Bush's War and the Smallpox Scare: Science vs Policy

The PBS production “Frontline” recently presented a two day documentary titled “Bush’s War” and included factual details of what led up to the war in Iraq. It was clear from the documentary that the U.S. administration was attempting to provide to the American public a rationale and encourage popular support for going to war with Iraq. Weapons of mass destruction and biologic warfare preparations by Iraq were attributed to valid sources but, of course, subsequently no such preparations were found and the sources were shown to be faulty.

What was not revealed in the “Frontline” story was the Bush administration apparent attempt to further encourage public support for war by implying that Iraq had become a potential threat to cause a fatal smallpox epidemic within the United States and that the threat was sufficient to begin a mass smallpox vaccination program for the American public. This was against professional scientific evidence and advice given to the leader in public health matters, the U.S. Centers for Disease Control and Prevention (CDC), which operated the program. These facts were developed through an investigation by the Institute of Medicine (IOM)* with its publication in 2005. The entire story of the IOM investigation was summarized by Matthew K. Wynia in the March/April 2006 issue of the American Journal of Bioethics. Here are some excerpts from Dr. Wynia’s article “Risk and Trust in Public Health: A Cautionary Tale”.

Indeed, according to the IOM the vaccination program the Administration created, and CDC endorsed, was "an unprecedented departure" from routine vaccination policy making and there is, "little to suggest that scientific and public health reasoning that typically characterized public health policies was a priority in this case"

According to the investigation, it appears that the CDC was pressured by the administration to participate in the vaccination program.

In fact, the smallpox vaccination program was created just as, "the administration was beginning to build a case for war against Iraq." Dr. Julie Gerberding, the Director of the CDC, in October 2002 drew the connection between vaccination and war planning when she explained the decision not to follow earlier advice from ACIP [Advisory Committee on Immunization Practices] by noting that no new "imminent" smallpox threat existed but, "we are in the process of considering war on our enemies. The context has changed a bit". This contextual change was apparently a very strong influence, because, the IOM reiterates, "There was no apparent public health reasoning behind the decision to offer the vaccine to the public" and indeed, to do so, was "contrary to the basic precepts of public health ethics, which focus on a fair and reasonable balance of risks and benefits among individuals and for the population as a whole."

The IOM criticizes government leaders for not providing any clear rationale, but suggests that a rationale could be inferred from statements by the President and other administration leaders. The IOM notes, for example, that the President, in explaining the vaccination program on December 13, 2002 stated that, “we believe that regimes hostile to the United States may possess this dangerous virus”, The report further notes that press accounts claimed, "two unnamed U.S government officials ... revealed that the federal government had information about Iraq's possession of smallpox virus" and the federal government had "named Iraq as one of the nations suspected of possessing smallpox”.

Though the vaccination program never met the President’s goal of an initial 500,000 civilians vaccinated (only 38,004 were vaccinated with 100 adverse reactions, 2 permanent disabilities and 2 deaths), after April 2003 (“mission accomplished”) and there was no admission by the administration of a lowered threat but the vaccination program was essentially abolished presumably because, as Dr. Wynia writes “public levels of fear were no longer needed to support the invasion."

What this story is all about is grossly unethical behavior by our government, as revealed by the Institute of Medicine investigation, in promoting a vaccination program not based on scientific evidence or scientific advice but to gain public support to begin a war. What was gained was public acceptance of a pre-emptive strike on Iraq. What was lost? Well, as Dr. Wynia emphasizes in his article, it could well be the future trust by the public and healthcare community in the CDC. Will the CDC present to the public the science of an issue or be pressured to follow the orders of another administration? ..Maurice.

*The Institute of Medicine serves as adviser to the nation to improve health. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The mission of the Institute of Medicine embraces the health of people everywhere.
Reference: IOM (Institute of Medicine) 2005. Committee on smallpox vaccination program implementation, board on health promotion and disease prevention. A. Baciu, A. P. Anason, K. Stratton and B. Strom, eds, “The smallpox vaccination program; Public health in an age of terrorisrn” Washington DC: National Academies Press.