Extending the Global Smallpox Bioterror Policy Debate: Yale School of Management's Edward H. Kaplan Questions Empirical Claim for Efficacy of Ring Vaccination; Argues that Vaccination Coverage is the Key
New Haven, CT, December 18, 2002 - The global eradication of smallpox stands among the most critical public health achievements of the last century. Edward H. Kaplan, the William N. and Marie A. Beach Professor of Management Sciences at the Yale School of Management (SOM) and Professor of Public Health at the Yale School of Medicine, continues to argue that in the event of a smallpox bioterror attack, rapid mass vaccination of the population in the area of the attack is preferable to ring vaccination, where only the contacts of smallpox cases would be vaccinated.
His latest research study published in Epidemiology, January 2003, Vol. 14 No. 1, co-authored with Lawrence M. Wein of Stanford's Graduate School of Business, is titled "Smallpox Eradication in West and Central Africa: Surveillance-Containment or Herd Immunity?" It describes a case study that some public health officials resurrected during the recent smallpox vaccination debate as an empirical argument favoring ring vaccination. This case has been presented at key meetings addressing smallpox response policy in the United States. Raising difficult questions about the reported analysis and interpretation of these data, Kaplan and Wein confront the conventional wisdom that ring vaccination ended smallpox in this part of the world. Instead, they assert that the decline in smallpox cases observed was a result of increased vaccination coverage, and in particular, that the relationship between smallpox cases and vaccine coverage was the same before and after ring vaccination was introduced.
Kaplan and Wein point out that in the United States and in many other countries today, there is virtually no immunity to smallpox, which could place large populations at great risk.
"Because bioterror-induced smallpox outbreaks would likely lead to cases worldwide," says Kaplan, "planning should begin now to ensure that rapid vaccination could be implemented immediately in inflicted regions around the globe. It is of paramount importance," he added, "that policy makers in developed countries and at the World Health Organization (WHO) formulate a strategy for coping with global outbreaks when devising their vaccine stockpiling and distribution policies."
Under a plan announced earlier this month by President Bush, as many as 500,000 U.S. troops serving around the world will be inoculated, along with Mr. Bush himself as commander-in -chief. The stated goal is for the U.S. government to protect those on the front lines of a bioterror assault. For civilians, the decision to be vaccinated will be voluntary, and not mandatory as is for military personnel. Initially, teams of health-care workers in each state - including the medical professionals who would be expected to treat smallpox cases and investigate any outbreak - will have access to the vaccine late next month. Next, the vaccine will be made more widely available and inevitably offered to as many as 10 million local police, firefighters, and emergency rescue workers. Only after emergency responders have been immunized would the general public gain voluntary access to the vaccine in 2004.
"The President's current plan wisely vaccinates a cadre of first-responders who could rapidly vaccinate the rest of the population in the event of a bioterror attack," Kaplan added. "Ensuring now that such an emergency response would be possible if required is the most immediate feature of the President's plan, for which I commend him and his advisors."
The Institute for Operations Research and the Management Sciences (INFORMS) recently presented Professor Kaplan with the INFORMS President's Award for his previous study, "Emergency Response to a Smallpox Attack: the Case for Mass Vaccination" (co-authored with Lawrence M. Wein and MIT's David L. Craft), but moreover for his contributions to the welfare of society via 15 years of HIV/AIDS research. Among his numerous honors, he has received the Lanchester Prize and Edelman Award, two of the top awards in the field of Operations Research. Professor Kaplan was the 2001 Naor Lecturer of the Operations Research Society of Israel, and has also twice received the Lady Davis Visiting Professorship at the Hebrew University of Jerusalem, where he investigated AIDS policy issues facing the State of Israel.