The smallpox vaccine has a higher rate of serious side effects than routine vaccinations. It’s estimated that out of every million people who get the shot, at least one to three of them will die. That could translate to hundreds of deaths, and thousands of life-threatening illnesses caused by the vaccine. The vaccine actually makes some people contagious with smallpox for a time. Smallpox vaccination can be effective after exposure, which reduces the need to pre-vaccinate millions.