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Smallpox Immunization:
A Dangerous Mistake

The Bush administration has initiated a national policy to immunize all willing Americans against the smallpox virus. This is a mistake. Smallpox was once a terrible killer which was eradicated from the earth in 1980 by the World Health Organization. However, two samples of the smallpox virus were spared (one at the Vector laboratory in Russia and one at the Centers for Disease Control in Atlanta, Georgia) and since that time the virus has been made into biological weapons. This is the rationale for the immunization of the entire country, although both the former Soviet Union and the United States are signatories of the Biological and Toxic Weapons Convention, which calls for the destruction of all stockpiles of biological weapons.

There are grave concerns regarding the immunization of the entire country. The smallpox vaccine is a living virus similar to, but distinct from, the smallpox virus. It is not safe for everyone, and serious side effects exist. These side effects can result in death and long-term disability. People with certain skin disorders, such as eczema, are at higher risk. People with chronic diseases such as cancer and HIV are particularly high risk, as are pregnant women.

Previously unknown fatal cardiac disease is being attributed to the limited first round of smallpox immunizations. According to the CDC, up to 25% of the US population should not receive the vaccine as they would suffer an alarmingly high rate of complications. Not only are the people who receive the vaccine at risk, but so too are others with whom vaccinees come into contact because the live virus from which the vaccine is derived is shed from the inoculation site for up to 3 weeks.

Data from the 1960s shows us that with a national smallpox vaccination program there is likely to be at least 300,000 serious and 15,000 life-threatening reactions to the vaccine. In fact the numbers today are liable to be higher because of more skin disorders and chronic disease in the population. In the last century, when smallpox existed in the wild, the risk of vaccination was acceptable in the face of potentially contracting the disease. To be sure, the horror of a biological weapons attack here in the United States is incomprehensible and reasonable steps should be taken to protect citizens. However, an all-out immunization of the entire country is not the way.

A better approach is to vaccinate a small group of key health care providers. This is a sufficient first step as the vaccine can be administered to the population after exposure to the disease and still be effective. The New Mexico Department of Health has adopted just such a rational policy

Many health care workers strongly disagree with the strategy adopted by the Bush Administration and are refusing to accept the vaccination. Many hospitals have declined to participate. In the case of an outbreak, those of us who staff the emergency departments of hospitals will ultimately be on the frontline of fighting this disease and administering medical aid to patients. However, in my emergency department, I am not aware of a single physician or nurse who has agreed to be vaccinated. We are just like you, we are concerned with the safety of our patients, family and friends. As health care workers, we understand that while the risk from smallpox is theoretical at best, the danger from this vaccine to our patients and loved ones is real and significant. If administered nationwide, people will suffer and die from a vaccine to protect us from a disease that hasn't existed for over two decades.

At this time, the real danger from smallpox is not the potential for death and injury from the disease. The real danger is the climate of fear that has been created. Since the tragic and criminal events of 9/11/2001, this country has been changed. We have been changed by our grief and by our sense of vulnerability. We look to our leaders for inspiration and hope, and instead we find every changing terror alerts and fear-mongering. What has made America great is our optimism and can-do attitude, but now we find ourselves afraid to travel and stocking up on duct tape and plastic sheeting. More than smallpox vaccinations, we need an inoculation against the virus of fear. I urge you to consider logically the risks of this vaccine to yourself and loved ones before you agree to be inoculated. Do not let irrational panic drive you to the wrong decision.

— Miles Nelson, M.D.

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Miles Nelson, MD, is an emergency room physician at St. Vincent Hospital, Santa Fe, New Mexico. He is also a co-founder of Citizen Action, which works on radioactive and chemical contamination from the area known as the mixed waste landfill located at Sandia National Laboratories.

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EDITORS NOTE: In the April 2003 issue of 'Emergency Medicine News,' it is noted that the American College of Emerency Physicians (ACEP), the American Academy of Emergency Medicine (AAEM), and the Society for Academic Emergency Medicine (SAEM) support a limited program of voluntary immunization of health care workers, as advocated by Dr. Nelson.