can repeat the question, but am I bright enough to ask it?"
The fear of smallpox as a weapon of mass destruction in the hands of terrorists is based either on the public information, which is speculative and anecdotal, or on military or secret intelligence sources which are unavailable.
During the past several months, I've been frustrated by the smallpox puzzle and the accompanying national agony about vaccination. Dozens of people have cornered me asking "what should I do about vaccinating my family" or, more pointedly: "are you or your family getting vaccinated?"
I was vaccinated against smallpox hundreds of times in the smallpox program in India, and again by CDC last year during the "smallpox bio terrorism" sessions for first responders. In this regard, it is appropriate that as President, you were recently vaccinated. My children, wife, mother, brother and neighbors have not been recently vaccinated and I do not recommend it, at least not yet. Based on the risks and benefits of what we know today, I do not recommend anyone rush out to get vaccinated unless they will be a "first responder" or work in a hospital emergency room.
Why? My decision is based on trying to solve many simultaneous equations. The smallpox dilemma has no simple answers, and making the correct decision may, literally, be a matter of life and death.
The facts today: Smallpox as a disease does not exist. It has been eradicated. A very small amount of the virus which causes smallpox, Variola, has been held frozen in liquid nitrogen in two "legal and secure" facilities in Atlanta and Moscow, as agreed to by the 150+ member states of the World Health Organization. It is easy to "awaken" the demon of smallpox if it is removed from these freezers. Except for a very controversial and potentially destabilizing removal last year of some viral material by U.S. Army scientist Peter Jahrling who used those viruses to infect monkeys with smallpox with the thought of testing smallpox anti viral agents and improved vaccines all the other legal viral samples remain in place. The fear of smallpox as a weapon of mass destruction in the hands of terrorists is based either on the public information, which is speculative and anecdotal, or on military or secret intelligence sources which are unavailable. Vaccination of 280 million Americans could cause potentially fatal vaccine side-effects in tens of thousands and death in 500 to 1000. In order to justify so many vaccine side-effects, there must be real evidence of incremental risk of an epidemic caused by vaccine preventable smallpox. There are at least three gating items, all of which must be true before it is logical to begin vaccinations against a disease which does not exist:
As is quite clear from credible journalistic sources, Gating Item #1 appears to have occurred-Russian scientists operating under a Gorbachev approved billion dollar 5-year plan manufactured as much as 100 tons of Variola virus annually at a then secret facility called, ironically, Vector, near Novosibirsk, Siberia in the Soviet Union during the 1980's. There may have been other programs that have remained secret, just as the CIA program "Bacchus" to build a miniature anthrax production lab stayed secret virtually until the anthrax attacks of 2001.
There is no public knowledge, and I stress "public" for obvious reasons, that Gating Item #2 is true. The major known sources of concern are:
As for Gating Item #3, no one knows. The well known Australian experiments altering a gene in mousepox suggests it would be easy for terrorists-or even college microbiology students who had access to pox to create a "superpox" impervious to today's vaccines. I won't go into the details but the bottom line is that if anyone had enough hatred and enough money, the creation of a vaccine-proof smallpox variant is well within the realm of the possible. Obviously, if the terrorists have vaccine-proof smallpox, it is silly to vaccinate anyone with a high risk vaccine that is impotent against genetically altered smallpox.
How great is the risk of adverse reactions? Again, no one can really quantify it because much has changed, for better and for worse, since the 1970's from which the last large datasets are available. At that time the death rate from vaccine was about 2 or 3 per million vaccinated, and the risk of serious side effects about ten times higher. There are factors today which might raise or lower the rate of complications. Thirty years ago far fewer Americans had immune systems compromised by chemo therapy or AIDs, and the prevalence rates of eczema, a serious contra indication to smallpox vaccine, were lower as well. On the other hand, recent data from Israel and from vaccination in the US military suggests that vaccinating young healthy pre-screened men and women carries very few risks of side effects and today's ICU medical care for vaccine complications is likely to markedly reduce fatalities. All in all, it is likely that ten to one hundred people per million vaccinated from the general public would have a very serious reaction or even death from the vaccine-somewhere between 3000 and 30,000.
And so, here we are, faced with the need to decide whether to vaccinate our families. We will each need to make personal decisions under conditions of uncertainty.
Here is why I chose not to vaccinate my family:
That is the conclusion that I have reached as of today. And unless or until that changes, I will not vaccinate my family and the ones that I love.