Developing new policies from old evidence

Last week, the Department of Health in London published interim guidelines for responding to a deliberate release of smallpox in the United Kingdom. 1 2 The guidelines describe contingency plans for diagnosis and management of the first cases, vaccination strategies before and in the event of an outbreak, and other essential measures to ensure outbreak preparedness and control. Two of us (RH and DM) have contributed to the development of the guidelines, and the aim of this editorial is to give a brief summary and highlight some of the underlying evidence. (Comments on the guidelines may be sent to smallpoxplan@doh.gsi.gov.uk before the end of this year.)

Developing policies to combat an eradicated infectious disease is difficult for two reasons. Firstly, it is impossible to balance the benefits and risks of interventions against the potential risk from disease. No one knows whether variola virus exists outside the two laboratories approved by the World Health Organization, whether it has fallen into the hands of organisations or individuals with the will and ability to use it as a weapon, or whether it can actually be disseminated in a way that would cause mass casualties. Secondly, the underlying evidence relies on historical data, which were collected in a different, now outdated context and are often incomplete. Nevertheless, analysis of historical data has provided valuable insights into the disease and …