World War, the Soviet Union produced huge amounts of smallpox virus in their bioweapons laboratory and by the 1970s maintained an annual stockpile of twenty tons of weapons-grade smallpox. This was enough to blanket 4,000 square miles of enemy territory. The virus was also adapted to create a shorter incubation period and mixed with other toxins to create other fatal effects. Other countries, including Iraq and North Korea probably possess smallpox virus as a potential biowarfare weapon. However, whether any country (as apposed to perhaps terrorist organizations) would choose to use this weapon when it would be likely that many in their countries would be contaminated is questionable.

Due to the controversial history of smallpox vaccines, the CDC recently has enacted a number of public forums to discuss the issues at hand. After this, the CDC and the Advisory Committee of Immunization Practices (ACIP) will submit its final recommendations to the White House, where Tommy Thompson and Tom Ridge will have final say. In other words, politicians will make the final decision regarding any new vaccine policy. This is happening at the same time that bills are being sent to legislatures in many states that would establish a type of martial law in the event of a potential or actual terrorist attack. These bills would allow enforce vaccination of ALL people, with prison sentences to any people who refuse, including physicians who do not follow established vaccination policy. As with other issues arising from the September 11 terrorist attack, serious questions of individual liberty versus terrorist prevention are being played out. However, not many people know of the kind of bills that are currently being submitted to legislatures throughout the country.

At the present time, there seem to be a few options available to the authorities. The first is compulsory vaccination of all people. Given the history of this vaccine, by far the most damaging of all vaccines used, this may be far too controversial and dangerous. Another strategy is to create a ring of safety around the outbreak by vaccinating any people who have come into contact with a person contracting the disease. However, it is questionable how effective this strategy would be. Another option being considered is to offer the vaccine voluntarily and attempt to encourage people to have the vaccine. This way, the government could see what effects the vaccine would have and most likely would get participants to sign a waiver form, avoiding responsibility for any side-effects.

Given the serious side-effects shown, certain people should not be vaccinated. This includes children under one year of age (studies show brain inflammation as high as one in 24,000 vaccinations in children under 12 months), people with eczema or a history of eczema, pregnant women, individuals with immune deficiency disease, immunosuppression and HIV infection.

Therefore, although there is evidence that smallpox vaccine may have helped in the long-term decline of the disease and perhaps prevented some fatalities in naturally occurring outbreaks, the extremely serious nature and number of side-effects of the vaccine make any new policy regarding smallpox of great consequence for our health. To introduce smallpox virus back into the bloodstream of the worlds population may have a devastating affect on millions of people and could achieve the very result that the terrorists themselves would want. We have to hope that the authorities do not overreact and consider all the facts very carefully.