Jewish World Review Nov. 17, 2003 /22 Mar-Cheshvan 5764
Smallpox Is Bush's Worst Failure
But He Can Fix the Problem
In the spring, a few days before America launched its war
on Iraq, a small caravan of civilian cars drove quietly
out of Iraq and across the Syrian border. The travelers
included two of Iraq's senior biological-warfare scientists
and several members of Saddam Hussein's secret service.
The security men waited inconspicuously in Damascus before
returning to Baghdad. The scientists disappeared for good.
Before doing so, however, they met with several members
of Hezbollah and gave them a number of small vials. Hezbollah,
in turn, conveyed the vials out of Syria. In due course,
a number of them reached a refrigerator in a small commercial
lab in Tangiers. The lab belonged to Al Qaeda. The vials
I made up everything you just read. We have no evidence
that Saddam possessed smallpox, and no reason to think that
Al Qaeda does or will possess it. Yet there is nothing unrealistic
about the scenario I sketched. It could happen. What is
the United States doing about it? Not enough.
"Not enough" doesn't mean nothing. Von Roebuck, a spokesman
for the Centers for Disease Control in Atlanta, said in
an interview that all 50 states, plus the District of Columbia
and several major cities, now have in place reaction plans
in case of a smallpox outbreak. By mail and satellite link,
the government has educated clinicians on how to recognize
and combat smallpox, which few of them have ever seen in
a patient (the disease was eradicated in the wild in the
1970s). The Bush administration is preparing a set of indicators
by which to assess the country's preparedness.
What has not happened, however, is this: the widespread
vaccination of the health and emergency workers who would
be called upon to cope with a smallpox crisis "first
responders," as they are called. The administration had
hoped to immunize as many as 500,000 of them by now. As
David McGlinchey reported in this magazine last week, "Volunteers
have stayed away in droves, and fewer than 40,000 medical
workers have been vaccinated." New vaccinations have slowed
to a trickle. "The whole thing just lost steam and everybody
stopped paying attention, including the administration,"
says Tara O'Toole, the director of the Center for Biosecurity
at the University of Pittsburgh Medical Center.
McGlinchey's article ably details what went wrong: exaggerated
fears of the vaccine's side effects; confusing signals from
the administration; underfunding; failure to address liability
concerns; lack of compensation for health workers made ill
by the vaccine or, as a safety precaution, sidelined for
up to two weeks after inoculation; above all, the failure
from President Bush on down to explain clearly why these
vaccinations are important.
Instead, the administration has seemed to switch to defensive
mode, downplaying the importance of vaccinations and emphasizing
other measures. The CDC's Roebuck stressed that 500,000
was never a formal goal and that many measures, not just
immunization, contribute to smallpox readiness. "We still
have a lot of work to do on the preparedness side we
freely admit that," he said. "We need to continue to vaccinate
more folks." Someone had better tell that to the Homeland
Security Department, where they're saying, as a spokesman
told McGlinchey, "We feel that we have enough inoculated
individuals should an outbreak occur."
Meanwhile, a number of public health types are telling the
country to relax about smallpox vaccination. The odds of
an attack are very low, they say, and advance immunization
isn't necessarily indispensable, and smallpox is only one
of many bugs and poisons out there anyway.
Are calls to shelve or down-gear the vaccination effort
justified? On a certain set of premises, yes. Unfortunately,
those premises are wrong. Here are the facts:
- Smallpox is not just another disease_. It is highly communicable,
especially to people tending the ill. It is believed to
have been weaponized in large quantities by the Soviet Union.
It is about 30 percent fatal and severely disfigures many
survivors. It is readily preventable by means of a safe,
effective, and available vaccine. After it strikes, however,
doctors can do little to help (there is no specific treatment).
If you can come up with any other bioweapon that touches
all those bases, you get a free box of cigars.
- Smallpox is not a small threat_. It is an indeterminate
threat. Which is not at all the same thing.
Where are the tons of smallpox material that the Soviets
are thought to have made? We don't know. Maybe all of that
stuff vanished from the face of the Earth. Maybe it is all
under vigilant guard at an incorruptible, supersecret Russian
facility, where not an ounce of it could escape. Want to
bet your life on it?
No smallpox has been found in Iraq, and as far as we know,
Saddam didn't have any. But if he did once possess smallpox,
its absence now is not necessarily a good thing. Where might
it be? Safely locked up in responsible hands? Bet your life?
Although we have no idea how large or small the risk of
a smallpox attack is, this gives no grounds for complacency,
because we are 100 percent sure about something else: America
is highly vulnerable to an attack should one occur. A smallpox
attack is second only to a nuclear attack on the list of
America's strategic vulnerabilities and for smallpox
we have a vaccine. Put it this way: If someone developed
a way to inoculate Americans against a nuclear blast, would
any responsible person hesitate to mount a major pre-emptive
immunization program on the grounds that no terrorist is
actually known to have a nuclear bomb right now?
