Public Policy in the Age of Weapons of Mass Hysteria: On the Decision to Vaccinate: Evaluating Risks and Benefits

Abstract

Fifteen years after 9/11, and after 80 billion dollars has been spent on biodefense, we still don’t have a sure-fire way to deal with surprise epidemics. Ebola was just a test – and we failed. Miserably. This is the first in a series of articles that examines the propriety of our policy regarding pandemic projections and prioritization of research. I first examine the hype that generated our bio-terrorism response before evaluating the technological feasibility for using a bio-terrorist weapon, (exemplified by smallpox) as conceived in various published reports and war-games. While theoretically, in the laboratory – a nickel’s worth of anthrax or smallpox can do untold damage – the challenge is deployment. Microbiologists and virologists may be adept and creating designer microbes with a license to kill – but getting it from the lab to the victim’s target organ is a challenge – complicated by weather conditions, security constraints and engineering obstacles inherent in deployment technology. So, while if you are a rogue state, it might be nice to have a miniature nuclear war-head – without the missile to deploy it – all you have is a photo-op for a magazine cover. Understanding the terrorist mind and objectives is a necessary component to bio-terrorism preparedness, and one that seems to be lacking in our current governmental set-up. It appears the response is being led by compartmentalized scientists without ample training in understanding the criminal mind, or engineering (deployment) technology.The second part of the article is a risk-benefit analysis, evaluating the value of mass vaccination (for smallpox), comparing risks of the vaccine, likelihood of harm and the competitive need for other vaccines. I suggests a framework for evaluating the likelihood of a bio-weapons, and its detection. I further compare the response with West Nile disease, in terms of likely harm and efforts deployed to address it. Finally I suggest some engineering techniques as “first aid” measures, should an indoor terrorist attack occur.