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Since President Bush announced the smallpox vaccine would likely be made available to the American public in 2004, my patients have all been asking me the same question: Should they get the smallpox vaccine? Which is why President Bush's intention to make the old smallpox vaccine available to the entire population by 2004 might not be so wise. It could raise false hopes because there's no way to vaccinate everyone overnight. It could also limit the ability of doctors to counsel their patients on whether they should subject themselves to a somewhat risky vaccine. Smallpox is one of our oldest scourges. It should scare us. But we would do well to remember that even before there was a vaccine, smallpox never took over a whole region the way polio or influenza did. And smallpox isn't about to do that now

If a smallpox vaccine recipient inadvertently transmitted the virus in the vaccine to other people and they fell ill, who would pay for the sick people's medical care? The question arose over the weekend after President [Bush] announced a plan to vaccinate about 10 million health care and emergency workers with smallpox vaccine, which contains a live virus that is closely related to the one that causes smallpox. Smallpox vaccination differs from other immunizations because recipients can accidentally transmit vaccinia, the virus in the vaccine, to other people, in effect involuntarily vaccinating them and putting some at risk of life-threatening complications

The question arose over the weekend after President Bush announced a plan to vaccinate about 10 million health care and emergency workers with smallpox vaccine, which contains a live virus that is closely related to the one that causes smallpox. Smallpox vaccination differs from other immunizations because recipients can accidentally transmit vaccinia, the virus in the vaccine, to others, in effect involuntarily vaccinating them and putting some at risk of life-threatening complications. General recommendations are that people who have recently been vaccinated stay out of close contact with others or cover the vaccine site with a bandage, because the virus can be shed from the site for several weeks after inoculation. Some hospital officials say that newly vaccinated workers who take care of patients will be required to wear special semipermeable bandages at work, because they are better than gauze at containing the virus. If secretions from a smallpox vaccination soak into clothing or blankets, the vaccinia virus may survive in the fabric for a day or two and could theoretically infect someone else who comes into contact with the item, said Dr. Donald A. Henderson, the epidemiologist who led the global smallpox eradication program and who now is a senior science adviser to Mr. [Tommy G. Thompson]

A new smallpox vaccine will be provided free to Americans who want it if the vaccine, now being manufactured, passes licensing tests as expected in 2004, Tommy G. Thompson, the secretary of health and human services, said yesterday. As long as there are no smallpox cases, the vaccine is unlikely to be given to children, even if parents request it, because it has not been tested on them, said Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. Researchers had hoped to conduct such studies in children, but ethics panels at medical centers refused to allow them, citing federal regulations banning human experiments in which risks outweigh benefits, he said. Plans are still being worked out to provide vaccine for Americans who want it now. Dr. Fauci said that one way was for people to enroll in clinical trials being conducted to study smallpox vaccine

Instead, Mr. [Bush] authorized a voluntary program to vaccinate about 450,000 doctors, nurses and emergency workers who would be the first to respond to any effort by terrorists or hostile nations to use smallpox as a weapon. The vaccinations are expected to be given from late January through March. In recent months, an advisory panel on immunization policy, many public health leaders and infectious disease experts have expressed deep concern that smallpox vaccination, the most dangerous human immunization, posed too great a risk for the public because no case of smallpox has occurred anywhere since 1980. Dr. E. Stephen Edwards, president of the American Academy of Pediatrics, urged the Bush administration to ''consider the devastating effects'' smallpox vaccinations could have on children. ''No trials have been conducted on children,'' who may have a higher incidence of injury from the vaccine than adults, Dr. Edwards said

Which is why the president was right to make it clear in his speech yesterday that he was not recommending the old smallpox vaccine for the entire population. Doing so would have limited the ability of doctors to counsel their patients on whether they should subject themselves to a somewhat risky vaccine. In my experience, if people know that a vaccine or a treatment is out there, they are probably going to want it -- whether it will be helpful or not. With new, safer vaccines around the corner, doctors should be in as strong a position as possible to persuade people who are not at risk from using the live vaccine

The initial phases of the vaccination plan would cover about 500,000 military personnel and 500,000 civilians, mostly health care and emergency workers who would most likely be exposed if someone contracted smallpox, officials said. Smallpox vaccination is complicated and dangerous because the virus in the vaccine can be transmitted inadvertently to other people, state and infectious disease experts said. [C. Mack Sewell] said New Mexico planned to immunize just 120 people in the first round, gradually expanding to about 12,000, a process that could take six to nine months. The state's plan, he added, had major uncertainties. 'As with everybody else, it remains to be seen how many people will volunteer for this,' Sewell said

AFP, NATIONAL ARCHIVES photo 1946: Photo taken Aug. 1, 1946, in Tazewell County in Virginia shows Jewell Ridge Coal Company's doctor giving smallpox vaccination to children. U.S. military personnel and emergency workers soon will begin receiving smallpox vaccines as part of a plan to thwart any terrorist attack using the deadly virus, a U.S. official said on Wednesday. AFP photo SMALLPOX: Photo from the Centers for Disease COntrol and Prevention shows smallpox lesions on a person's leg. Smallpox kills about one in three unvaccinated people. The virus in the vaccine also can be transmitted to other people

The initial phases of the vaccination plan would cover about 500,000 military personnel and 500,000 civilians, mostly health care and emergency workers who would most likely be exposed if someone contracted smallpox, officials said. Eventually as many as 10 million people in law enforcement, health care and emergency response could be offered the vaccine. Defense officials said troop vaccinations could start today. The vaccine, made of a live virus closely related to smallpox known as vaccinia, can cause death or injury in susceptible people. They could presumably decline to be vaccinated, but they would remain vulnerable to infection with vaccinia virus shed by those who had taken the vaccine. The first American troops to be vaccinated would be military specialists who would respond to a smallpox outbreak, as well as forces assigned to units in the Middle East or that could eventually deploy there, military officials said. Of the 1.4 million service members on active-duty, 350,000 to 500,000 would be vaccinated under the new policy, the officials said