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SOM Prof: Mass Vaccination Best Response to Smallpox Attack
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Business New Haven
8/19/2002
By: Melissa Nicefaro
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In the event of a smallpox attack, a mass-vaccination policy would likely result in fewer deaths and faster disease eradication than alternative vaccination strategies, reports a new study published in Proceedings of the National Academy of Sciences (PNAS).
Since the terrorist attacks of September 11, 2001, the best response to a smallpox attack has been the subject of vigorous debate.
The response plan drafted by the Centers for Disease Control and Prevention (CDC) and endorsed June 20 by the government's Advisory Committee on Immunization Practices endorses what is known as “ring” vaccination. This calls for isolation of confirmed smallpox cases and targeted vaccination of only those who have been in contact with infected individuals, with a mass vaccination effort to take place only if the initial vaccination and quarantine methods are unsuccessful.
That policy is highly controversial: The July 10 Wall Street Journal editorialized that “Washington is stuck on a response that would result in the most people dying.”
Yale School of Management expert Edward H. Kaplan, the William N. and Marie A. Beach Professor of Management Sciences & Professor of Public Health, teamed with colleagues from MIT's Sloan School and Operations Research Center to find a better way. The researchers used a mathematical model to compare a number of different vaccination strategies on disease spread and death resulting from a smallpox attack on a large urban center.
Parameters of this new mathematical model include the number of people initially infected, the transmission rate, the fraction of potential contacts named by infected individuals, and the resources available to track potential contacts and administer vaccinations.
Under several scenarios, the model predicted that mass vaccination would stop the spread of infection faster and result in fewer deaths than targeted vaccination or the CDC plan. In fact, the ring-vaccination plan led to an estimated 4,120 additional deaths compared to a mass vaccination plan implemented from the beginning in a large attack on a city with ten million inhabitants.
Kaplan and his colleagues found that a pre-attack vaccination of a portion of the population lessened the gap between the different strategies.
According to Kaplan, these results suggest that unless a pre-attack vaccination is used to increase immunity within the population, a mass vaccination strategy should be seriously considered.
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