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The proponents of universal immunization seem willing to accept a "moderate" number of vaccine-related deaths and permanent neurologic impairment to reduce the morbidity and mortality and the civil disruption that would result from a large-scale smallpox release. 5, 6 While imperfect, Kemper and colleagues' back-of-the-envelope calculations remind us of the serious downsides of a universal vaccination strategy. Physicians who have taken an oath to "first do no harm" will struggle with the idea of vaccinating their patients to ward off an ill-defined and seemingly remote threat.

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Water phase ingredients may comprise water and any water-soluble components in water, including one or more active agents. Zwitterionic surfactants are used in the compositions and methods of the present invention.]