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National Security Health Policy Center - Smallpox Study |
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NSHPC Study on Smallpox Vaccines and Vaccination BACKGROUND PAPER In recent months there has been considerable debate concerning plans for reinstating the production of smallpox vaccines and the possible reintroduction of smallpox vaccination. The debate is fueled by the concerns about the possible use of smallpox in a bioterrorist attack, and has become more prominent following the anthrax attacks on the United States that occurred in October 2001. The subsequent decision by the United States government to produce and stockpile smallpox vaccine for possible use in a national smallpox vaccination program has further engaged the public in the policy decisions that would be needed to support such a program. In the United States there are now three candidate vaccines, with similar origins and history of use that are under consideration. In the United Kingdom a vaccine of different origin, and with a very different history has been selected - prompting the questions "what constitutes a coherent plan to protect against the potential threat from smallpox?" and "how certain can we be that the new vaccines will be safe and effective?" The latter question of vaccine efficacy is of prime importance given that there is no possibility of testing any vaccine for efficacy against the human form of the disease, as it was eradicated during the successful programs that were sponsored by the World Health Organization (WHO). Safety considerations can however be addressed through human trials, and are an important part of the strategy being pursued by the U.S. government programs. So what can be done to assess the possible value of the new vaccines? The answer, in part, is to examine the data from the past use of smallpox vaccines and try to assess where successes and failures can guide future decisions. To this end the National Security Health Policy Center (NSHPC) has undertaken a major research program to determine what lessons can be learned from the historical experience with smallpox disease and smallpox vaccination. The review is not yet complete, but some data has already been developed that has relevance to the current public debate concerning the choice of vaccine strain, and the issues of vaccine efficacy. As this data may help to clarify some of the current concerns that are being debated by experts and the public, an interim report has been prepared that documents the findings to date. The principal source of data that can help to answer the important questions about smallpox and smallpox vaccination can be found in the records of the worldwide eradication campaign (WEC), and in the experience of countries that had eradicated the disease before the intensive WEC finally succeeded in releasing the world from the deadly grip of smallpox. Unfortunately, the database stopped some 20 years ago when the eradication campaign ceased, but the existing data can reveal important clues to the present dilemma. A second source of data is much less organized but nevertheless proving to of great value. This is the documentation that began with the very first attempts to control smallpox through vaccination, a period when smallpox was an every day reality in most countries of the world, and a time when pioneering experimental work was done to try and control the disease. This data, often found in the contemporaneous letters between physicians and researchers, offers great insights and valuable data concerning the early work on smallpox and the origins of the vaccines that finally met the challenge. It is from both the WEC data, and these latter sources that the NSHPC has derived its findings. The interim report is provided below. The principal researchers on this project are Susan Prior and Stephen Prior, Ph.D. The full report will be completed and published later in the year. Link to Interim Findings |
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