To Vaccinate or Not To Vaccinate?
by Ken Rude

Okay, it's made from cow pus. And it's full of live viruses.

Does that mean you should stay away from the smallpox vaccine?

There are valid concerns about side effects. About one thousand out of every million vaccinated will develop side effects, and about fifteen to fifty out of a million will be severe enough to be hospitalized. And one or two out of that million will likely die.

To put it another way, 999,000 out of a million will handle the vaccine just fine. And at least 999,998 will survive. There, I think you've had enough stress in your life already.

Like everybody else, I thought smallpox had been eliminated. For millennia one of the greatest scourges of humankind, the disease killed 200 million worldwide in the twentieth century alone. A worldwide eradication program, one of the greatest public-health successes in medical history, wiped the virus completely out of the natural world. The last case in nature was in Somalia in 1977, and the last case anywhere was accidentally contracted in a lab in 1980. Since then, the virus has officially existed in only two places, one at the US Center for Disease Control in Atlanta, and the other at Moscow's Institute for Viral Preparations.

But the secrets governments harbor are sometimes very different from the stories they tell in public. Consider the former Soviet Union, and the story told by Kanatjen Alibekov, former deputy director of the Soviet bio-weapons program. Alibekov defected to the United States in 1992 and changed his name to Ken Alibek, the name under which he now directs the George Mason University Center for Biodefense. In the bad old days he oversaw a massive bio-weapons program which produced, among other goodies, twenty tons of smallpox virus from the small amounts officially under Soviet protection.

Russia has since claimed to have destroyed the Soviets' weaponized smallpox, but one can never be sure that nothing survived. The shadow world inhabited by rogue governments, terrorist organizations and criminal outfits contains a thriving black market for weapons of almost every imaginable variety. Here, there's common ground between the operatives with enough money to buy anything, and out-of-work scientists with little to sell other than vials of Soviet germs. Who knows what found its way out of official hands?

Or consider everyone's favorite twenty-first-century bogeyman, Saddam Hussein. 1972 marked the beginning of Iraq's bio-weapons program. It was also the year of Iraq's last naturally occurring smallpox outbreak, when 800 Iraqis came down with the deadly illness. Saddam was, at the time, Iraq's vice-president and its de facto ruler. Did Saddam collect smallpox for his weapons program? Iraq says no, as one would expect, but there are unsettling hints at what the truth might actually be. Blood drawn from Iraqi soldiers captured in 1991 during the first Gulf War showed that some had recently been inoculated against smallpox. And weapons inspectors in 1994 found a freeze dryer labeled smallpox. Iraq claimed this freeze dryer, a component in the weaponization of germs, was actually used in the preparation of smallpox vaccine.

As of this writing, none of Saddam's biological or chemical weapons have been found. What happened? He had a very active program at one time, and a great many of these weapons were discovered and destroyed by the first round of United Nations weapons inspectors. There are only three possible explanations for where the rest went:

1) All were destroyed, either by UN weapons inspectors or, later, by the Iraqis themselves;

2) They are hidden somewhere--who knows where?--in Iraq, and currently nobody has access to them because those who knew of their existence have fled or been killed;

3) They are in somebody's hands, inside or outside of Iraq. Is Saddam still alive somewhere and still in control of his worst weapons? Or did Saddam disperse them to foreign agents such as Al Qaeda?

The third possibility gives one pause.

When you've been infected by smallpox, you don't know it for the first seven to seventeen days. It's incubating and, thank God, you're not contagious. Problems start when you begin developing body aches, headaches and a high fever. You might already be contagious--and these are pretty general symptoms. (Remember, only a small number of doctors on Earth have actually seen a case of smallpox.) Two to four days later, this early phase is followed by a rash, which first emerges as small red spots on the tongue and mouth. The sores break open, spilling loads of fresh virus onto your breath. You have just entered smallpox's most contagious phase.

Within a day, your body has become covered with a rash, and you may actually start to feel better. But by the third day, the rash has become raised bumps. You are still highly contagious, and now your fever rises and remains high.

