The smallpox slowdown.

Byline: The Register-Guard

If the Bush administration still believes that smallpox immunization is an important part of the nation's strategy to protect itself against bioterrorism, it will have to do a better job of persuading people to line up for the shots. For reasons that seem sensible, the public health and emergency response workers who have been asked to volunteer for vaccinations have stayed away in droves.

The logic of immunization is that people accept a degree of risk to avoid a greater danger to themselves or society. The risk of harmful side effects from the vaccine is small but serious - about 40 in 1 million have life-threatening reactions, and one or two die. The Bush administration has not convinced people that the risk of a smallpox outbreak is great enough to warrant even the slight risk - not to mention the discomfort and inconvenience - that immunization entails.

The Bush administration had planned to immunize 450,000 health-care and emergency services workers against smallpox, creating a core group of protected people who could respond to a smallpox outbreak. Only 38,000 have volunteered so far, including just 115 in Oregon.

The federal government attempted to allay one obstacle to immunization by creating a program to compensate people who suffer harmful side effects after receiving the smallpox vaccine. But President Bush signed the legislation on May 1, and progress toward the goal of 450,000 immunizations has not improved - nationwide, according to The Washington Post, only 50 to 100 people are being immunized each week.

The problem is that a smallpox shot is perceived as insurance against an event whose possibility seems vanishingly remote. The last naturally occurring case of smallpox was recorded in 1977. In 1980, the World Health Organization announced that the disease had been eradicated, marking one of history's greatest achievements in public health.

The current fear is that a rogue nation or terrorist group would obtain lab samples of the smallpox virus and use them as a weapon. Concerns that such a crime might occur have eased since the war in Iraq ended without the discovery of biological weapons stockpiles. Dr. Julie Gerberding, director of the federal Centers for Disease Control and Prevention, says the smallpox vaccination program was not specifically related to Iraq, but not surprisingly, the public's sense of urgency about the threat has ebbed.

Meanwhile, other threats - SARS, the West Nile virus and such mundane killers as smoking and traffic accidents - continue to claim the daily attention of people working in professions related to public health. Confronting these actual dangers has understandably been a higher priority than the theoretical possibility of a smallpox outbreak.

If the Bush administration still believes that the smallpox threat warrants a large-scale vaccination program, it must communicate solid reasons for its worries. Any information about the loss of laboratory smallpox samples or biological weapons programs run by hostile forces should be shared with the public. The administration has been justifiably reluctant to cause panic about the smallpox threat, but now it must deal with the opposite. Based on the information available, Americans have made a rational evaluation of the smallpox threat and concluded that no emergency exists. The federal government must either accept that evaluation, or explain why it's wrong.