Why can't I get a smallpox vaccine even at my own expense?
March 31, 2010 12:56 AM   Subscribe

Why is the smallpox vaccine not available to members of the public on a voluntary basis in the US?

I'm not saying this keeps me up at night or that I want to rush right out and get vaccinated should it become available, but I cannot figure out why in the world it's not allowed. It's particularly odd to me since the feds, in effect, forced me to have it as a child in the early 70's or they wouldn't let me attend school. Now, as an adult, they won't allow me to have it? (I know I had Dryvax as a kid and they now use a different vaccine. Just saying.)

What am I missing?

You'll shed virus and infect others
Don't the members of the military? Do they quarantine them in basic training or what? What if I agree to be quarantined at my own expense?

Shedding the virus will harm immunocompromised people.
Again, do they quarantine the military members who are vaccinated and not allow any immunocompromised people near them?

Too many risks.
I'll sign a waiver. Members of the military who are vaccinated don't have a choice. Why don't we hear about them dropping like flies from the vaccines?

Manufacturers don't want to risk lawsuit.
Again, I'll sign a waiver, and I'll pay them the retail price (they can set the market price) of the vaccine out of my own pocket (my insurance company won't even mind, then). They like money, right?

The feds are afraid the vaccinia virus will "leak" out and be weaponized.

We're talking a pretty benign cowpox relative here, right? It still exists in nature, doesn't it?

You could get one of the rare side effects that make you very sick and need expensive treatment which insurance won't cover, and you can't afford.
I'll sign a waiver and show proof of billionaire-ness.

The chances of smallpox appearing are incredibly small, and the chances you'll become infected are even smaller.
I don't want to risk it because Ken Alibek and his former crowd did some nasty things and there are tons of poor people in Russia, North Korea, Iran, etc. who might have gotten their hands on the results and Osama's boys have tons of cash and don't like my type.

Even if you become infected, the feds have three days to inoculate you before any real harm happens.
Katrina. If I take care of it now, I'm one less person to burden the feds, and I pay for it. There's no cost to the public.

It's against a UN/WHO agreement.
It's the vaccinia virus! I don't want the real stuff - not even if it's a dead version.

I know I had many more, but I accidentally closed firefox and lost all my links. I've been musing over this occasionally for months as a simple thought exercise, plus I've been scouring the web all night tonight. What the heck am I missing? I know it's going to be something maddeningly simple or so mindlessly bureaucratic I didn't think of it.

I'd also like to point out that I could substitute the other mandatory vaccinations (anthrax, there's gotta be more) in place of smallpox above and all would still apply, except I wasn't forced to be vaccinated against those things when I was a kid (AFAIK) like I was for smallpox.

I guess my point in asking this was that we talk so much about individual freedoms in the US, but we don't seem to have so many in reality. Yes, it's a tiny little issue, but the little ones start to add up quickly. I think we can all pretty much agree on that one.

TIA
posted by InsertNiftyNameHere to Health & Fitness (29 answers total) 1 user marked this as a favorite
 
Well, say you were part of some cult-like group, such as the Rajneeshi's for example, or Om Shin Rikyo, who took it into their heads to attack the people they saw as their persecutors with smallpox they had somehow gotten from a Ken Alibek.

The first thing you would do is vaccinate your members. If you couldn't get the vaccine, you probably wouldn't bother to try to get the virus.

By making the vaccine very difficult to get, the government tells itself it's making a smallpox attack less likely.
posted by jamjam at 1:26 AM on March 31, 2010 [1 favorite]


You're making plenty of arguments which should be telling you why you can't just go out and buy a bunch of smallpox vaccine.

Your question doesn't seem to be so much about why you can't get vaccinated as about why the society you live in doesn't subscribe to your own libertarian values. The same arguments about signing waivers could be made for not wearing a seatbelt or making snuff movies.
posted by le morte de bea arthur at 1:53 AM on March 31, 2010 [3 favorites]


I imagine that it is primarily because the production of a smallpox vaccine is no longer commercially viable, and thus, drug companies aren't interested in producing it.

The remaining vaccines that do exist are likely to be stockpiled, and therefore, not available for purchase by the general public.
posted by ryanbryan at 1:54 AM on March 31, 2010 [2 favorites]


As you know, the vaccine contains live vaccinia virus which can occasionally (up to 6 times in 100,000 cases) be spread to others. It can then cause the third party complications that could be life-threatening, especially if they are immunocompromised or have a heart condition. Your right to inject yourself with vaccinia could, possibly, kill someone else (which, needless to say, infringes their right to not die).

