The United States Smallpox Bioterrorism Preparedness Plan: Rational Response or Potemkin Planning?

Abstract

Smallpox was a major bogeyman after the terrorist attacks on September 11, 2001. The Bush administration launched a major smallpox vaccination campaign, and the Centers for Disease Control and Prevention (CDC) was directed to develop a national response plan for a smallpox bioterrorism attack. This paper grows out of an article written in 2004 on the failure of that smallpox vaccination campaign in the civilian population and implications for the CDC’s smallpox response plan. Since the 2004 article, public health systems across the United States have lost key personnel and resources due to budget cuts, Hurricane Katrina showed the danger of relying on local emergency response, and the H1N1 vaccination campaign illustrated how hard it is to implement a new vaccination program.

The thesis of this paper is that these events further undermine what was already a questionable smallpox response plan. But one more ineffective government response plan would hardly be news. Since the Duck and Cover films of the 1950s, the federal government has attempted to mollify the public with patently inadequate response plans for events that experts understand cannot be mitigated. The official United States nuclear war strategy was called Mutually Assured Destruction because it was assumed that there would be few survivors — making duck and cover little more than a cruel joke to frighten a generation of children.

The smallpox response plan is useful to study because the plan itself — unlike duck and cover — is based on good science and experience. It fails because the necessary public health infrastructure has been undermined, and because more than 30 years of politically expedient public health decisionmaking has made it impossible to deal with large scale threats when dealing with those threats has significant political costs. It is a Potemkin plan, which, like the villages in Potemkin’s story, exist only to fool the eye. This paper will show ways to recognize Potemkin planning, which is the first step to realistically facing risk.

Keywords: national security, bioterrorism, smallpox, cdc, vaccine, immunization, quarantine, isolation, H1Ni, public health, public health law, epidemiology, infectious diseases, communicable diseases, contact tracing, disaster planning, Potemkin

JEL Classification: I18, H56