ARE YOU worth $1.70?
That's the $10 million question the Maryland government must soon decide. Before it answers that question, it must answer another one: Is Maryland ready for smallpox?
My answers to the first and second questions are a resounding yes and no, respectively.
In my experience I unfortunately found that government doesn't usually act unless there is a major crisis or a major fear or threat of one. What can you do now? To make knowledgeable decisions, you must be well informed about smallpox, and there should be public discussion about what should be done.
As bad as anthrax is, smallpox is 100 times worse. Death rates on average from smallpox could run over 30 percent for those infected people never vaccinated against it and about 20 percent for those who were vaccinated as a child.
Anthrax is not contagious. Smallpox is. Smallpox can be inhaled from as far away as 4 feet. Bacteria cause anthrax, which is treatable with appropriate antibiotics. Virus causes smallpox, and it is essentially untreatable.
Smallpox begins as a sudden, eruptive contagious disease caused by orthopoxvirus, a member of the family poxviridae.
Once you become exposed to the virus, the average incubation phase is from eight to 14 days. During this time, you may have the sudden onset of high fever and chills, headache and backache. These symptoms last from two to five days. Then, raised pimples appear on your body, which become pitted sacs (vesicles), which develop into pus sacks, which dry and form scabs, which fall off and leave a permanent marking of the skin (pock marks).
Smallpox was a recognized internationally dreaded human plague for more than three millennia.
In 1796, Sir Edward Jenner discovered that the harmless cowpox virus could protect humans from getting smallpox virus infection. From 1966 to 1977, Dr. Donald A. Henderson directed the World Health Organization's (WHO) very successful global smallpox eradication campaign. He is now director of the Center for Civilian Biodefense Studies at the Johns Hopkins Bloomberg School of Public Health and senior advisor to federal government and the Department of Health and Human Services on civilian biodefense issues.
The last, naturally occurring, reported case of smallpox was in Somalia in October 1977. An important factor in the success of eradicating smallpox was that humans are the only host. In the traditional sense, there are no human carriers, and there are no animal reservoirs for smallpox virus.
In 1979, after two years without a reported case of smallpox, WHO marked the disappearance of smallpox from the planet. It recommended that countries stop vaccinating against smallpox and those laboratory stocks of the virus be destroyed. Vaccinations have essentially eradicated smallpox.
The only documented reservoirs of the smallpox virus were in containment laboratories in Atlanta and Moscow. Unfortunately, the bioweapons program in Siberia and other parts of the Soviet Union created stockpiles of the deadly smallpox virus. No one can be sure that they are all accounted for or that terrorists or terrorist governments haven't employed some of those scientists to transform smallpox into weapons of mass destruction.
One infected terrorist could be potentially more dangerous than a commandeered aircraft loaded with fuel. As a society, we must work toward the destruction of these laboratory stocks. We must do all we can to keep smallpox eliminated at the same time we eliminate the bioterrorists. We must not give in to panic, but we must act with extreme caution.
A possible way to protect ourselves is to create a stockpile of vaccine so that every Marylander could be vaccinated upon the first appearance of smallpox anywhere (not prematurely, because of some possible adverse side effects). To be prepared for this, we must mobilize our statewide public health departments to act and draft plans, now.
The cost to produce the smallpox vaccine would be about $1.70 per person, or about $10 million to inoculate all Marylanders. We could probably recoup our funds from the federal government if and when it decides to pay for inoculation of all Americans. But I would start planning now, just in case.
This is what responsible state government is all about.
Are you worth $1.70? I think so.
Neil Solomon, M.D., Maryland's first secretary of health and mental health from 1969-79, is a member of the board of directors of the International Council of Caring Communities, a U.N. organization.