ee 4 Tack | Joshuc Lederberg ot . La we Lo of ay Ks cena e EGE i pe WERT ORG Ht: LROT 4 Hide COEUE ah AE WDE MEER E SUAS. my i Og ¥ . ; Cheap helen ¢ ER AY | Ca ry FTRETB ATR [ a j ai rey” SEMA EEG cee EE GES mE THE ERADICATION of vaccinated adults builds up, no smallpox has been im- smallpox is one of the mafor programs of the World Health Organization’ and may become one of the con- “ spicuous suecesses of inter- national cooperation human welfare. for The virus is spread by di- rect contact from infected to susceptible people, is often lethal, and, onee established, the infection responds poorly if at all to any exist- _ ing medical procedures. ‘he ' ‘Main weapons against small pox have been quarantine of exposed people and immuni- “gation of healthy anes to contain the virus and deny it the fertile ground it needs for continued spread. ¢ “The WIO programs are shrinking the territory still occupied by smallpox as on endemic disease, the main foci still Icft being in South Asia, Indoncsia, Central Al- * rica and patches of Brazil. THIS “ERADICATION” however, cannot be accepted at face value; that is, statis-° tices about the decline of smallpox as a reported dis- - ease cannot be interpreied as the disappearance of the smallpox: virus from planet. the The danyer is that “eradi- cation” will be followed by “eomplacency and relaxation of the very measures that -eontain the virus. lf a large population of sensitive, un- oe nd Dear Dr. Lane-- the consequences of a new epidemic would be most se- rious, for the disease tends to be mast sevcre in young adulis as compared to its oc- currence: in children who are exposed earlier in life in endemic refions. Demands for just such a relaxation have already been voiced. Writing in the New Jingland Jeurnal of Medicine, Vrs. ¢. 41, Lene and J. D. Suter of tne Na- tional Cemmunicahle Dis. ease Center take issue with the present recommended practice of routinely vacci- nation l-year-olds. Pediatri- cians prefer to vaccinate children of this age not be- cause they are at high risk of exposure to smallpox but because they are then leust vulnerable ta rare side-ef- fects. Significant complications occur in about 0.01 per cent. of vaccinations. In 1563, nine deaths were recorded as a consequence of some 14 mil- ion vaccinations; none of these were primary vaccina- tions of l-year-olds. Assum- ing some corrections in the figures, Drs. Lane and Mil- Jar 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 aoe. FEB 21 1970 May I have reprints of your papers on this? In retrospective re-reading, I see I may have underplayed the non-lethal complications suffered by routine l-yr. vaccination. Have you any perception of how well these might be mitigated by more careful case -selection. Is it known that routine vaccine is genetically homogencous? Could there be : . *1. 1 5 _ a neurotropic mutant (like Burnet's neuro flu of years ago, 4 By or was ceed Der that Newcastle?) ported into the United States since 1949. The pro- ercssive eradication of smallpox the world over would further lessen the chances of new. introdue- tions. And It would be un- likely that as many as 210 cascs of smalipox 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 confron- tation of personal versus community values, The per- | son 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 commu- nity. These are essentially the only measures we have against a disease that has claimed ten million victims in recorded history. A dete- rioration in our standards of community protection would expose the entire population to eventual risks of the ut- most gravity. The critics of vaccination have an important point, but they are grasping the wrong end of the stick. A complica- tion 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 disor- ders, New vaccines are being introduced that show some promise of having even lower rates of side-ef-. fects. Above all, the community has a Jarge, special responsi- bility to learn how to mini- mize the burdens on individ. ual subjects who participate in vaccination programs more for the public than for their individual bencfit. We still know very little about why the vaccine does get out of hand in rare cases. The recent course of budget- ary policy for health re- search flics in the teeth of that responsibility. © 1970, The Washington Post Coa.