Transcript The Law and Politics of Smallpox

The Law and Politics of Smallpox
Edward P. Richards
Modeling Infectious Diseases
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What makes a disease a plague?
Which plagues make good bioterrorism agents?
You can predict this from a core set of variables
You manage a natural epidemic or bioterrorism
event by modifying these variables
Key Variables
I = Infectivity
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How easy is it to catch the disease?
The flu is easy
 Respiratory spread (you rub stuff in your eyes)
 Causes coughing which sheds virus
 Same as smallpox
HIV versus Gonorrhea
Anthrax – can be pneumonic, but not often
Bioengineering to increase infectivity
S = Severity of illness
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The usual flu is a massive world wide epidemic
each year but it is not severe so we do not care
 In 1918-1919 flu was deadly
 That is why SARS scared the epidemiologists
so much
Severity includes treatablity
 Treatability only matters if you can do it
 Creates terrible justice issues if limited
T = Susceptible population
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How many people can catch the disease?
Vaccinations attack disease by reducing the number of
susceptible persons
 Direct protection
 Herd Immunity
 Jacobson v. MA
People need to fear the disease
 Tort law has undermined faith in vaccination
 The CDC and many states have lost the will to say
vaccination will be mandatory
P = Persistence
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Does the disease persist in the environment?
Anthrax spores stick around
 Probably not nearly as dangerous as people think
 We have created such fear that cleanup will be difficult
Smallpox can linger on personal effects but not in the
general environment
Cholera, typhoid, plague, SARS, and many diseases have
non-human hosts which makes eradication impossible
D = Duration of infective Stage
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How long can you spread the disease?
Makes a huge difference in the ability to restrict
individuals
 Tuberculosis can be months or more
 SARS was 10 days
 Smallpox is about 2 weeks on the outside
The longer the period
 The more demand for due process
 The higher the cost of providing for people
M = Mixing coefficient
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How many people can you infect?
Depends on the number of people you contact in
a way that can spread the disease
 HIV – took the bathhouses in the US
 Smallpox in NYC is much more dangerous than
in a small town in Maine
Key issue in quarantine and restrictions
TF = Terror Factor
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The product of the other factors
These can be manipulated to change perceptions
Smallpox
 2002 – seen as terrible threat
 2003 – CDC pushes models that reduce I and M
so smallpox does not spread quickly
 Why?
What does this mean for Emergency
Response?
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Which variables can you affect?
Anthrax
 Pre-exposure antibiotics
 Limit exposure by limiting movement
Smallpox
 Vaccinate
 Quarantine
Smallpox demands massive restrictions
and mandatory vaccination in a hurry
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CDC now downplays the time factor
Official policy says no mandatory vaccinations
No realistic plans for mass immunization
Feds completely ignore the problem of
immunosuppressed communities because of
AIDS politics
No serious discussion of whether
smallpox is a real threat
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Why are suddenly worried?
If it is real, should we do routine immunizations?
How would we change these decisions if the
vaccine was safer?
Making the hard choices
What did TOPOFF ignore?
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How do we enforce quarantine when people
resist?
How do we force people to be vaccinated?
How do we keep people out of health care
facilities?
How do we defend vaccine centers from people
who do not want to wait?
How do we keep core services working when
people do not go to work?