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http://www.nytimes.com/2002/12/14/politics/14THRE.html?tntemail1

Bush Signals He Thinks Possibility of Smallpox Attack Is Rising

By WILLIAM J. BROAD

or months, Bush administration officials have talked about the threat of a smallpox attack but have offered no strong proof. But by asking millions of Americans to accept the risks of smallpox vaccinations, President Bush has signaled that he thinks the possibility of an attack is rising as the United States considers a war against Iraq and assesses long-term dangers.

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Even if Saddam Hussein is removed in Iraq, federal officials said yesterday, the specter of a smallpox attack will not disappear.

The announcement of the nation's first smallpox vaccination campaign in three decades is part of a long-term strategy to protect the country from a contagious virus that killed one in three unvaccinated people.

The administration's decision to offer 10.5 million health care workers and other Americans a vaccine against a conquered disease says more about the perceived risk of a smallpox attack than volumes of official statements and Congressional testimony, or even Mr. Bush's assurances yesterday that the United States faces no imminent threat.

It means officials are willing to accept the potential public backlash from complications of the vaccine.

"We live in a new world," said Jerome M. Hauer, assistant secretary for emergency preparedness at the Department of Health and Human Services.

In an interview, Mr. Hauer said Mr. Bush's decision was rooted in a calculus that looked at the smallpox threat over the long term — not just weeks or months but years and decades.

The risks accumulate over a long time, Mr. Hauer said, and that drives officials to take prudent steps now to prepare for the worst. Medical experts estimate that the vaccine could give vaccinated individuals some protection against the disease for decades.

By vaccinating millions of Americans, Mr. Hauer said, "you're testing your logistics, developing trained cadres, and protecting medical response teams. So in the event of an incident, you don't have to be concerned about vaccinating those groups." He added that vaccination could then begin of people who had come in contact with infected people "and, if necessary, mass vaccination."

Yesterday, Mr. Bush seemed to bend over backward not to create a panic, to understate the threat, never once mentioning potential war with Iraq. His strongest statement on the danger was that "regimes hostile to the United States may posses this dangerous virus."

Dr. Alan P. Zelicoff, a physician and smallpox expert at the Sandia National Laboratories, said in an interview that the administration was engaged in no bluff or bluster, but had carefully weighed the long-term risks of a smallpox attack.

"I think the administration has got it just about exactly right," he said of offering the vaccine to 10 million people. "The question is not what is the risk of attack in the next six months or year, but what is the risk over the effective lifetime of the vaccine, which is measured in decades."

Intelligence agencies believe that Iraq may have collected the smallpox virus from a natural outbreak that struck there in 1971 and 1972. Based on interviews with defectors and other informants, the agencies also believe that North Korea has the virus and that Russian scientists, impoverished by the collapse of the Soviet Union, may have sold the virus to terrorists.

Experts on risk assessment say a short-term danger grows as time passes. For example, a coin flipped has only a 50-50 chance of coming up heads, but flipped many times will eventually land heads up.

In the case of smallpox, experts also fear that over time, the chance grows that the virus and the knowledge and technology needed make it into a weapon will spread.

The administration's move to protect the nation against such threats comes at a potentially high cost.

Ten million Americans involved in health care, law enforcement, and emergency response are to be offered the vaccine on a voluntary basis by this summer. State and local officials say it will be a huge logistical challenge.

Ten million civilians is 20 times the roughly half million health workers slated for the first, even quicker round of vaccinations. The larger number is likely to produce health repercussions too big for Washington to ignore even if, as expected, only half the target population ends up volunteering for the vaccine. Based on previous statistics, five million immunizations could translate into five deaths and 500 serious illnesses.

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Those casualties might not occur. Though doctors have no recent experience with smallpox, it is possible that modern drugs and treatments could save more lives than in past epidemics.

But many infectious disease experts say that, if anything, the risk estimates could be understated. Since routine smallpox vaccination ended in the United States in 1972, millions of Americans have contracted illnesses that in theory make them more susceptible to complications. People at risk include those whose immune systems have been weakened by cancer or AIDS.

The smallpox push is reminiscent of an earlier vaccination episode that involved the anthrax vaccine. Again, it occurred in reaction to Saddam Hussein.

In December 1997, six years after the Persian Gulf War, the Pentagon announced that it had decided to vaccinate its 2.4 million solders and reservists against anthrax. It was unclear what prompted the decision. Iraq's program to make biological weapons had been exposed more than two years earlier, and Clinton Administration officials offered no public assessment of what new dangers existed, if any.

In time, the anthrax program turned into a public-relations disaster, with hundreds of soldiers refusing to take the shots and some even suing the government. One fear, discounted by federal officials, was that the vaccine can cause serious side effects, as medical experts agree that the smallpox vaccine did in the past and can do again today.

Things may be different for the Bush administration's smallpox push. Dr. Zelicoff said he expected a public-education campaign by federal officials over the next few months to more clearly articulate the issues posed by what medical experts call history's worst killer.

"You have to understand the long-term benefits, which are enormous," Dr. Zelicoff said. "Thinkers in the administration are planning to make that argument publicly, and I believe the public will accept it once they see that the initial cadre of vaccinated people does all right."

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