I'm not sure whether members of the military are quarantined or not, but that's not really relevant to the key point: your freedom to inject vaccinia endangers others. It's plausible that the military made a cost-benefit analysis and found that the small risk of death and disability due to post-vaccination spread of vaccinia among the military (where there would be fewer immunocompromised individuals and people with heart conditions) outweighed the costly logistics of quarantining. (Also, if an intake of soldiers were all immunised at once, and everyone else on the base was too, who would the vaccinia be spread to anyway?)

You also suggest that you'd pay for the quarantining yourself if it were found to be necessary. Well, yeah. But it's a bit more complicated than that. We couldn't just take your word for it -- a quarantine procedure would have to be written by experts and approved, and your personal quarantine set-up would need to be audited. So the CDC would be diverting tens or hundreds of thousands of dollars to give you your individual freedom to inject yourself under quarantine with vaccinia -- tax dollars that would have to be diverted from other, potentially life-saving, CDC programs.
posted by dontjumplarry at 3:22 AM on March 31, 2010 [2 favorites]


Let's put it this way: How about a polio vaccine? Do you want one of those, too?
posted by autoclavicle at 4:15 AM on March 31, 2010


Smallpox has been eradicated. They don't want to make MORE of it.

And there's no point to it. There is almost literally zero chance any of us will ever be exposed to it.

And isn't the vaccine painful and cause scars? Or is that the polio vaccine? I know my parents have scars from one of their childhood vaccines.

(More detail- vaccines don't prevent the disease or the infection. They just give ones body a head start if they ever encounter the virus and for the most part, prevent the infection from gaining hold and creating the bad effects of the disease. More importantly, by vaccinating a population, over time, the sheer numbers of viruses in the wild goes down and that's just as important in preventing the disease.)

(Looking at it another way- suppose we wanted to eradicate kangaroos. We would go around and sterilize all the kangaroos we could get our hands on. The kangaroos continue to live their lives and [attempt to] mate. Some low percentage would successfully mate, because we can't get everyone, and the vaccine can't work in 100% of the cases. But by increasing the odds that the kangaroos can breed, in a generation or two, all the kangaroos are gone.)
posted by gjc at 5:24 AM on March 31, 2010


You can't buy it yourself because it's a controlled substance. You can't buy any other kind of vaccine without a prescription either.

The reason you can't get a prescription for it is because prescriptions can only be issued in compliance with FDA regulations, and the FDA has determined--based upon good and compelling evidence--that the risk of receiving the vaccine is greater than the risk of getting the disease. Ergo, the guidelines rule out the administration of the vaccine to the general population.

The reason you aren't allowed to make your own decisions here is exactly why you aren't allowed to decide you need surgery or morphine or any other serious medication or procedure: you aren't in a position to accurately assess your condition or the risks involved in treatment.

If you want to contest this, you need to contest the entire prescription model, and I'm not sure you want to go there.
posted by valkyryn at 5:39 AM on March 31, 2010 [5 favorites]


CDC Smallpox Vaccine FAQ page:
Many vaccinations are required. Why don’t people have to get the smallpox vaccine?
The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention. (added Nov 13, 2002)
posted by Remy at 5:42 AM on March 31, 2010 [3 favorites]


For the same reason the U.S. Navy doesn't have an anti-Viking contingency plan. It would be silly to spend time and money fighting something that doesn't even exist anymore as a realistic threat.
posted by EarBucket at 5:46 AM on March 31, 2010 [8 favorites]


Let's put it this way: How about a polio vaccine? Do you want one of those, too?

Slight derail -- this reply confused me. Autoclavicle, are you not vaccinated against polio? If not, how did you avoid that? I understood it to be standard, along with MMR etc. (And if you've ever planning on traveling to parts outside the western world, please do remember to get your once-in-adulthood polio booster! Polio runs a-wild in the overpopulated parts where I'm currently living...)
posted by artemisia at 5:52 AM on March 31, 2010


To be fair, gjc, it's inaccurate to say the risk of contracting smallpox is "almost literally zero". There's a genuine risk that a state or terrorist group might release the virus maliciously, using either stolen US or Russian stocks or the unaccounted-for former Soviet stocks. Indeed, significant disaster management planning is going on for just this eventuality.
posted by dontjumplarry at 5:56 AM on March 31, 2010


The answer to a lot of your 'I'll sign a waiver' and 'I'll voluntarily go into quarantine' counter-arguments is red tape. There's no program to set up to support what you're asking. Who are you giving the waiver to? Your doctor? The pharmacist who supplies the drug? The drug company? Your local health department? The Department of Health? The same possibilities apply for who would supervise your quarantine.

