This article assesses the potential public health risks associated with an intentional release of the smallpox virus as a biological weapon. Although naturally occurring smallpox was eradicated decades ago, its high contagiousness, severe mortality, and waning population immunity mean a deliberate attack could trigger a global health catastrophe. However, we argued that proactive, peacetime mass vaccination carries greater overall risk than benefit due to the severe adverse events linked to traditional first- and second-generation vaccines. Instead, national preparedness should focus on developing clear emergency response plans, securing safer third-generation vaccines, and prioritizing targeted immunizations for essential frontline workers—such as healthcare and emergency personnel—in the event of a verified threat or active outbreak.
The deliberate or accidental release of smallpox was a dominant public health concern in the early 2000s amid global anxieties over bioterrorism. I co-authored this review with my supervisor, Prof. Andrzej Zieliński, in connection with our participation in the Congress of the Polish Association of Epidemiologists and Infectiologists. It was a fascinating project, as it allowed me to review diverse modeling papers, outbreak scenarios, and epidemiological simulations—exploring different risk assumptions with a healthy dose of imagination! 🙂