Bioterrorism only beaten by preparation and understanding

Probably Australia would need between 2 and 5 million doses of vaccine to feel safe. Currently we hold between 500,000 and 1 million doses of the old live virus. But regardless of how many doses we currently hold, who would we deliver it to, where and how? These are important questions.

Given a single occurence or cluster of smallpox cases, the timely delivery of vaccine becomes a priority. Also, given the wave of public reaction, fear and hysteria that we might expect to result, would not the public overwhelm the vaccination depots set up and would not the "worried well'' overrun local GP practices? This certainly happened in the past, and simulation exercises in the US suggest that it could happen again.

How would we manage this human reaction? To do so we need to enter the frame of reference of the average citizen and understand how they see risk and how this differs from how experts see risk. And who could we expect to be vaccinated? Key medical and emergency workers certainly, but who else? The current management plan suggests a "ring fencing'' campaign, where cases and immediate contacts would be vaccinated. But given that smallpox has an incubation period of up to 17 days, and that people move around a lot, how easy would tracing contacts prove?

And what about the impact on our healthcare facilities? Again the management plan discusses establishing "care centres'' - quarantine hospitals? - which would be established in key locations. There seems little doubt, however, that existing healthcare facilities would be pressed to the limit.

Hopefully, a bioterrorist event will never happen in Australia, but if ever it does, we need to be assured that we are properly prepared and fully understand all the issues.