A Model for a Smallpox-Vaccination Policy - "We developed scenarios of smallpox attacks and built a stochastic model of outcomes under various control policies....Conclusions: The analysis favors prior vaccination of health care workers unless the likelihood of any attack is very low, but it favors vaccination of the public only if the likelihood of a national attack or of multiple attacks is high."

The Public and the Smallpox Threat - Results of a national survey indicating that there are a number of false beliefs among citizens about smallpox and vaccination.

How Contagious Is Vaccinia? - Vaccinia is the live virus used in smallpox vaccination. This article discusses the safety of vaccinia.

A Different View of Smallpox and Vaccination - An argument for alternatives to vaccination.

A Smallpox False Alarm - Interesting account of diagnostic and public health issues that arose when smallpox was considered a possibility in a recent case.
posted by fold_and_mutilate at 12:29 AM on December 20, 2002

I know this isn't a good question to ask in a community bulletin board. I know I'm going to come across looking vain, superficial, or pretentious. However, I remember when I was young, asking why older people had a strange big scar on their shoulder. I was told that it was how a smallpox vaccination was administered. So, my question is, if I am given a smallpox vaccination, will I have the same scar/crater on my shoulder? Can I elect to have the shot somewhere less visible?
posted by jmccorm at 1:04 AM on December 20, 2002

I have one and I'm 32... am I in that older category? I say, wear it with pride my friend.
posted by Witty at 1:08 AM on December 20, 2002

jmccorm: it's possible to give the vaccination on the inner side of the upper arm, rather than the outside. That hides the scar better. I would imagine it isn't done this way often because the vaccination causes a small abscess, which must be cared for and kept clean and dry while it scabs over and heals. This is more difficult to do if it's on a part of the body that is often pressed up against the chest; especially when the vaccination is given to a child, as it usually was when vaccination was standard.

The CDC has a Smallpox information page here, but I don't think that issue is covered.

Anyway, I'm proud of my scar. Chicks find it sexy, especially when they hear the danger I had to go through to get it.

"One chance of death in a million, babe."

"Ooooh!"

"And 17 chances of serious illness as defined by the CDC."

"You must have been terrified!"

"Nah. My mom holding my hand, and anyway, I got a lollipop afterwards."
posted by Slithy_Tove at 1:35 AM on December 20, 2002

Can I elect to have the shot somewhere less visible?

Not a bad question at all, although unless you're in groups mentioned in the articles, it's unlikely you'd need a vaccination.

The vaccine is administered with something called a "bifurcated needle." It's designed to merely break your skin superficially. It's not like a hypodermic needle (designed primarily for intramuscular injection), which is often used for things like influenza vaccinations...or the multiple vaccinations kids get.

When you are vaccinated, your skin is pricked 15 times or so with this needle, which has been dipped in the vaccine. The vaccinated area will redden and blister, fill with pus, and form a scab, which usually falls off around the third week after vaccination.

Previously the vaccine was occasionally given in areas other than the deltoid (the big muscle where you've seen that "crater" on your friends' shoulders) for cosmetic reasons. However, the recommendation is usually that the deltoid be used (as I understand it) because of concern about different body skin sensitivity to vaccination, and most efficacy studies were based on folks who were vaccinated in the deltoid region.

Ask your physician what he/she thinks. But there are a number of important risks more serious than minor scarring associated with the vaccine, and there are definitely people who should not get the vaccine. The articles linked above discuss these risks, and other web resources like the Centers for Disease Control have good recommendation summaries.
posted by fold_and_mutilate at 1:36 AM on December 20, 2002

What a great post.

I don't care if the vaccine leaves a tattoo of cherries; I'd rather have it than not, although there are several informative points above that might give me pause.

In any case, I'd like to have the choice: My sister called a doctor's office a few months ago to inquire about a smalpox vaccine for her daughter, and the nurse said; "we don't have it."

When my sister asked why the vaccine wasn't available because of possible terrorist viral attack, the nurse said; "We'd prefer not to think about that."

