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Is it time to revive smallpox vaccinations?

Is it time to revive smallpox vaccinations?

By Christy Feig
CNN Medical Unit

(CNN) -- Americans haven't been routinely vaccinated for smallpox since 1972. But the federal government is debating whether a program should be restarted.

"The White House is reviewing my recommendations, and hopefully we'll have a decision in the near future," said Health and Human Services Secretary Tommy Thompson.

The World Health Organization declared smallpox eradicated worldwide in 1979, but experts said they are concerned the existing virus from labs could fall into the hands of terrorists.

"I would say that the risk of a smallpox attack is very real," said U.S. Sen. Bill Frist, R-Tennessee, who is also a physician. "I would say that that risk is increasing compared to say five or 10 years ago, and I would say as a nation that we do remain highly vulnerable if smallpox is used as an instrument of war."

Most Americans under 30 haven't been vaccinated, and it's questionable how long the vaccine protects those who have been. For example, one study found that of 621 microbiologists in Maryland who received smallpox revaccination between 1994 and 2001 as a precautionary measure, 6 percent remained immune from their previous vaccinations.

Weighing vaccine's risks, benefits

But who should be vaccinated without a specific threat? Those who would be exposed first to an infected patient such as emergency workers? Or should all Americans be allowed to decide if they want to be vaccinated?

"Every American should have the opportunity to make an informed individual choice to evaluate those risks plus those benefits to receive that smallpox vaccine," Frist said.

Bioterrorism basics 

But weighing the risks and benefits of the vaccine is complicated.

"There's a lot of people who should not be vaccinated with smallpox vaccine," said Dr. Robert Belshe of the St. Louis University School of Medicine, who has worked on several smallpox vaccine trials.

"The logistics of conducting a large scale vaccination program, if we're talking on the order of millions, would be enormously complex and difficult to conceive how we would successfully do that," Belshe added.

The vaccine is riskier than most and can cause serious side effects and even death in some people.

People at greatest risk

According to Dr. D.A. Henderson, director of the Office of Public Health Preparedness in the Department of Health and Human Services, the people most at risk are those who:

  • have eczema;
  • have immune deficiency disorders;
  • are receiving cancer treatment;
  • are getting an organ transplant;
  • have severe complications from HIV.
  • People are also at risk of getting a virus similar to smallpox from someone who recently has been vaccinated.

    "Persons who live in households who have people with immunosuppressive conditions or taking drugs for cancer, chemotherapy for example, or households who have an infant less than 1 year of age, these kinds of persons should not take smallpox vaccine," Belshe said.

    Of course, people can die as well.

    During the 1947 smallpox outbreak in New York, more than 6 million people were vaccinated. Two died from the disease and eight from vaccine side effects. Experts said they believe that number might be even higher today because of the increase in eczema, HIV and the number of people undergoing cancer treatment.

    "We estimate maybe two to four deaths per million may be more likely today -- not just one per million," Henderson said.

    In addition, experts said they fear today's litigious culture may have an effect that wasn't present when Henderson worked with the vaccine to eradicate the disease in the 1960s and 1970s.

    "We have more trial lawyers," Henderson said. "We have a whole different attitude toward liability and vaccination."




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