Because there's no real demand or need for random smallpox immunizations, none of those groups have programs set up to support the whims of a few survivalists or eccentrics who might insist that they have a smallpox immunization. The bureaucratic cost of doing that sort of thing as a one-off would be ridiculous, it would suck time from programs that actually matter in order to do something that won't help anyone and might cause harm.
posted by jacquilynne at 6:01 AM on March 31, 2010


To answer some of your questions: Yes. Servicemembers who get it do go into quarantine, sort of. If you're a reservist, for instance, you're not getting it in basic training -- you're getting it as part of your deployment mobilization preparation, which is done at a military base that you're restricted to. You're given gloves to use when you change the bandage that goes over the immunization site, and bags to seal those gloves in when you're done. You're warned, over and over and over again, not to let anyone touch your immunization site for a week. Add that to the fact that servicemembers, on average, are in better medical shape than your average person, are under pretty tight control and are used to following orders.

Whereas you want to sign a waiver and have everyone trust that you're not going to take the bandage off and go rubbing against people on the subway.
posted by Etrigan at 6:54 AM on March 31, 2010


Smallpox has been eradicated. They don't want to make MORE of it.

The vaccine isn't made out of smallpox virus.

And isn't the vaccine painful and cause scars? Or is that the polio vaccine? I know my parents have scars from one of their childhood vaccines.

That was the tuberculosis skin test. (Which wasn't a vaccination.)
posted by Chocolate Pickle at 8:48 AM on March 31, 2010


And isn't the vaccine painful and cause scars? Or is that the polio vaccine? I know my parents have scars from one of their childhood vaccines.
That was the tuberculosis skin test. (Which wasn't a vaccination.)

smallpox vaccine leaves a nickel-to-quarter-sized, puckered scar - usually administered on the upper arm.
From the CDC FAQ:
Vaccination on the upper arm also will allow for easy visualization of a vaccination scar in emergency situations where vaccination status may need to be quickly assessed.
posted by namewithoutwords at 9:24 AM on March 31, 2010


For the same reason the U.S. Navy doesn't have an anti-Viking contingency plan.

Oh, but we do!

posted by valkyryn at 9:55 AM on March 31, 2010 [1 favorite]


There are billions of more statistically likely ways to die that you don't protect against every day (for logical reasons). Why would you want to inject yourself with an unnecessary vaccine? The statistical likeliness of complications from the vaccine are higher than the likelihood of you getting smallpox.
posted by Raichle at 10:06 AM on March 31, 2010


jamjam: "Well, say you were part of some cult-like group, such as the Rajneeshi's for example, or Om Shin Rikyo, who took it into their heads to attack the people they saw as their persecutors with smallpox they had somehow gotten from a Ken Alibek.

The first thing you would do is vaccinate your members. If you couldn't get the vaccine, you probably wouldn't bother to try to get the virus.

By making the vaccine very difficult to get, the government tells itself it's making a smallpox attack less likely.
"

Good point, and I wouldn't doubt this has had some effect on policy. There's just one problem with this solution; It assumes you're dealing with a rational adversary. It does nothing to prevent against those who would willingly infect themselves, wait until they were the most efficient carriers, and then enter a crowded public place. Sure, the individual acting as the transmission medium would die, but they already do that all the time as suicide bombers.

It's true, though, that this has been war gamed to death so I wouldn't doubt that the government came to the same conclusion as you mention. Seems like an unreasonable gamble to me, though.
posted by InsertNiftyNameHere at 1:37 PM on March 31, 2010


ryanbryan: "I imagine that it is primarily because the production of a smallpox vaccine is no longer commercially viable, and thus, drug companies aren't interested in producing it.

The remaining vaccines that do exist are likely to be stockpiled, and therefore, not available for purchase by the general public.
"

ryanbryan: "I imagine that it is primarily because the production of a smallpox vaccine is no longer commercially viable, and thus, drug companies aren't interested in producing it.

The remaining vaccines that do exist are likely to be stockpiled, and therefore, not available for purchase by the general public.
"

I think you might have nailed it with this one. Best info I've found so far is this old page: Developing New Smallpox Vaccines From it: The facilities, expertise, and infrastructure required for producing the virus in this way are no longer available.

