Forget the Advice -- Give Us Vaccinations

Wendy Orent writes frequently on infectious disease and is writing a book about plague.

If you have followed the recent advice of the Department of Homeland Security, you have now laid in gallons of water, a battery-operated radio, duct tape, plastic sheeting and enough nonperishable food to last. For how long? No one knows. You have also prepared backpacks stuffed with warm clothes and blankets for each member of the family, and you have them all ready to go. Where? That’s unclear.

If you feel inadequately prepared, don’t expect much help from the Homeland Security Web site You’ll find basic tips, like to turn on a radio in the event of an attack. And there are some intriguing illustrations, like one of a man looking for the source of a chemical or biological attack while dead fish float nearby.

But to those of us who grew up in the ‘50s and ‘60s, the government advice seems eerily reminiscent of those senseless single-file trips to a dank school basement, where we sat waiting for the all-clear bell to sound. The basements were mysterious and a trip down there was more fun than a fire alarm, which sent you outside to freeze. But what was the point? The bombs, if they had come, would have reduced us to a powdery residue, or left us to die of radiation sickness. We were too young to understand the terrible futility of “duck and cover.”

The new prescriptions are equally futile. Our government is once again treating us like docile second-graders in a dusty basement. Let’s start with the concept of duct tape and plastic sheeting, an idea that comes from Israel, where it makes some sense. Scud missiles shrieking overhead are a real possibility in Israel, within easy striking distance of Iraq. Israelis are in a position, though we can hardly call it enviable, of having time to learn when a missile attack is coming, and to gather inside their sealed and sheeted rooms before a missile hits.


What enemy are we cowering from, in our sheeted rooms? Where will the Scud missiles be launched from, and how will we know to pull our children inside? Maj. Gen. Bruce Lawlor, chief of staff to Homeland Security Secretary Tom Ridge, recently told the New York Times, “People who are making fun of it don’t know what they’re talking about.” In fact, he said, Israelis purchased large quantities of duct tape and plastic sheeting during the Gulf War. They “relied on it” for their safety, and “it has worked,” he said.

Well, not exactly. The Scud missiles that Iraq launched at Israel during the Gulf War had no chemical or biological payloads, and so the sealed rooms saved no one. But four people died of heart attacks in their sealed rooms, and seven suffocated from incorrect use of gas masks; 229 people were apparently injured by inappropriate self-administered antibiotics, to protect against an anthrax attack that never came. Whether the sealed rooms would have saved lives had chemical or biological weapons been used, we have no way of knowing.

A U.S. government chemical weapons expert who asked not to be identified has little patience with the recommendations, which, developed for Israel, make no sense in the United States.

“What I think makes sense is to get away from contamination, which is what people do anyway. We run from fire, we run from hazards. People will know what to do. If you get the stuff on you, you’d shower it off,” the expert said. “In most cases, with a chemical agent, you have time to get it off. And the effects of the more fearsome agents, such as cyanide, can be lessened with medical treatment. The worst-case scenarios are of enclosed spaces where people have no option to flee, but those would probably be limited in scope.”

In any event, a large-scale chemical attack using military agents such as sarin or VX is most unlikely. Another expert says, “If bad guys can get enough chemical agent into the country to launch a major attack, you’ve got bigger problems than chemical weapons.”

As for biological weapons, for your sealed room to do you any good, you’d have to know that an attack was coming. As a government scientist who wishes to remain anonymous puts it, the Homeland Security recommendations “give the illusion that you are doing something useful, but do not really address the problems. On the biological side, it’s just totally ridiculous, because you are never going to know you’ve been attacked by a bio- agent cloud until it’s over.”

In the unlikely event you knew an attack was coming, just staying indoors would probably protect you. In 1979, a technician working in the ultrasecret biological weapons laboratory of Sverdlovsk in the Soviet Union forgot to replace a filter, causing an explosive release of dry anthrax powder into the air. Sixty-eight people downwind from the plant eventually died of anthrax. As Peter B. Jahrling of the U.S. Army Medical Research Institute of Infectious Diseases puts it, “In Sverdlovsk, the folks inside the leaky houses were not infected; only those who were outside in the early morning hours when the release occurred were infected. So dilution is the solution, and anything which cuts down on the dose ought to be beneficial.”

Simple masks would work as well, even against smallpox and plague, the two contagious threat agents. In 1910-11 and again in 1920-21, plague experts stopped major natural outbreaks of deadly pneumonic plague in Manchuria simply by imposing a quarantine on the sick and their contacts, by keeping people at home and by wearing gauze masks whenever anyone was exposed to plague patients. Regarding smallpox, probably the most feared agent, Jahrling says, “N-100 masks probably work with 99% efficiency against smallpox. I’d opt for something that reduced my exposure one-hundredfold.”


These simple suggestions may be better than nothing. But in any event, offering us the option of “protecting ourselves” is an easy way out for the administration. There is a real solution to the threat of biological agents, but it calls for force and direction that the administration does not seem to have. It is vaccination in advance of an attack, vaccination against the most serious threat agents, anthrax, smallpox and plague.

There is no safe, effective plague vaccine, although scientists are working to develop one. But where is the smallpox vaccine? After temporizing for nearly a year, the administration finally decided to offer vaccinations to health-care workers and public safety personnel. In the last month, with war probably imminent, fewer than 8,000 civilians have received the vaccine, and 100,000 troops.

Instead of giving the American people a real choice -- access to existing vaccines against smallpox and anthrax -- we’ve been offered duct tape and plastic sheeting and told to protect ourselves. One bioterror expert who insists on anonymity maintains that in the end “more people will die from suffocation from gas masks and sealed rooms than from chemical or biological attacks. The one thing that would prepare us would be mass vaccination, and they’re not even talking about that.”

Duct and cover? Thanks a lot.