!! spellx done
195  `Eradication' of Smallpox Shouldn't End Containment
     The Washington Post  February 22, 1970

     The eradication of smallpox is one of the major programs of the
World Health Organization and may become one of the conspicuous 
successes of international cooperation for human welfare.

     The virus is spread by direct contact from infected to susceptible
people, is often lethal, and, once established, the infection responds
poorly if at all to any existing medical procedures.  The main 
weapons against smallpox have been quarantine of exposed people and
immunization of healthy ones to contain the virus and deny it the 
fertile ground it needs for continued spread.

     The WHO programs are shrinking the territory still occupied by
smallpox as an endemic disease, the main foci still left being in 
South Asia, Indonesia, Central Africa and patches of Brazil.

     This "Eradication" however, cannot be accepted at face value;
that is, statistics about the decline of smallpox as a reported 
disease cannot be interpreted as the disappearance of the smallpox virus
from the planet.

     The danger is that "eradication" will be followed by complacency
and relaxation of the very measures that contain the virus. If a large
population of sensitive, unvaccinated adults builds up, the consequences
of a new epidemic would be most serious, for the disease tends to
be most severe in young adults as compared to its occurrence in children
who are exposed earlier in life in endemic regions.

     Demands for just such a relaxation have already been voiced.
Writing in the New England Journal of Medicine, Drs. J. M. Lane and J.
D. Millar of the National  Communicable Disease Center take issue with
the present recommended practice of routinely vaccination 1-year-olds.
Pediatricians prefer to vaccinate children of this age not because
they are at high risk of exposure to smallpox but because they are
then least vulnerable to rare side-effects.

     Significant complications occur in about 0.01 per cent of 
vaccinations.  In 1968, nine deaths were recorded as a consequence of 
some 14 million vaccinations; none of these were primary vaccinations of
1 year-olds.  Assuming some corrections in the figures, Drs. Lane and
Millar calculate a basic risk of about one death per million 
vaccinations, or a total of about 210 in the United States between 1970
and 2000.

     They also point out that no smallpox has been imported into the
United States since 1949. The progressive eradication of smallpox the
world over would further lessen the chances of new introductions.  And
it would be unlikely that as many as 210 cases of smallpox would ensue
even if a traveler did bring the virus back.  But that would be a 
consequence of the very programs now being criticized.

     Vaccination is a very clear example of a confrontation of personal
versus community values.  The person who avoids vaccination exposes
himself to some small risk of infection, but he also exploits his 
fellow citizens who submit to it for the benefit of the community.

     These are essentially the only measures we have against a disease
that has claimed ten million victims in recorded history.  A 
deterioration in our standards of community protection would expose the
entire population to eventual risks of the utmost gravity.

     The critics of vaccination have an important point, but they are
grasping the wrong end of the stick.  A complication rate of 0.01 per
cent is a burden we should not have to pay, but much of it would be
preventable now by more careful selection of patients who already give
indications of being at high risk, like children with eczema or with
immunological disorders.  New vaccines are being introduced that show
some promise of having even lower rates of side-effects.

     Above all, the community has a large, special responsibility to
learn how to minimize the burdens on individual subjects who participate
in vaccination programs more for the public than for their 
individual benefit.  We still know very little about why the vaccine 
does get out of hand in rare cases.  The recent course of budgetary 
policy for health research flies in the teeth of that responsibility.
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