On December 1^st, 2001, the Canadian government started stockpiling smallpox vaccine. On June 21^st, 2002 the National Vaccine Information Center, the oldest vaccine safety organization in the U.S. endorsed the decision by the Centers for Disease Control (CDC) to immunize health care workers against smallpox as the first line of defense against a possible bio-terrorism attack. Many other countries are following suit by either stockpiling vaccine or starting mass-vaccination campaigns. However, some experts against the vaccine are asking if forced, mass vaccination is just another form of terrorism. They point out that although the idea of mass preventative vaccination may sound reassuring that smallpox vaccines are known to have a very high risk factor, causing disability, smallpox or even death and the vaccines have a high cost to the public. Supporters of mass vaccination state that stockpiles of smallpox vaccine would help prevent large numbers of deaths in the case of an outbreak. However, they do not provide answers to the questions posed by experts against the vaccine campaign.

Vaccine advocates point out that in 18^th century England, smallpox was the cause of one in ten deaths and was only eradicated from the earth in 1979 after worldwide immunization campaigns. Since then the smallpox virus has been isolated to a few labs in the U.S.A. and Russia. However, recent events have triggered the fear that countries hostile to the U.S. could have purchased some of the virus for use in biological weapons and perhaps even genetically altered it to create a more effective weapon (Kaplan).

The first question set forth by cautionaries, however, is the motivation behind the vaccine itself. Barbara Loe Fisher of the National Vaccine Information Center (NVIC) wonders if mass forced vaccinations are just another indication that the terrorists have won by inducing mass fear in the American public. Other experts in the field point out that stockpiling small pox vaccine sets a dangerous standard for future anti-terrorism policies. If the government decides to stockpile smallpox vaccine then they must also agree to stockpile other vaccines when they become available - vaccines such as the AIDS or anthrax vaccines. Fisher points out that forced vaccination also poses many constitutional problems. She says, "Even in the event of a proven biological weapons assault and smallpox outbreak, sacrifice of the informed consent ethic would result in state-forced vaccine-induced injury and death of a biologically vulnerable minority in service to the majority, posing serious constitutional and moral questions” (Fisher). 

The second problem with mass vaccination is the issue of how effective or even needed the procedure would really be. There is actually a window up to four days in which to vaccinate a person after they are exposed to the virus, meaning that mass pre-vaccination is not really necessary. Furthermore, whereas smallpox used to kill up to 30% of those infected, recent medical advances could bring that down to 2% - the same rate of death from the common flu (Fisher). Another concern over the effectiveness of the vaccine is over the disease itself. Some doctors fear that bioterrorists could have altered the disease to make it more lethal, thus rendering all current vaccinations useless against the new disease (NVIC).

The third question raised by the stockpiling of smallpox vaccine is how safe the vaccine really is. A new study claims that the current U.S. strategy for containing a deliberate release of smallpox could lead to tens of thousands of unnecessary deaths (Kaplan). The policy - to trace, vaccinate and quarantine all those infected and exposed - would be too little and take too long to protect a large metropolitan area such as New York. Advocates state that the mass immunization technique was the one that successfully controlled wild smallpox outbreaks in cities in the last century. However, other organizations say that even a mass immunization would be dangerous as the vaccine itself carries a high risk factor. In fact, in evaluating the potential risk of a bioterrorism attack with real, as well as unpredictable, risks of exposing large numbers of children and adults to a prophylactic mass vaccination program for smallpox, some health officials have already concluded that the risks of mass vaccination outweigh the theoretical benefits (NVIC). This is because the live virus vaccine causes reactions in almost everyone who gets it and causes life-threatening reactions in 1 in 4000 people. The vaccine virus can also help spread the disease from one person to another and up to 50% of the US population have health problems that put them at high risk of injury if they take the vaccine. The vaccine is especially dangerous to people who have a history of eczema or dermatitis. The original smallpox vaccine invented by Jenner used cowpox as a vaccine, while the modern version uses a live mixed virus that has a wide range of host possibilities. The modern vaccine was never tested while the original one was (NVIC).

The fourth question raised by the recent approved proposal is if the vaccination campaign would actually create a problem where none now exists. Even though CDC experts continue to insist the theoretical probability of the eradicated virus being intentionally released is "very low”, they are, at the same time releasing the vaccine itself into the general population. Just the vaccination of the proposed 200,000-500,000 healthcare workers could spread the virus itself to some of the most vulnerable people in the world – those who are being treated at hospitals (NVIC). The NVIC says, “Because live vaccinia virus vaccine can cause vaccinia viral infection in the vaccine recipient or in a close contact of the recently vaccinated person, those who get vaccinated will be exposing themselves and others to the vaccinia virus and potential complications” (NVIC).

The fifth question raised by the smallpox campaign is the cost of the campaign itself. The Bush administration has finalized a $428 million deal to expand its stockpile of smallpox vaccine so that it has some 286 million doses on hand by the end of next year (CNN).  Future cost estimates bring the total predicted cost of the vaccine to nearly two billion, not counting the high cost of administering the vaccine itself or the legal costs involved in dealing with any vaccine reactions that may occur.

Last, but not least, the administration of such a vaccine campaign poses many risks in itself. Entire bottles of vaccines or batches of vaccines make good targets for terrorists who may want to taint bottles of vaccine with poison. A tool of this kind could be used against the general American public or could even be directed against a hand-picked group of people such as a religious organization or ethnic group who would all use one facility to vaccinate (Fisher). Secondly, at the time vaccination became necessary panic may ensue unless the government creates thousands of new sites and hires thousands of people capable of administering the vaccine. Under the right circumstances long lines to vaccination facilities could create the auctioning off of ones place in line, thus creating great opportunity for coercion of the general public. In short, any campaign born out of fear instead of faith has little chance of success. As it says in the Qur'an, "And warn with it those who fear that they shall be gathered to their Lord-- there is no guardian for them, nor any intercessor besides Him-- that they may guard” (Qur'an 6:51).

[5.52] But you will see those in whose hearts is a disease hastening towards them, saying: We fear lest a calamity should befall us; but it may be that Allah will bring the victory or a punishment from Himself, so that they shall be regretting on account of what they hid in their souls.

• CNN. Administration to Buy Smallpox Vaccine. November 29, 2001.

• Clarke, Tom. Nature News Service. Macmillan Press. July 10, 2002.

• Harper, Tim. “The Rock Collects Vaccines.“ Dec. 1, 2001. The Star Online.

• Kaplan, E. H., Craft, D. L. & Wein, L. M. “Emergency response to a smallpox attack: The case for mass vaccination.” Proceedings of the National Academy of Sciences, (2002).

• Fisher, Barabra Loe. “Statement on the CDC Plan to Release Smallpox Vaccine.” National Vaccine Information Center. June 24, 2002.

• NVIC “Smallpox Vaccine and Mass Immunization.” National Vaccine Information Center. 2002.

 

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