A medical battalion
It was a bold executive decision. Faced with a bioterrorist threat, the commander in chief issued an order that every soldier be inoculated against smallpox, despite serious concerns about the medical risks involved.
The year was 1777, and the commander of the forces--the Continental Army--was George Washington. Hearing of possible enemy plans to infect his troops with the dreaded virus, the future president had all recruits to his ragtag army "vaccinated" with infected material. This was an especially daring order in the Colonies, where the practice of inoculation was widely condemned, not only as dangerous but as ungodly. But his call proved right. Washington subsequently lost no soldiers in the great smallpox epidemic that swept the Colonies, and indeed some historians believe this decision determined the outcome of the War of Independence.
Who would have thought that another commander in chief named George would face a smallpox immunization dilemma--only now with a far safer virus, vaccinia, a weak cousin of smallpox. In mid-December, President Bush ordered that his troops be inoculated and then went a step further, calling on medical professionals to volunteer for precautionary vaccination to be ready to serve in the event of a smallpox crisis. It's a threat, he said, that is low but not zero.
Voluntary vaccination of healthcare workers began in late January, but not without controversy. Some in the medical community worry that the limited evidence of terrorist intent doesn't justify the risks. Hospitals raise legitimate concerns about adding to existing strains on already stressed medical professionals and facilities. And many, including members of Congress, believe that it is crucial to put in place a compensation program for those who experience serious vaccination side effects.
These issues must be addressed but should not obscure the very real possibility that an ongoing threat exists. Smallpox may have been eradicated from nature, but it appears to have survived in the test tubes of terrorist scientists, who nurture it as a poor man's atom bomb.
Smallpox is arguably the most dreaded disease of all time. We have not seen a case in the United States in 54 years, yet its grisly face is easily recalled. The virus brutally attacks the specialized tissues that cover the body and line its organs--the skin, the mouth, the cornea covering the eyes, the sensitive surfaces of the air passages. Fiercely contagious, it ravages the young and the infirm and leaves survivors scarred if not disabled.
This horror makes smallpox a choice agent of terror--as does the celebrated cessation of vaccination programs virtually everywhere on the globe. Without the lifelong resistance that comes from having had the disease, or the protection of vaccination, we are more vulnerable than ever in our history. One case of smallpox will cause a feverish panic everywhere. The public will turn first to their doctors--whom they expect to be calm and ready.
On the front lines. In that context, the administration's plan appropriately puts the medical community at the front lines in any smallpox outbreak. The appearance of smallpox anywhere will very likely precipitate a call for mass vaccination. Accomplishing this task in a matter of days will require hundreds of thousands of medical workers, already immunized and trained.
The medical volunteers who are offered vaccinations will be healthy adults. Even so, some serious complications are bound to occur. There is also the risk that the volunteers will accidentally transmit the virus to others at greater risk. Both will require hospitalization and a raft of vaccinated caregivers. Furthermore, only vaccination well ahead of imminent danger will solve the current critical shortage of lifesaving vaccinia immune globulin (VIG). VIG is extracted from human serum from vaccinated adults. Full of antibodies already targeted against pox virus, it is a staple in the treatment of smallpox or vaccine-related illness. Indeed, thousands of the newly vaccinated medical volunteers will be volunteering yet again to donate their own blood serum to build stores of this precious product.
Controversies aside, there is an enormous amount of work to be done to make America safe in this new war on terrorism. When it comes to biological weapons pointed at civilians, we simply cannot succeed without a civilian medical battalion trained, protected, and ready. They will write the next chapter in the history of smallpox.
This story appears in the February 10, 2003 print edition of U.S. News & World Report.
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