Reactions and Overreactions: Smallpox Vaccination, Complications, and Compensation

Abstract

The smallpox vaccination program was unique in public health history. The disease has been eradicated. No one is known to be at risk of infection. It is possible that scientific research stocks of the virus could be misappropriated, and the virus used as a weapon. The benefit of a prophylactic vaccination program is unquantifiable. There could be no benefit. But that there is danger to some in vaccination with the live vaccinia virus vaccine is certain. Driven by the post-9/11 fear that the unthinkable was thinkable, the view that no form of violation of norms of civilized conduct could be excluded, the government pressed for and obtained a reversal of the policy - 30 years old, of not vaccinating citizens against smallpox disease.

The federal government started a program in which it intended to vaccinate in the first stage 500,000 health workers. Only 38,000 volunteered in the first 8 months of the program. The military vaccinated half a million people, who had no choice. Compensation programs and studies of adverse health effects of a resumed smallpox vaccination program were intensely debated. A very spare program of compensation was enacted. Fortunately few civilians volunteered and few were injured. Cooperating with military officials, previously unrecognized complications such as myopericarditis were observed in significant numbers. This made possible quick identification of the cardiac hazard and the promulgation of new clinical guidelines for excluding volunteers at risk for such illnesses.

The conduct of the military program was exemplary in its commitment to study the adverse health effects of vaccination. The military also cooperated in an exemplary way with public health authorities who were able to make prompt adjustments of the protocols and exclusions.

An important impact of September 11, 2001 may be an excess of fear. The civilian vaccination program failed because few volunteered. Now that we have military smallpox vaccination teams and a large pool of vaccinated workers in our military service, we should be able to end that voluntary civilian program.

Keywords: smallpox, vaccine, vaccination, liability, compensation,

JEL Classification: I18, N40