Thank you f_and_m.
posted by hama7 at 4:09 AM on December 20, 2002

national debate? horseslop. most americans are simply counting the days until these fear-mongering power-hungry fascist assholes are out of office. i wouldn't put anything in my body that the bush cabal recommended.
posted by quonsar at 4:21 AM on December 20, 2002

Doesn't the government recommend vitamin C?
posted by Pretty_Generic at 4:26 AM on December 20, 2002

I think the liklihood of a smallpox attack is being greatly exaggerated to continue to subdue the public with nameless fear, and so I don't care to have the vaccine. Although I might be more inclined to if it actually did leave a tattoo of cherrries.
posted by jennyb at 4:49 AM on December 20, 2002

Doesn't the government recommend vitamin C?
your point being...?
[quonsar unfolds his frog-like legs and hobbles painfully out of the room]
posted by quonsar at 5:30 AM on December 20, 2002

I'm 32 as well. Me and my better half were talking about this the other night. She asked if had ever gotten a smallpox vaccine and I honestly don't remember. She said that they were still routine whaen I was a toddler.

As to whether or not they'd be neccessary and/or dangerous now, I'm honestly not sure, but I'd hate to be wrong either way.
posted by jonmc at 5:56 AM on December 20, 2002

True Story: My family and I went to the Philippinesin the mid 80's and my step father who is a Doctor ended up doing some healthcare at a village of pygmies who the people who we had come to visit (they were sociologists) had befriended and were somewhat studying. Anywho, as a rite of passage to manhood the boys would get a sticky piece of cotton stuck on their shoulder then lit on fire. They were not allowed to put it out on their own, it had to BURN out. So they understandably ran around like chickens with their heads cut off, then they have passed into manhood. Enter my Mom, who is 5'10" and has an athletic build. She has smallpox vaccine scar on her shoulder in the exact place the men had their burn scars, appearing as if she had also passed this ritual into manhood. Needless to say, no one fucked with her.
posted by CoolHandPuke at 6:26 AM on December 20, 2002

I think the liklihood of a smallpox attack is being greatly exaggerated to continue to subdue the public with nameless fear

??? Please explain how this would be likely to "subdue the public." Also, I don't get the "nameless fear" bit. It's got a name, and it's pretty nasty.

Also, to be fair, if the government was really just trying to alarm the public, it would force everyone to get the vaccine, not just military personnel.

Ultimately, as jonmc suggests, it's all just a crapshoot. If the government does nothing, and an epidemic does break out, all anyone will ask is why they didn't do anything now.
posted by pardonyou? at 6:29 AM on December 20, 2002

I work for a city government, as well as side-work for the county in which I live. I attended a conference last week on this very subject. Most counties and cities across the nation-as we speak- are organizing volunteer smallpox clinics in the event that the President gives the okay.
I am now deep in it, working with the city and county to organize 6 clinics in East Texas which would be capable of vaccinating the population of 6 or 7 counties in a few days.
I think the most common mistake made about the whole thing is that there isn't enough of the vaccine to go around. There's PLENTY of vaccine to go around, just not enough of the drugs which help in counteracting the side-effects of the vaccine.
Also, I learned that the vaccine is theoretically only good for 5 to 10 years, so everyone who has been vaccinated before still has to do it again. I always thought it was a lifetime thing....
It may never happen, but rest assured that it is being taken care of. In the event of an emergency, we should all be able to receive the vaccine in plenty of time. Be prepared, if you have time, to volunteer for the clinics. Everyone is needed!
posted by bradth27 at 7:02 AM on December 20, 2002

Please explain how this would be likely to "subdue the public." Also, I don't get the "nameless fear" bit. It's got a name, and it's pretty nasty.

Indeed it is, but the question that really needs to be asked is if the threat of smallpox is being overstated. The mere mention of the word has been enough to nudge every news outlet on television to do a big piece on smallpox preparations, not to mention spur local efforts, the likes of which are being staffed by praiseworthy folks like bradth27.

But how big of a threat is this really? And is it not possible that the Bush administration is making it out to be more of a threat than it really is to throw a real scare into us - perhaps to forestall any questions about the whole war on terror, or for that matter, war on Iraq.
posted by kgasmart at 7:31 AM on December 20, 2002

What quonsar said. The real threat of a smallpox out break is exactly zero. This is another ploy designed to keep us scared and off balance. People who are scared don't ask as many questions. People who are scared do what they're told.

