HOWARD FEINBERG has a piece on the ethics of smallpox vaccination.
My own feeling is that we should vaccinate. That’s because vacccination doesn’t just have a preventive value, but a deterrent value: terrorists are less likely to attempt to use smallpox if the target population is vaccinated. And that’s important because any effort by terrorists to use smallpox produces a high likelihood that it will spread around the world and once again infect people in places where lousy healthcare and infrastructure will make it hard to get rid of. I think that possibility has to be weighed in the balance: by vaccinating, we’re not just protecting Americans, but Indians, Somalians, Cambodians, etc. (Interestingly, the Islamic world, because of bad healthcare systems and the tradition of the Haj, is especially vulnerable to such “collateral damage,” though I’m not sure the terrorists are smart enough to realize that — or perhaps inclined to care even if they do).
Yeah, the vaccine has (minor) risks. But compared to seeing this horrible scourge loosed on humanity once again, they’re small.