Is the smallpox vaccination plan "unscientific, unethical, and unsafe," as we asserted in our Viewpoint column? In regard to safety, the projection we cited-that one to two deaths per million would occur as a result of the program-proved to be an underestimate. Since our article was written in January, at least three deaths have occurred out of fewer than 40,000 vaccinations: two among health workers and one among military personnel.1

Was the plan based on science or a political agenda? In an investigation of the vaccination program's origins, reporters from the journal Science wrote, "Almost uniformly, the public health experts were opposed to immunizing the general public to protect against an uncertain attack."2

One letter writer asserts that there's "certainly enough military intelligence and other data" to support the initiation of a vaccination program, but before the war, secretary of state Colin L. Powell conservatively estimated that Iraq's stockpile of chemical weapons was 100 to 500 tons.3To date, U.S. military inspectors haven't found evidence of these weapons, and there are reports that intelligence was fabricated and manipulated for political purposes.4

It's unethical for the harms caused by a medical intervention to outweigh its benefits. In the case of the smallpox vaccination program, the harm (adverse effects resulting from the administration of the vaccine) is known to be substantial, but the benefit has never received scientific-much less public-scrutiny. As to the costs of the vaccination program, the money allocated did not cover all of the vaccination program's costs, forcing local health officials to divert resources from other services.5We believe that Americans would be better protected if the billions of dollars spent on preparing for biological terrorism and the hundreds of billions of dollars spent on weaponry were applied to health care, education, and the establishment of decent living standards, both in the United States and elsewhere.

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