By ordering these vaccinations Bush is putting lives in danger for no good reason. Day by day the man moves further and further into the evil place. This sounds like something we'd expect to see North Korea doing.
posted by y6y6y6 at 7:52 AM on December 20, 2002

My conspiratorial mind has two thoughts.

The first thought is that the government is hyping the possible negative side effects of the vaccine to prevent a mad rush of the population hording it in stockpiles, instead hoping that we'll be too afraid to take it and thus have plenty left over for soldiers and, well, government employees.

The second is the opposite, that the government is hyping the possibility of an outbreak to increase the overall fear within the populace to better control and subdue them.

Perhaps the two are not mutually exclusive.
posted by Civil_Disobedient at 8:05 AM on December 20, 2002

pardonyou?: A public scared of a smallpox outbreak or a terrorist attack is less likely to get their panties in a twist about the economy, loss of freedoms, environmental concerns, etc. Therefore keeping their attention focused on a threat that I belive is being greatly exaggerated (the threat of smallpox, another terrorist attack, Iraq, really pick one) will allow our current administration to get away with more things that wouldn't escape the public's attention were they not otherwise occupied.

I follow the news fairly closely, and all I've heard about smallpox is that a vaccine will be offered. I haven't heard anything about the actual threat of an outbreak. Where would it come from? What makes the government think it's a possibility? I haven't even heard a vague announcement that "reports indicate that an outbreak of smallpox is possible in the nect five years." All I've got is that some millitary personnel are being vaccinated and a very special episode of ER.

None of this is meant to pass judgement on those who prefer to have the vaccine at all, but just to explain why I am suspicious of the need for it. If I'm wrong, well, I'll be dead wrong and there's one less anti-Bush voter to worry about.
posted by jennyb at 8:17 AM on December 20, 2002

The real threat of a smallpox out break is exactly zero. This is another ploy designed to keep us scared and off balance. People who are scared don't ask as many questions. People who are scared do what they're told.

That doesn't jive with reality. The government has explicitly said that they consider the risk of outbreak to be low, and thus are only requiring use of the vaccine for military personnel. They are not recommending that the public gets the vaccine unless and until there is evidence of an outbreak. I don't know where you get off calling that a "ploy" "designed to keep us scared and off balance." Frankly, I don't think the public has demonstrated any kind of panic or fear at all -- let alone the paralyzing fear that would "subdue the public."

I also love how you consider yourself sufficiently qualified and knowledgeable to decree the risk of smallpox "exactly zero."

Of course, don't let me get in the way of your rank speculation.
posted by pardonyou? at 8:26 AM on December 20, 2002

Me, I can take my chances, small as they are. But I am not in the habit of gambling, however good the odds, with the lives of my loved ones. If it comes available, I'd like to get the smallpox vaccine for the wife and son. Just in case. In the meantime, I think people who are used to thinking critically about government will continue to, and people who are not will continue not to. I don't see a lot of panic in the streets over the possibility of contracting smallpox, but I do see a lot of witching about the economy and about Bush in general (even outside of the rarified air here at Big Blue). Sheep will always be sheep and ripe for shearing, but goats don't automatically line up for the cutters just because some whispers "wolf."

Foldy: credit where it's due: great post, especially so in light of what passes for FPPs these days. *tips hat*
posted by UncleFes at 8:45 AM on December 20, 2002

While I'm not about to trust my government even as far as I could throw it - one sliver of my brain tends to think the current stance on vaccinations is a good one.

Obviously the chances of an attack of this nature are extremely low, but I can't even begin to imagine the scene if someone tried to carry something like this out. Nevermind the horrible effects of the disease itself, the panic alone in a major metropolitan area would cause catastrophic upheaval... I think it's better to have these discussions now, it's rare enough that our government actually prepares for anything in advance.

Of course, having eczema and psoriasis leave me up shit's creek either way, as I'd have a good chance of experiencing a reaction to the vaccine almost as serious as the disease itself. Having been born in '69 but not being able to see the scar, I asked my mom if I'd received the shot. She found the date and noted I'd had a reaction that lasted several days. I'm not too keen on trying my luck a second time...
posted by jalexei at 8:51 AM on December 20, 2002

I recently attended a couple of seminars on smallpox in a homeland security context. Concerning the likelihood of smallpox being used as a terror weapon, two points really stood out. First that there were in the 70s and 80s thousands of scientists in the then Soviet Union working on biological weapons, most of whom are now unemployed. Secondly, the lab equipment needed to build weaponized smallpox can be purchased for around $250,000 (as opposed to millions and millions needed back then).

