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U.S. To Vaccinate 500,000 Workers Against Smallpox

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    NHNE News List Current Members: 674 Subscribe/unsubscribe/archive info at the bottom of this message. ... U.S. TO VACCINATE 500,000 WORKERS AGAINST SMALLPOX By
    Message 1 of 1 , Jul 7, 2002
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      By William J. Broad
      The New York Times
      Saturday, July 6, 2002


      The federal government will soon vaccinate roughly a half-million health
      care and emergency workers against smallpox as a precaution against a
      bioterrorist attack, federal officials said. The government is also laying
      the groundwork to carry out mass vaccinations of the public -- a policy
      abandoned 30 years ago -- if there is a large outbreak.

      Until last month, officials had said they would soon vaccinate a few
      thousand health workers and would respond to any smallpox attack with
      limited vaccinations of the public. Since 1983, only 11,000 Americans who
      work with the virus and its related diseases have received a vaccination,
      according to the Centers for Disease Control and Prevention.

      The plan to increase the number of "first responders" who receive the
      vaccination to roughly 500,000 from 15,000 and to prepare for a mass
      undertaking of vaccinations in effect acknowledges that the government's
      existing program is insufficient to fight a large outbreak.

      The government's new vaccination safeguards come amid continued talk in
      Washington of war against Iraq, which terrorism experts suspect of
      maintaining clandestine stocks of the virus, as well as growing criticism of
      the government's limited plan. Only Russia and the United States have
      declared stocks of the virus.

      A highly contagious disease, smallpox was declared eradicated globally in
      1980, eight years after the United States stopped routine vaccinations.

      Until its eradication, smallpox killed roughly one in three people who were
      infected but not vaccinated. Because immunity is believed to diminish with
      time, most people alive today are considered vulnerable to smallpox. But
      federal officials have long resisted the resumption of mass smallpox
      vaccinations, citing the probable risk of serious side effects, even death.

      Last month, a federal advisory panel backed a plan for "ring vaccinations,"
      in which health workers would isolate infected patients and vaccinate people
      in close contact with them, forming a ring of immunization around an
      outbreak and a barrier to its spread. In theory, such a strategy can work
      because the vaccine, if given within four days of exposure to the virus,
      protects people from the disease.

      Some experts on infectious disease said the plan's main virtue was that it
      required little smallpox vaccine.

      The government's more aggressive plans are possible because vaccine supplies
      are rapidly increasing as a result of crash manufacturing and stockpiling
      efforts begun soon after last fall's terrorist strikes, officials said.
      Also, studies have found that existing vaccine doses can be diluted without
      loss of effectiveness.

      "Now we can act differently because we have more vaccine," Dr. Donald A.
      Henderson, senior science adviser to Tommy G. Thompson, the secretary of
      health and human services, said in an interview. Dr. Henderson, who led the
      global smallpox eradication effort, added that in a crisis "we can make
      vaccine available on request throughout the community."

      Officials said that about 100 million doses of the smallpox vaccine (160
      million if diluted) are in hand and that by late this year or soon
      thereafter enough will be available for every American, more than 280
      million people.

      Health and military experts, citing new models of how the contagion can
      spread and new disclosures about how the weaponized virus can sail on the
      wind, have recently argued that limited, local vaccinations could produce
      thousands if not millions of needless infections and deaths. Most critics of
      the ring vaccination plan advocate mass vaccinations of the United States
      population -- but often before a smallpox attack, not after, as the
      government is now planning.

      In addition to vaccinating more "first responders," the government plans to
      develop ways to speed vaccine deliveries around the country and help states
      plan how to carry out mass vaccinations after an attack.

      Officials said the vaccinations of hospital workers and smallpox response
      teams, to begin fairly soon, would help train health professionals in
      smallpox vaccination and educate the public to the attendant risks.

      The White House, Defense Department and other federal agencies are involved
      in the vaccination planning. "Everyone is aware," an administration official

      Jerome M. Hauer, acting assistant secretary for emergency preparedness at
      the Department of Health and Human Services, said the agency hoped to send
      planning documents on how to best conduct mass vaccinations to cities and
      states in the next week or two. Mr. Hauer added that logistics changes to
      that end were under way at the Centers for Disease Control and Prevention in
      Atlanta, which oversees the production, safekeeping and distribution of the
      nation's stockpile of smallpox vaccine.

      Other details of the plans, such as who would receive peacetime
      vaccinations, have yet to be approved by Mr. Thompson, officials said.

      In interviews last week, health officials said the government had not
      abandoned its longstanding plan for ring vaccinations of people near a
      smallpox outbreak, the approach health workers used decades ago to eradicate
      the highly contagious disease from human populations. But the added steps,
      officials said, will make it possible to move far more aggressively if a
      terrorist attack ends up infecting more than 100 people or so.

      Critics had said the ring approach, while useful in battling natural
      outbreaks, would do little or nothing against a moderately skilled enemy
      intent on mayhem.

      "Unless the initial attack is very small and the infectiousness of the agent
      is quite mild, ring vaccination is not going to do much good," said Edward
      H. Kaplan, a Yale public health specialist who questioned the method's value
      at a federal meeting in Washington three weeks ago.

