Heritage Foundation Leadership for America

Washington, Dec. 9, 2002 - President Bush should order front-line military personnel vaccinated for smallpox immediately, urge state and local health agencies to vaccinate "first-responders" to terrorist attacks, and allow the public to get vaccinations, says a new paper from The Heritage Foundation.

Some health officials, including Health and Human Services Secretary Tommy Thompson and the American Medical Association, have discouraged widespread pre-emptive vaccinations because some people (estimates range from 1 in 8,000 to 1 in 67,000) become ill after receiving them and about one in a million dies. Others, citing liability concerns, urge a more cautious approach.

But the benefits, according to Michael Scardaville, policy analyst for homeland security in Heritage's Davis Institute for International Studies, far outweigh the risks. Emphasizing pre-emptive vaccination, he says, would reduce the spread of the disease if it were used as a weapon, improve health workers' ability to treat victims, reduce panic and deter some terrorists from using smallpox against U.S. targets altogether.

Moreover, Scardaville says, making it voluntary for civilians would respect an individual right to choose whether to accept the risks involved and help cushion the blow of liability against health-care professionals who supply or administer the vaccines.

Time won't allow for sufficient post-attack vaccination, he says. Millions could die from a well-planned attack against an unsuspecting and unprepared American public. Virtually no one under age 30 in the United States—about 42 percent of the population—has been vaccinated and thus would be vulnerable to contracting smallpox in the event of an attack. Even those who have been vaccinated already might not be immune, he adds.

Those who oppose mass pre-emptive vaccinations advocate a "ring" approach, in which everyone known to have come into contact with a smallpox victim is vaccinated. But, Scardaville says, post-exposure vaccinations must be administered within four days to work. And much of that time could be lost just trying to certify that the "contact" person has smallpox.

Only one lab in America, the Centers for Disease Control in Atlanta, can confirm a smallpox diagnosis, and its tests can take eight to 24 hours, Scardaville says. Then, it can take 12 to 24 hours for the vaccine to reach distribution points. Thousands of secondary cases could be created before a single primary case is confirmed, he warns.

For now, Scardaville says, the Defense Department should proceed with plans to vaccinate about 500,000 of its 1.4 million active duty personnel. It should expand the program to include National Guardsmen likely to be called upon to assist civil authorities during a domestic smallpox attack.

The Center should work out a strategy to begin voluntary vaccinations early next year, draft guidelines for distributing the vaccine to hospitals nationwide, and develop ways to inform citizens of the risks involved, the Heritage analyst says. Local officials should determine which first-responders—police officers, firefighters and emergency medical personnel—need vaccines. And the federal government should begin to address how it will make enough vaccines available for those who wish to receive them.

"There are risks involved, and government must address how they will be handled," Scardaville says. "But from a national security standpoint, the only step that makes sense is to ensure that as many Americans as possible are vaccinated before an attack."