Boston, MA — Many Americans fear if terrorists strike again it will be with biological weapons. Smallpox poses the deadliest threat because it is easily spread from person to person, there is no treatment, and fatality rates range from 20 to 30 percent. Dr. William Bicknell, professor of international health at Boston University’s School of Public Health, urges wide public debate of an alternative to the current Centers for Disease Control plan for selective vaccination and quarantine after a terrorist attack. He emphasizes prevention and proposes voluntary, pre-exposure vaccination.
The New England Journal of Medicine will release Dr. Bicknell’s article and several others related to smallpox on Thursday, March 28 at 5 p.m. on its website. NEJM timed the early release to coincide with a related announcement from the Office of the Secretary of Health and Human Services. Bicknell’s “The Case for Voluntary Smallpox Vaccination” will appear as a “Sounding Board” piece on the editorial page of the NEJM on April 25.
“By immunizing the US population, smallpox’s value as a terrorist’s weapon will be dramatically reduced,” says Bicknell, a former commissioner of the Massachusetts Department of Public Health. “In case of attack, victims and un-immunized people will be far fewer and easier to manage. And, to the extent the risk of attack is decreased and containment is enhanced, the risk of secondary spread to un-immunized persons in other parts of the world is decreased.”
The federal government has ordered sufficient vaccine to immunize the entire US population but Bicknell disagrees with CDC’s proposal for administering the vaccine. CDC recommends a post-exposure “ring vaccination” strategy that entails rapid identification and quarantine of cases, with immunization of their contacts and contacts’ contacts.
“That works for small, localized outbreaks, where widespread immunity exists,” says Bicknell. “Controlling the epidemic after multiple simultaneous exposures in a non-immune and highly mobile population like we have in this country is a vastly different challenge. Also, malicious intent introduces multiple factors whose effect is unforeseeable.”
Bicknell also questions CDC’s assumption that individuals infected with smallpox are so visibly sick that they could be recognized, diagnosed and quarantined within the four-day post-exposure period during which vaccination may be partially effective.
Finally, the logistical complexity of administering millions of vaccinations in a crisis is daunting. “Official reassurances followed by an uncontrolled outbreak could provoke panic, flouting of authority, and breakdown of medical, public-health and law-enforcement services,” says Bicknell.
More than 119 million US residents born since 1972, when mass vaccination stopped, lack immunity. The immunity of those born earlier is waning and uncertain, says Bicknell. According to an International Communications Research study, 61 percent of Americans said they would get smallpox vaccine if it were available.
Bicknell concludes his article by emphasizing that pre-exposure vaccination decreases the risk of attack, the consequences of attack, the risks to the immuno-compromised and the risk to the rest of the world.
Founded in 1976, BU’s School of Public Health is committed to offering graduate education that meets the changing needs of working professionals and shaping a healthier and safer world through applied public health research.