URBANA, ILLINOIS — It's a tough decision, but someone has to make it. On Thursday 20 June, 15 scientific advisors will recommend to Tommy Thompson, the top US health official, who would get vaccinated should terrorists unleash the smallpox virus on US civilians. For 77% of Americans surveyed in a recent Gallup poll, the question was a no-brainer: everyone should. But that's not the current policy, and for good reason. The current smallpox vaccine is one of the most hazardous vaccines around. Because of that, and the terrorist threat, a handful of companies is trying to come up with a safer vaccine for a disease once thought dead and buried.

During the smallpox eradication campaign, health officials vaccinated people in endemic areas with live vaccinia virus, a weaker cousin of variola virus, which causes smallpox. The vaccine strain protected almost everyone from the disease. For most people, the side effects...

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