Why Has the Smallpox Program Stalled Out?

Three critical errors in thinking

Analysts cite three "mutually reinforcing errors" that have dogged and delayed the government’s national smallpox immunization campaign:

1. Not distinguishing between the risk of vaccination in healthy, well-screened adults and the risk to children and high-risk adults.

2. Not adequately recognizing the difference between naturally occurring disease and disease introduced by bioterrorism. For example, no one has epidemic-control experience with smallpox in a nominee, highly mobile population where exposure will be malicious rather than benign. The relevance of lessons from the eradication experience (characterized by very different circumstances) is limited.

3. Not sufficiently appreciating that the decision to undertake pre-exposure vaccination is far more than a medical decision about the risks of vaccination. Of equal or greater importance, it involves social, economic, and national security considerations.1


1. Bicknell WJ, Bloem KD. Smallpox and Bioterrorism: Why the Plan to Protect the Nation Is Stalled and What to Do. Paper No. 85. Washington, DC: Cato Institute; Sept. 5, 2003.