Recently the media has devoted extensive address regarding small pox vaccinations for our military, our healthcare providers, and finally the general population.  One of the great triumphs of the healthcare community has been the eradication of small pox as a naturally occurring disease.  As the number of small pox cases in the world was decreasing, it was recommended in 1971 that mandatory vaccination against small pox be stopped in the United States.  This was done because there had been no naturally occurring cases since 1947 and there were rare but definite side effects including potential mortality that came from small pox vaccination. Since there had been no naturally occurring cases of small pox in the United States for twenty two years, the risk of vaccination was no longer felt warranted and the practice was stopped.

We are now faced with the sad and grotesque prospect of man’s inhumanity to man being manifest as a terrorist initiation of a small pox epidemic.  It is ironic how smug human’s are in our belief that we have an intellect superior to other animals on this earth.  Whatever intellect we have is tarnished by the brutality that we spend on each other.  Deer or horses or dogs and other animals fight each other over food or mates or territory, as do humans.  But acts of terrorism randomly harming or killing uninvolved members of the species are unique to humans.  The reintroduction of small pox into our society can only be done through such a terrorist act.  Thus our need to protect ourselves through a reintroduction of the small pox vaccination to the population of the United States.

The need for vaccination of our population because of a possible small pox exposure is perhaps best exemplified by what happened to the Mandan Sioux Tribe in North Dakota in 1837.  In that year, a riverboat came up the Missouri River to trade with the Mandan Sioux.  Unfortunately, small pox was carried on that boat and blankets contaminated with the virus were traded to the Indians.  It was estimated that there were 1537 members of the Mandan tribe at that time.  Two years later, there were 31 of them left due to the epidemic of small pox that occurred.

Other examples include the estimate that 3 ½ million Aztecs were killed by small pox in the 1500’s when Cortez landed in Mexico.  That same river boat that decimated the  Mandan Sioux was responsible for a 90% decimation of the black foot Indians in the 1830’s.  Even the population that had  previously been exposed to small pox suffered a 15% mortality when an epidemic struck Boston, Massachusetts in the 1700’s.  The point being that small pox is an incredibly contagious condition in an unexposed and unimmunized population.  There now being 31 years without vaccinations in the United States our young population could be decimated if an epidemic were to get started.

As an additional note, our country was recently quite substantially disrupted when anthrax was sent through the mail and there were a dozen mortalities that occurred.  Anthrax is endemic (meaning it is everywhere) in our soil and yet cases are very rare because this is not a contagious disease.  Imagine the havoc that could come if a disease were to get started as contagious as small pox.

The question of the danger of small pox vaccination is related to those few individuals who are not immunologically able to deal with the vaccine.  The vaccine is actually a live form of small pox called variola minor.  Most people simply get the pox scab at the site where the immunization is done and the infection does not spread.  However, if a person happens to be immunologically compromised, a full systemic infection can occur.  Thus, if someone had an undetected leukemia or other weakening type of illness, such as AIDs, major illness could come from the small pox vaccination.  The vaccination is not without risk to the individual but the risk to the entire population of not vaccinating could be devastating.  The laws of the United States protect the rights of the individual and this vaccination will not be made mandatory but our government needs to consider the preservation and benefit of the entire population.   Therefore small pox vaccination will be recommended for all those willing to participate.

Previous recommendations were that an individual be vaccinated preschool, again in high school, and one more time in adult life.   Thus the entire population of the United States except those under the age one or with an identified immunocompromised state would be recommended to have a vaccination.

As we enter the year 2003, it is sad that small pox vaccination becomes one of our considerations.  Our ancestors who struggled to survive cold and hunger were undoubtedly exposed to a greater trial than our facing small pox vaccination.  But there is something just bizarre in human beings creating their own crisis in these times.  One wonders if humans will ever really be civilized.

In the coming year, lets hope the small pox vaccinations won’t be needed and that somehow we can all learn to live together and help each other.  We of the healthcare community remain ready to help as we can to both treat but more importantly prevent illness and discomfort.  We hope that we can continue to be a help in this new year.  Happy New Year to All!