The Bush administration is within weeks of deciding which people will be given the initial smallpox vaccines, so it's not too early for Native American families to decide if they should get the shots.
First in line for vaccinations will be those most likely to be exposed to the deadly virus - people in the military, along with police, medical workers and other emergency responders.
Most other Americans probably will receive the vaccine on a voluntary basis, unless there is an outbreak of the deadly virus.
The problems that many health experts, policy analysts and politicians have been struggling with involve health risks from the vaccine itself and a limited supply of it. The situation reminds me of Woody Allen's story of two people complaining about lunch. One says, "The food here is terrible." The other says, "And such small portions."
One in 10,000 of those who are vaccinated could suffer from encephalitis (which swells the brain), progressive vaccinia (which eats the body) and other severe side effects.
Young children would be particularly vulnerable to complications. The vaccine is a live virus. It takes more than 30 days after the shot for a scab to form. Youngsters who touch the inoculated area could spread the vaccinia to their faces, causing blindness or worse, and could infect others. Medical professionals are advising parents to not vaccinate pre-school children.
Fifteen million doses of the vaccine have been licensed by the Food and Drug Administration. Nearly 300 million doses have yet to be licensed.
Some in official Washington think the unlicensed doses should be used only in an emergency situation. Others think the emergency is now and vaccinations should be mandatory for everyone. Still others think Americans should make up their own minds for the time being.
Smallpox vaccinations were regularly administered in America until 1972. It is thought that persons who were vaccinated are no longer immune.
After the disease was eradicated globally in 1980, stockpiles of the virus were to have been destroyed, except for samples in two laboratories in the United States and Russia. Earlier this month, a CIA assessment came to light that France, Iraq and North Korea also have the smallpox virus, and al Qaeda has spent serious money attempting to get its own stash.
It is not known if these countries have genetically engineered smallpox or, more troubling, if the available antigen is effective against a genetic strain.
Smallpox. The very word is terrifying. The dreaded disease spreads quickly and kills about one-third of those infected.
For Native peoples, smallpox is a symbol of all the terrible things that Europeans did to our relatives and all the diseases they inflicted on us. Whole nations and cultures were obliterated by foreign pathogens. Others were reduced by 50 percent and higher.
Many non-Indians have a fantasy view of this past: Indians were killed for land and gold, and that wasn't nice, but Indian deaths from diseases were accidental. "Unwittingly" is the word used repeatedly in history books, as in, the Europeans unwittingly brought diseases with them and spread them among the Indian population.
It is absurd to think that Europeans did not know the nature of their diseases, from the common cold to syphilis. British children even circle-danced to a ditty about how people appeared and died in the epidemics of plagues: "Ring-a-ring-a-rosy / Pocket full of posies / Ashes, ashes / All fall down." They may not have known that the fleas on the rodents carried the Black Death, but they knew enough to kill the rats.
They did not know what we know today, but they knew from centuries of experience which diseases their children got, how to care for them and how long they would be sick. They knew if victims needed to be isolated, if their clothes needed to be burned and if the dead had to be handled and disposed of in any special way to contain the scourges.
Only the idiots could have failed to see the devastating effect that even the childhood diseases had on the Native people they encountered. They knew full well what had happened and could happen to Indians who were exposed to measles and mumps, which killed as many Indians as smallpox did.
There is a graveyard of Indian people - boys and men, girls and women, ages eight to 30 - who were taken from their homes to Hampton Institute as hostage-students from 1878 through the early 1900s. There in Virginia on the Chesapeake Bay, just 180 miles south of Washington, D.C., they died. Etched into tombstones are their names and nations, years of their short lives and causes of death. Among the most common reasons listed for their demise include consumption, influenza and pneumonia.
Indian people still contract and die from these new diseases at a higher rate than other segments of American society. We had no traditional medicines or healing ways for these diseases and have found indigenous treatments for very few.
Because of this susceptibility and history, some Native people think that Native Americans should be the first to be vaccinated against smallpox. Others think we should resist being the guinea pigs and should observe the effects of vaccinations on others before making any decisions.
Historic inhibition about being part of a medical control group puts me in the latter camp. Also, I'm following my doctor's very recent advice, which I pass along to you.
I asked if I should have a smallpox shot when the vaccine becomes available and the good doctor said, "Absolutely not. There's a danger of getting encephalitis and dying from the brain swelling. It's rarely a good idea to get the first batch of anything new."
Native governments should inform their citizens of their options and make plans for dealing with emergencies that might arise. In the event of an outbreak, it is possible that people will flee cities for rural areas and reservations. Even if only tribal citizens were to return home, reservation populations would swell by half.
It would be prudent to have a reservation evacuation plan or a strategy for moving from one part of tribal land to another. Tribal workers and leaders could take this opportunity to develop emergency preparedness plans, not only in connection with bio-attacks, but also for more likely accidental or intentional occurrences. On any given day, transuranic, hazardous, toxic and nuclear wastes are transported through or adjacent to Indian territories, and the potential for disaster should not be ignored.
The threat of bioterrorism is very real in Washington, D.C., which is still caught in the post-9/11 anthrax vortex. The local mail distribution center for our Capitol Hill neighborhood and many federal offices - the Brentwood facility where postal workers were infected with the insidious white powder that killed them - remains closed and quarantined, and mail still is selectively screened and irradiated.
While there are plans in place for the safety of certain high-level federal officials and judges, the vast majority of their colleagues and staffers (and those of us in unofficial Washington) are on our own. Perhaps some Native nations will develop plans that will show Washington how to care for all the people in an emergency.
Suzan Shown Harjo, Cheyenne and Hodulgee Muscogee, is president of the Morning Star Institute in Washington, D.C., and a columnist for Indian Country Today.