Looks like you could very well be correct about this. The flaw in my logic may have been that there was still production going on. I noticed that I found a few Canadian pages that appeared to give me the impression that they are way ahead of the US on this issue. Perhaps the US is simply not publicizing things as much, though. Now, I think the milion dollar question I have is, are there currently any smallpox vaccines licensed and approved by the US Federal Government. I'll have to work on finding that out.

Great call! Thanks.
posted by InsertNiftyNameHere at 1:57 PM on March 31, 2010


dontjumplarry: "As you know, the vaccine contains live vaccinia virus which can occasionally (up to 6 times in 100,000 cases) be spread to others. It can then cause the third party complications that could be life-threatening, especially if they are immunocompromised or have a heart condition. Your right to inject yourself with vaccinia could, possibly, kill someone else (which, needless to say, infringes their right to not die).

I'm not sure whether members of the military are quarantined or not, but that's not really relevant to the key point: your freedom to inject vaccinia endangers others. It's plausible that the military made a cost-benefit analysis and found that the small risk of death and disability due to post-vaccination spread of vaccinia among the military (where there would be fewer immunocompromised individuals and people with heart conditions) outweighed the costly logistics of quarantining. (Also, if an intake of soldiers were all immunised at once, and everyone else on the base was too, who would the vaccinia be spread to anyway?)

You also suggest that you'd pay for the quarantining yourself if it were found to be necessary. Well, yeah. But it's a bit more complicated than that. We couldn't just take your word for it -- a quarantine procedure would have to be written by experts and approved, and your personal quarantine set-up would need to be audited. So the CDC would be diverting tens or hundreds of thousands of dollars to give you your individual freedom to inject yourself under quarantine with vaccinia -- tax dollars that would have to be diverted from other, potentially life-saving, CDC programs.
"

I understand all that you're saying and I think you make extremely valid points. As I said, I'm looking at this problem from more of a theoretical view rather than a practical one. Some may say that's a waste of time and energy, but it's what I do when I shovel the snow off the driveway, mow the lawn, or drive solo on a long, boring car trip. Thanks for the great input.
posted by InsertNiftyNameHere at 2:01 PM on March 31, 2010


EarBucket: "For the same reason the U.S. Navy doesn't have an anti-Viking contingency plan. It would be silly to spend time and money fighting something that doesn't even exist anymore as a realistic threat."

I don't think your analogy holds up. It appears to be as real a threat as loose nukes, dirty bombs, or chemical attacks: Soviet bio-weapons.
posted by InsertNiftyNameHere at 2:08 PM on March 31, 2010


autoclavicle: "Let's put it this way: How about a polio vaccine? Do you want one of those, too?"

If I ever go to a third world country, you bet your sweet backside I'm getting a polio vaccine prior to leaving the US, as well as a whole host of others. And I can get those as easily as arranging the process with my local doctor. I believe I could also get the vaccines by simply asking as well (no travel needed, or I could lie) even if I was simply paranoid. I have no plans to do so, however.
posted by InsertNiftyNameHere at 2:13 PM on March 31, 2010


dontjumplarry: "To be fair, gjc, it's inaccurate to say the risk of contracting smallpox is "almost literally zero". There's a genuine risk that a state or terrorist group might release the virus maliciously, using either stolen US or Russian stocks or the unaccounted-for former Soviet stocks. Indeed, significant disaster management planning is going on for just this eventuality."

Thank you for mentioning this. As you imply, there seems to be a surprising amount of war gaming this very scenario by the US military and Federal Government that many people are clueless about. I was kicking myself for not leaving this in my original post. There's plenty more info out there for those who don't believe wiki.
posted by InsertNiftyNameHere at 2:19 PM on March 31, 2010


Etrigan: "To answer some of your questions: Yes. Servicemembers who get it do go into quarantine, sort of. If you're a reservist, for instance, you're not getting it in basic training -- you're getting it as part of your deployment mobilization preparation, which is done at a military base that you're restricted to. You're given gloves to use when you change the bandage that goes over the immunization site, and bags to seal those gloves in when you're done. You're warned, over and over and over again, not to let anyone touch your immunization site for a week. Add that to the fact that servicemembers, on average, are in better medical shape than your average person, are under pretty tight control and are used to following orders.

Whereas you want to sign a waiver and have everyone trust that you're not going to take the bandage off and go rubbing against people on the subway.
"

Many thanks for that great info. I wasn't really serious about the voluntary quarantine thing, but it does seem to me to be a theoretical option, practicalities and expense aside.
posted by InsertNiftyNameHere at 2:22 PM on March 31, 2010


Raichle: "There are billions of more statistically likely ways to die that you don't protect against every day (for logical reasons)."

