Altman, Lawrence K. "Smallpox Vaccine Knowledge Found Lacking," New York Times, 10
May 2002, p. A32.
ATLANTA, May 9 - Doctors and the public poorly understand the dangers of the smallpox
vaccine and need to be better informed if vaccinations are to be reintroduced after an absence of
30 years, federal health officials and infectious disease experts said here today.
Focus groups conducted for a panel of scientists advising the government uncovered a catalog of
misinformation about the smallpox vaccine - the first vaccine to bve developed (in 1796) and
considered to be the most dangerous. Unlike most other immunizations, smallpox vaccine can
harm recipients and their contacts. Resumption of vaccination on a large scale would probably
lead to thousands of serious complications and hundreds of deaths, as it did when millions of
Americans were routinely vaccinated.
Today, the focus groups found, some doctors mistakenly believe that the disease still occurs
naturally. Many doctors, particularly those under 40, know little about the vaccine's
complications or how to 7se two-pronged needles to administer it. The doctors also expressed
concerns about liability if they were to give the vaccine.
Many nonphysicians said they assumed that the vaccine was safe, provided lifelong protection
and was still given to children. (Before 1972, many Americans were periodically revaccinated.)
Many participants said they believed that exposure to the smallpox virus was always fatal; in
fact, the death rate is about 30 percent.
Dr. Glen Nowak, from the Centers for Disease Control and Prevention, reported the findings to
the panel, known as the Advisory Committee of Immunization Practices and the National
Vaccine Advisory Committee. The government asked it to determine by June 20 whether to
continue the policy of prohibiting vaccinations unless the disease returns in a bioterrorism attack
or to allow smallpox vaccine to be offered to everyone who wants it.
"The current knowledge levels of physicians and the public likely limit understanding" of
strategies intended for determining small pox vaccine use before or after a bioterrorist attack, Dr.
The disease control centers and the committee plan to hold forums around the country over the
next few weeks to discuss the risks and benefits of reintroducing smallpox vaccination.
Current guidelines, published in June 2001, do not recommend smallpo0x vaccine for the public.
Vaccination is limited chiefly to laboratory workers directly involved with smallpox virum or its
close virological cousins. The limits were based largely on the lack of enough vaccine. Tests
have shown that the 15 million doses can be diluted to 75 million. The drug company Aventis
Pasteur has donated about 80 million doses that have been frozen since 1958 and that the
government says would be used only in an emergency. The government is also buying 220
million doses made by a new laboratory technique. Delivery is expected by year's end.
Dr. D. A. Henderson, who led the worldwide smallpox eradication program in the 1970s and is
now an adviser to Tommy G. Thompson, secretary of health and hyuman services, told the panel
that there was no information to suggest that a smallpox attack was likely.
Yer, Dr. Henderson said, "there is a tremendous deman for smallpox vaccine from every
quarter," including parents and health-care and other workers who would be the first to respond
in an attack.
If an outbreak occurs, the disease control agency says it will respond with the technique known
as ring vaccination, which was used to eradicate the disease.
In the event of an attack, the agency current policy - based on the advisory committee's
recommendations last June - is to give priority for vaccination to individuals who had face-to-
face contact with smallpox patients in a household, workplace or during transportation to a
hospital; contacts of cases; or exposure to a deliberate release of the virus.
Dr. Henderson and other speakers at the meeting cited myriad problems if sxmallpox vaccine
were to be offered to all Americans who want it.
A crucial problem is that the Food and Drug Administration has approved none of the smallpox
vaccines for marketing and classifies all of them as investigational. The classification requires
that each individual give consent before receiving the vaccine. Even the new generation of
vaccine will require informed consent until at least late 2003m, said Dr. Phil Russell, a health
and human services official.
The standard smallpox vaccine can cause a variety of severe, even fatal, reactions. People with
AIDS and other diseases that damage the immune system are one particularly vulnerable group.
Millions of individual with skin disorders like eczema, atopic dermatitis and acne are at risk for
potentially fatal complications. The panel was told that serious reactions can occur in someone
who had eczema years ago, a problem complicated by the fact that many adults may not know
they had it as a child.
A recipient of smallpox vaccine may infect another person through transfer of the virus by hand
or bathing, and the infection can be far more severe in such contacts than in the vaccine recipient.
Other complications include impaired vision from infection of an eye, heart or bone; anemia; and
The blood supply could shrink if smallpox vaccinations became widely used because donors are
rejected for one year after a vaccination.