Although the vaccine itself is risky, the risk is minuscule.
A few cardiac deaths following recent inoculations seem
to have been unrelated to the vaccine. So far, says Michael
T. Osterholm, the director of the University of Minnesota's
Center for Infectious Disease Research and Policy, the vaccine
has proved as safe as expected, if not safer. "No deaths
none in this country were associated with smallpox
vaccination," he said in an interview, "and that was including
500,000 military vaccinations."
- Immunization is critical_, above all for first responders.
This year's SARS epidemic proved how fast and far infections
can travel in today's world. "When one or two cases of smallpox
are documented in one city somewhere," Osterholm says, "there
will be thousands of Americans rushing to emergency rooms
with rash illnesses thinking they have smallpox." There
will be fear, uncertainty (confirming smallpox takes time),
and 24/7 news coverage. "We'd better have health care workers
who feel confident being on the front line, to see those
patients," says Osterholm. Otherwise, "we'll have many health
care workers who will not have been vaccinated who will
say, 'Look, I'm not going to care for these patients
I just can't care for them.' Every emergency room will be
overwhelmed. It'll be like we saw with SARS, with health
care workers literally walking off the job out of fear.
If anyone thinks we're going to be able to vaccinate all
those health care workers in two days while they're also
investigating the outbreak it's not going to happen."
Toronto is a large city with a modern and sophisticated
health infrastructure, yet SARS, which killed or sickened
a few health workers while frightening others, "paralyzed
a major segment of Ontario's health care system for weeks,"
according to a recent Canadian report. Compared with smallpox,
SARS is a head cold.
- Too few health workers have been vaccinated._ "There's
no 'probably,' " says Osterholm. "It's too small now. It
is inadequate." O'Toole concurs. Smallpox preparedness,
she says, has advanced by "some small increment" since September
11, "but essentially our readiness is not improved since
2001." Among experts, the consensus seems to be that vaccinating
the whole country after a smallpox attack, from the current
state of readiness, would take not days but weeks or even
Jump-starting the vaccination program may now be difficult.
Among health workers, O'Toole and Osterholm say, cynicism
and complacency have set in. Looking at the program's poor
execution, many people have concluded that the government
wasn't serious about vaccinating. Administration statements
pooh-poohing the program's stall can only confirm that impression.
Only one man in America could turn the situation around,
and his name is George W. Bush. In Iraq and elsewhere, he
has shown what a bulldog he can be when a national security
problem engages his full attention. On smallpox, however,
he has dropped the ball.
Imagine, President Bush, how you would look to history if,
a year after you left office, America were devastated by
a smallpox attack one for which you left the country
underprepared, despite ample knowledge of the nation's vulnerability.
Does that get your attention?
JWR contributor Jonathan Rauch is a senior writer and columnist for National Journal. Comment by clicking here.
11/03/03: Bush Is No Cowboy. But If He Were, It Wouldn't Matter
10/24/03: Who Can Win in 2004?: Just use This freshness test
10/17/03: America Has A Brilliant Strategy For Iraq: Muddle Through
06/10/03: Corporate lying is bad. But allowing it is good
05/29/03: After Iraq, the Left has a new agenda: Contain America First
05/13/03: Bush Didn't Squander The World's Sympathy. He Spent It.
04/29/03: With his tax cuts, Bush pre-empts the future
04/14/03: How to secure the homeland without leaving the house
04/02/03: It's time to break up the college color cartel
03/18/03: Yes, Bush Has A North Korea Policy. It Might Even Work
03/04/03: Can a young Dem save his party from itself?
02/20/03: America can beat Iraq. But can it vanquish France?
02/04/03: Stop whining, America, and get serious about Smallpox
01/23/03: Has Bush bitten off too much?
01/08/03: With a hum instead of a roar, the fuel-cell is here
12/12/02: Forcing Americans to put their money where their mouths are
09/30/02: Once again, a President Bush saves the U.N. from its friends
05/08/02: The world on a screen
03/12/02: To make peace, should Israel first take back land?
02/22/02: A NYTimes columnist defends his paper's principles
02/14/02: Bush's gas tax
01/31/02: Don't Fear Bin Ladenism's Strength. Fear Its Weakness
01/17/02: Next Stop In The War Against Terrorism: Damascus
01/03/02: Countering the smallpox threat
12/06/01: Discovered! The Mullahs' minutes, or: How to end Western society
11/05/01: Why Bush (Senior) Didn't Blow It in the Gulf War
10/01/01: Charter Schools: A New Hope For America's Latinos
09/20/01: What leaders said about the attack--and what they meant
08/22/01: They Secretly Cloned Mozart!
© 2002, The Atlantic Monthly, from where this is reprinted