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Facing the Smallpox Threat

July 11, 2002

Remember the "Cipro panic" that spread across the United States in October after a Florida photo editor died of inhalation anthrax? Americans not only bought all of the antibiotic ciprofloxacin on U.S. shelves, many crossed the Mexican and Canadian borders and emptied pharmacy shelves there too.

A trace of such anxiety reemerged Wednesday when an academic journal published a study questioning a Bush administration interim policy, under which smallpox vaccinations would be made available to health workers and others likely to be in close contact with infected people before the general population.

The authors, principally Edward H. Kaplan of the Yale School of Management, raised doubts about this so-called ring vaccination strategy. In today's densely populated, mobile society, the authors contended, ring vaccinations could allow a larger outbreak that would take longer to control and spawn more panic than a mass vaccination.

But despite the study's assertions, there is much to be said for the administration's approach to managing a smallpox epidemic. This month, Health and Human Services Secretary Tommy G. Thompson plans to give a speech outlining the administration's strategy. There are three facts he should highlight to reassure the public and answer the criticism.

First, there is no shortage of the vaccine. The government has 100 million doses in its stockpiles and expects to have a dose for every U.S. resident by early next year. Second, there is broad support in the public health sector for the ring strategy. Finally, Kaplan's study was based on mathematical models, not tested real-world observations.

Thompson still has much more to do to protect the nation against smallpox, which is probably a much greater threat than anthrax. There is abundant evidence that at least three nations--the former Soviet Union, Iraq and North Korea--created and possibly sold potent strains of smallpox for use as weapons.

Thompson should give states--which must devise their own smallpox management plans by October--guidance in weighing the benefits of mass vaccinations against risks including recently vaccinated people transmitting the disease and the vaccine itself seriously harming some people with weak immune systems.

To its credit, the administration has not dismissed the real threat that smallpox poses. But with public health systems in tatters in many cities and counties, including Los Angeles, stockpiling vaccine is only a start.

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