Don't wait to defend against worst attack

October 01, 2002|By Steve Chapman

CHICAGO -- Smallpox is the all-time champion of mass slaughter. It has killed more people than any contagious disease in human history, including up to 500 million in the 20th century.

Eradicating it in the late 1970s was one of the greatest medical achievements. But in this case, extinct may not be forever. What the last century extinguished, the new one could resurrect.

One of the more interesting things we will learn from a war with Iraq is whether Saddam Hussein has secret stockpiles of the virus and whether he will use them against the American people. The Soviet Union had a program to produce smallpox microbes as a weapon of war, and no one knows what happened to that arsenal.

When the United States attacked Iraq in 1991, Mr. Hussein had biological and chemical weapons ready for use, but he stayed his hand rather than risk being vaporized. This time, though, the Bush administration has made it clear that his regime will not survive, and that he may not, either. If Mr. Hussein is going down, he may try to take as many Americans with him as possible.

He could hardly find a better instrument than smallpox. Thirty years ago, a smallpox attack would have been futile, because nearly everyone was inoculated against the disease. But mass vaccinations are a thing of the past. Many Americans have never had them, and the rest have most likely lost their immunity.

The effects of an epidemic would make Sept. 11 look like a mild inconvenience. Smallpox can't be cured, and it typically kills close to one-third of those it infects.

With war imminent and the anthrax scare still fresh in our minds, the federal Centers for Disease Control and Prevention last week released a plan to counter the smallpox threat. It consists of two parts: Doing nothing, and then praying.

I'm exaggerating. But what is striking about the government plan is that it prescribes a mass inoculation of Americans only after the first infections emerge. At that point, with panic sweeping the country, the plan calls for millions of people to get the vaccination in a very short period of time -- the equivalent of trying to build a dike in the middle of a flood.

Dr. Mohammed Akhter, executive director of the American Public Health Association, told The New York Times, "This is a huge and massive undertaking, the likes of which we've never seen in our history. There's no way the state and local health departments would be able to implement the plan."

The vaccination can work even after a victim has been infected, if it's administered within four days of exposure. That's a poor excuse for waiting until the catastrophe begins. The normal, prudent practice is to immunize people before the disease appears. But so far, the government has shied away from letting people decide for themselves if they'd like to obtain protection from this ghastly disease now rather than take their chances later.

Why? Because the vaccine can have serious side effects. Experts say that if all Americans were inoculated, between 180 and 400 people would die and others would suffer brain damage.

But that is a risk we as a nation accepted in the days of routine smallpox vaccinations. And a one-in-a-million risk of death is one a lot of people would happily take rather than run the risk of having no immunity when a biological attack occurs. A poll by the Harvard School of Public Health found that 59 percent of Americans would get the vaccine now if they could.

The tough issue presented by smallpox is that people with impaired immunity, such as those who have HIV or those undergoing cancer treatment, may contract the disease merely from contact with someone who has been recently inoculated. But these are the same people who would be most vulnerable if an epidemic were to break out.

Mass inoculations now would confer some valuable protection on these people, and everyone who isn't inoculated, by greatly blunting the impact of any outbreak. Equally important, immunizing a lot of Americans now would discourage Mr. Hussein from resorting to bioterror by letting him know it may be for nothing.

We have the means to protect ourselves against the worst that Mr. Hussein can inflict. Instead, we're naked to our enemies, and our government is deliberately leaving us exposed.

Steve Chapman is a columnist for the Chicago Tribune, a Tribune Publishing newspaper. His column appears Tuesdays in The Sun.

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