A new scientific article argues that past strategies to fight smallpox outbreaks were relatively ineffective and urges the United States not to adopt similar tactics today.  Some experts, however, criticized the article as simplistic and wrong, Science reported today (see GSN, Dec. 20, 2002).

Ring vaccination — the practice of isolating smallpox victims and vaccinating the network of people around them — does little or no good to stop a smallpox epidemic, according to a new article from Yale professor Edward Kaplan and Massachusetts Institute of Technology professor Lawrence Wein.

In the January issue of Epidemiology, Kaplan and Wein take aim at the ring vaccination theory and a graph used in scientific papers in the 1970s that purports to show the effectiveness of ring vaccinations.  In fact, the two say, mass vaccinations, not targeted ones, proved more effective in controlling and wiping out smallpox and the graph was manipulated to improve the image of ring vaccinations.

D.A. Henderson, the long-time smallpox crusader and current White House biological terrorism adviser, acknowledged that the graph could have faults and was used to encourage uncommitted governments to conduct ring vaccinations.  Numerous experts including Henderson, however, have taken exception with Kaplan’s overall conclusion that ring vaccinations are of no use.

“Kaplan doesn’t understand what he’s talking about,” Henderson said.

The recent article is “very simplistic,” said Jeffrey Koplan, a former director of the Centers for Disease Control and Prevention who now works at Atlanta’s Emory University.  Koplan referred to the work as “Epidemiology Lite.”

William Foege wrote two papers that used the disputed graph and now works for the Bill and Melinda Gates Foundation.  He defended his findings in the 1970s and the concept of ring vaccinations.

In 1969, no more than 60 percent of West and Central Africa’s population was immunized against smallpox, Foege said.  That immunization level was insufficient to wipe out the disease, but ring vaccination made it possible, he added.

Even in India, where 90 percent of the population was immunized, smallpox kept appearing, Foege said.  With ring vaccinations, however, the disease was eliminated within a year, he added.

Kaplan said that he is now looking at the figures from the smallpox eradication effort in India, and he believes his theory holds in that scenario as well.  Bush administration officials are interested in his findings, he said (Martin Enserink, Science, Jan. 10).

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