This is what, I think, really scares policy makers: the barriers to making smallpox are virtually nil for a terrorist operation with a 7 figure budget, something that was not true before the collapse of the Soviet Union.
posted by turbodog at 10:40 AM on December 20, 2002

There have been recent reports that Iraq might have acquired a Soviet strain of smallpox which may be vaccine-resistant. If this is the case, then wouldn't attacking Iraq be as suicidal as attacking a nuclear power? I'm no expert, but I assume that the release of vaccine-resistant strain of smallpox would cause a global epidemic at least on the scale of the influenza epidemic of the 1920's.
posted by homunculus at 11:20 AM on December 20, 2002

I'd like to get the smallpox vaccine for the wife and son

What if the wife wants you to get it, too? What if the wife weighs the pros and cons and decides she doesn't want to be vaccinated?

Can I elect to have the shot somewhere less visible?

I'm one of the "older people", I guess, and my scar is on my leg, so at least when I was vaccinated, they'd give it in areas other than your arm.
posted by biscotti at 11:24 AM on December 20, 2002

What if the wife wants you to get it, too? What if the wife weighs the pros and cons and decides she doesn't want to be vaccinated?

Well, depending on availability, I suppose I could get it too, but I wouldn't want to take a dose that could go to a child or young adult, if availability was limited. I love life, and I believe that once it's over, it's over, but I'll not buy more at that cost. My wife is a very sensible sort, and not prone to cognitive dissonance. I doubt she would find the cons overwhelming the pros, especially with regard to vaccinating our son, but in the event she felt that she personally didn't want the vaccine, I would of course respect her wishes. If she wanted to deny our son the vaccine, that'd be a different story. But I have a great deal of faith that wouldn't occur. She is as unwilling as I to gamble with his life.
posted by UncleFes at 2:43 PM on December 20, 2002

God, I just looked--my scar's nearly disappeared over the years--it's a ghost of its former self. Just think what's going to happen to your tattoos in time, kids!
posted by y2karl at 3:05 PM on December 20, 2002

That's it y2karl! Smallpox vaccines for us skeptics that simultaneously tattoo us somewhere appropriate with the phrase "Bush ripped the world a new asshole and all I got was this lousy scar" to go.
posted by crasspastor at 6:07 PM on December 20, 2002

There have been recent reports that Iraq might have acquired a Soviet strain of smallpox which may be vaccine-resistant.

First that there were in the 70s and 80s thousands of scientists in the then Soviet Union working on biological weapons, most of whom are now unemployed. Secondly, the lab equipment needed to build weaponized smallpox can be purchased for around $250,000 (as opposed to millions and millions needed back then).

Oh, I wouldn't worry about those pesky little "facts." According to y6y6y6 (certainly gleaned from his "insider" status), the threat of a smallpox outbreak is "exactly zero." The government promoting a voluntary vaccine program is just trying to subdue us with fear. If you see someone with oozing pustules, walk up and give 'em a hug -- it's perfectly safe.
posted by pardonyou? at 6:44 PM on December 20, 2002

Alternatively, InCell has an oral vaccine and will soon begin human trials. No scars, no oozing pustules, fewer side effects.
posted by yonderboy at 7:11 PM on December 20, 2002

As a side note, I recently took a call from a polling firm asking my opinions on how much danger we (Americans) are in and whether I'd object to the installation of a federal bioweapons research lab here in Boston. The survey guy said they're building two national labs and trying to find the right places for them. I don't remember the budget numbers -- they weren't huge -- but apparently someone in Washington is taking the smallpox (etc.) threat seriously.
posted by swerve at 8:54 PM on December 20, 2002

That's it y2karl! Smallpox vaccines for us skeptics that simultaneously tattoo us somewhere appropriate with the phrase "Bush ripped the world a new asshole and all I got was this lousy scar" to go.

Either that or

Weaponized Avian Born Ebola--My Ass!
posted by y2karl at 8:55 PM on December 20, 2002