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Forty study participants reacted to the vaccine, and 69 participants did not.[ref] Smallpox vaccines have not been used on the general public in the US in over 47 years, and none of the study participants had previously received a smallpox vaccine.[ref] Read why the author of that smallpox vaccine study does NOT think it shows a reason not to vaccinate

If you dont have enough red blood cells then your oxygen delivery will be reduced which will then reduce energy production in your cells

[DOI] [PMC free article] [PubMed] [Google Scholar] 156.Tan D, Ertunc ME, Konduri S, Zhang J, Pinto AM, Chu Q, et al

Not automatically, but the risk is high without supplementation