The early rash phase lasts about four days, and then the bumps become pustules--small, hard spots that some people liken to BB's under the skin. You're still contagious. After five more days, the pustules begin to crust over and form scabs.

By about two weeks after the rash has appeared, most of the sores have scabbed over. But don't go throwing your house open to visitors just yet, unless you plan on spending the next couple of months attending your loved ones' funerals.

Once the sores have crusted over, the scabs start falling off, leaving pitted scars in their places. After a week of dropping scabs, they will all have fallen off. Congratulations are in order, because A) you're no longer contagious; B) you didn't sicken and kill anyone (we hope); and most importantly C) you survived!While you're figuring out what to do with your permanently scarred mug, let's once again go to the numbers:The smallpox vaccine will kill one or two out of a million.

Out of a million who get smallpox, 333,333 die. The rest spread the epidemic everywhere.

In my mind right now, I'm doing back flips into a pool of cow pus.

What's in cow pus is vaccinia, a viral cousin of variola major, the smallpox virus. When you get vaccinia into your system, you are quite literally vaccinated, a word derived from the bug's name. Most of us don't get sick from vaccinia, but our bodies mount an immune response anyhow. So when we sometime later encounter smallpox, our immune system mistakes it for that nasty old vaccinia again, and destroys it. Probably the first to notice this were 18th-century English milkmaids, who told Dr. Edward Jenner that, because they worked around sick cows, they were protected against smallpox. Jenner theorized there was something in a bovine condition called cowpox that gave the milkmaids immunity. (He was right--vaccinia, from vaca, the Latin word for cow.) And he did something you could not do nowadays: he took cowpox pus and injected it into little James Phipps, and later injected the little boy with smallpox. And, o blessed miracle, the child never came down with the pox.

The same basic technology, with some refinements, protects us to this day. So let's all get cowpoxes, okay? Well, like a lot of things, there s a complication. The vaccine-induced immunity lasts only so long--experience suggests it will protect you for only three to five years. Remember that smallpox vaccine they gave you in the 60s while you cowered under your desk during the Cuban Missile Crisis? (Okay, it's all one big blur. . . .) Well, it's worn off . . . So if we use up all our US of A vaccine protecting you and 279,999,999 of your best friends, then guess what? Come 2008 or so, some crackpot with a needleful of death has another shot at mass destruction. Especially if we don't re-stockpile vaccine--which is at least a possibility once the lawsuits start flying for the 300 of us who die in the first go-round.

So, to make a long story short, the vaccine is not available to the general public.

I think that's a wise decision. Vaccine use only at the first sign of smallpox outbreak is the best way of ensuring it will be available for front-line protection without its use becoming hopelessly bogged down in politics and litigation. Even more to the point, the contagious potential of smallpox in twenty-first-century America might possibly be quite exaggerated. And here I must tip my hat to America's marvelous public health system. One of the system's foremost strengths is the ability to organize quickly and act decisively in the event of a crisis. We have a great abundance of highly trained medical and technical personnel in this country, with the skills to identify and isolate those potentially exposed to a disease like smallpox. The ability of America to protect itself from SARS, a disease with no treatment and no vaccine, should give a smallpox terrorist pause.

And the specter of seemingly healthy smallpox carriers running around our airports spreading disease to thousands is likely highly exaggerated. First of all, you are usually not contagious until you're already so sick you're bedridden. Second, if you're intent on getting smallpox from somebody, you'd best be planning on spending some face time with them. You're not likely to get it from that guy on the stretcher over there in the other line at Burger King. And third, even if you accidentally took a bite out of that smallpox twinkie George Bush was saving for Fidel Castro, you don't have to panic. The vaccine will still protect you even if you don't get it till three or more days after you were exposed.

And finally, Osama bin Laden knows that smallpox is Pandora's box. If he ever did unleash a smallpox pandemic upon America, he knows he would be powerless to prevent a twisted American from parachuting the infection into Mecca and annihilating a defenseless population.

You don't want smallpox over here? Well, Osama doesn't want it over there, either.

Ken Rude, PT, practices at Pine Plains Physical Therapy in Pine Plains.