There are also billions more things I'll walk on every day than the surface of the moon. Does that mean I can't think about walking on the moon or post a question on AskMeFi related to it? If you think the question is ridiculous, I'm pretty sure you can simply cruise right past it without commenting.
posted by InsertNiftyNameHere at 2:28 PM on March 31, 2010


This is a beautiful thing to read. QFT:
The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977.

Those of us old enough to have had smallpox vaccinations often have a small scar from it.

Given the small but real risk of damage from a vaccination against the tiny, theoretical risk of being exposed to smallpox, it would be unethical for a health care provider to give you the vaccine, and the manufacturer's insurance company would likely be unwilling to accept the risk.

I'm surprised that you seem not to have been vaccinated against polio. It's low-risk, and you seem to want protections. With world travel so common, any infection can travel.

Personal freedom? You have the freedom to do many things, and say many things, but not the freedom to compel others to do what you want or provide what you want. The government makes the rules, some wise, some not. I'm happy that my next door neighbor can't build a 12 story condo block next door. I'm not so happy that the US Federal govt. treats marijuana as a heinous drug, and makes effective painkillers way too unavailable for people in pain.

When it comes to public health, the greater good can trump individual freedom. If you were to get TB, you might be quarantined, or be compelled to be treated. There's a lot of philosophical wrangling we could do on the topic of personal freedom. In Theora55Land, many personal freedoms are protected by transparency in government, free, fair elections, and a strong media.
posted by theora55 at 2:48 PM on March 31, 2010


smallpox vaccine leaves a nickel-to-quarter-sized, puckered scar

It didn't do that to me. I guess I'm one of the lucky ones.
posted by Chocolate Pickle at 3:23 PM on March 31, 2010


theora55: "This is a beautiful thing to read. QFT:
The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977.

Those of us old enough to have had smallpox vaccinations often have a small scar from it.

Given the small but real risk of damage from a vaccination against the tiny, theoretical risk of being exposed to smallpox, it would be unethical for a health care provider to give you the vaccine, and the manufacturer's insurance company would likely be unwilling to accept the risk.

I'm surprised that you seem not to have been vaccinated against polio. It's low-risk, and you seem to want protections. With world travel so common, any infection can travel.

Personal freedom? You have the freedom to do many things, and say many things, but not the freedom to compel others to do what you want or provide what you want. The government makes the rules, some wise, some not. I'm happy that my next door neighbor can't build a 12 story condo block next door. I'm not so happy that the US Federal govt. treats marijuana as a heinous drug, and makes effective painkillers way too unavailable for people in pain.

When it comes to public health, the greater good can trump individual freedom. If you were to get TB, you might be quarantined, or be compelled to be treated. There's a lot of philosophical wrangling we could do on the topic of personal freedom. In Theora55Land, many personal freedoms are protected by transparency in government, free, fair elections, and a strong media.
"

I have my scar from being inoculated as a child as well. As for the healthcare providers' ethics, that's a point I'd not considered. Thanks for enlightening me on that one. I think it's an important point. As to the polio vaccine, yes, I'm certain I had it as a child as was required by law way back then. I have not, though, had an adult booster, which I believe they recommend. If I go overseas I'll get it, but, otherwise, I'll take the risk.

And, perhaps most importantly, I didn't mean to imply that I thought I had the right to do whatever I want or be provided with whatever I want. Sorry if I gave that impression. I realize we all have an inherent societal contract with one another, and I'll be the first to admit that I've benefited greatly from it in many ways. And, FWIW, Theora55Land sounds like a pretty good place, IMHO. Thanks again for replying.
posted by InsertNiftyNameHere at 3:39 PM on March 31, 2010 [2 favorites]


but it does seem to me to be a theoretical option, practicalities and expense aside.

But in the real world practicalities and expense don't get put aside, in fact they rule. It is those practicalities and expenses that are stopping you from being able to ask for this vaccine, as dontjumplarry and valkyryn have both explained.

It's about rationing. Your country doesn't have endless time and money to waste on a teeny tiny risk (which smallpox is even when you add in possible bioterrorism) when instead it could be spent on something actually likely to help someone. This is the fundamental flaw of all your arguments, ignoring the practical realities of how things work.
posted by shelleycat at 5:48 PM on March 31, 2010


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