      In a report, the Cato Institute, a policy group in Washington, called ring
      vaccination "woefully inadequate for countering a direct attack."

      Critics argued that a number of factors had diminished the method's
      effectiveness since the disease was eradicated in 1980: populations are now
      increasingly mobile, levels of immunity are very low and advanced
      technologies have become commonplace, raising the odds that a smallpox
      attacker would be at least moderately skilled.

      "Today it's a totally different scenario," said William J. Bicknell, an
      international health expert at Boston University who recently faulted
      federal smallpox policy at a Cato meeting. The ring plan, he declared flatly
      in an interview, "will not work."

      Federal officials said the rising criticism played no direct role in shaping
      preparations for mass vaccinations.

      "The key to responding to any public health emergency is flexibility," Mr.
      Hauer said. "You listen to critics, but you can't let that drive policy. You
      have to do what's best for public health and national security."

      Ring vaccination, he added, was envisioned as simply a first line of defense
      that could quickly expand to much wider immunizations if necessary.

      Mr. Hauer added that the ring strategy was inherently small-scale because it
      required health professionals to carefully trace the whereabouts and
      contacts of infected people. Such work is so hard and time consuming, he
      noted, that ring vaccination is unsuitable as the only means of fighting a
      wide epidemic.

      He said another complication could arise if the disease broke out
      simultaneously in multiple cities, suggesting a strike of unknown size and
      danger. In that case, he said, "the forces pressing you to mass vaccinate
      become greater."

      Dr. Henderson, the chairman of the Secretary's Council on Public Health
      Preparedness at the Department of Health and Human Services, said critics
      have falsely portrayed the government as relying exclusively on ring

      "Let me be clear," he said. "If there is an emergency, and if we have to
      vaccinate widely, we need to be ready for it. That's what we're doing."

      Mass vaccinations are not without risk because the smallpox vaccine uses a
      live virus, vaccinia, a cousin of smallpox, that on occasion can cause brain
      damage or even kill. In the days of wide vaccination, roughly one person in
      a million died.

      The risk may be greater for people with weakened immune systems, like AIDS
      patients or people undergoing chemotherapy.

      The government is seeking more supplies of vaccinia immune globulin, a
      substance now in short supply that can prevent severe reactions in people
      with immune problems as well as the healthy. Officials said 700 doses are in
      hand and 3,000 will be available by the year's end.

      Despite the vaccine's well-known dangers, federal critics have increasingly
      called for various styles of mass vaccination -- including doing it on a
      voluntary or mandatory basis, before or after a smallpox attack.

      At a June 15 public forum in Washington on federal smallpox vaccination
      policy, Dr. Kaplan, of Yale, presented a study done with colleagues from the
      Massachusetts Institute of Technology that described how a smallpox attack
      could affect a crowded metropolitan region like New York City. What began as
      1,000 infections at a train station or airport, he said, would spiral over
      weeks and months into 97,000 deaths if fought with ring vaccination alone.

      "By contrast," he said, "post-attack mass vaccination would result in only
      525 deaths" from the smallpox virus, which takes about two weeks to develop
      in the body before symptoms become obvious.

      Some federal officials call this study unrealistic. But at the meeting, such
      ideas gained force as new evidence came to light on how powdered smallpox
      can be used as a biological weapon.

      Dr. Alan P. Zelicoff, a smallpox expert at the Sandia National Laboratories,
      reported that he and experts from the Monterey Institute of International
      Studies had linked a 1971 outbreak in the Kazakh Republic to a Soviet field
      test of weaponized smallpox.

      Dr. Zelicoff, a physician, quoted a former Soviet official as saying the
      accident occurred when a plume of smallpox germs sailed about nine miles on
      the wind.

      By the meeting's end, medical experts were questioning not only the ring
      plan but also federal assertions that the smallpox threat is low.

      Dr. Kenneth I. Berns, president of the Mount Sinai Medical Center in New
      York City, said he judged the probability that Iraq possessed weaponized
      smallpox as "reasonably high" and that Saddam Hussein would use such germs
      in a war against the United States as "quite high."

      "That's the confounding issue that we all face," Dr. Berns told the forum,
      according to a transcript.

      Frank public discussion of the Iraqi threat, he added, "is absolutely

      In interviews, officials of the Department of Health and Human Services
      declined to comment on federal threat assessments but detailed wide
      contingency planning for mass smallpox vaccinations.

      On June 20, a federal panel known as the Advisory Committee on Immunization
      Practices backed the idea of immunizing some emergency workers before any
      attack. Experts estimated that the immunizations would go to some 15,000
      health care and law enforcement workers who would be most likely to respond
      to a biological attack and come in contact with victims.

      But Dr. Henderson, the health department's senior adviser on bioterrorism,
      said the tentative new plan was for many more to be vaccinated. "We could
      easily be at a half-million without too much difficulty," he said.

      Wide peacetime vaccinations, he said, would help educate not only the
      nation's medical community on the practical aspects of smallpox immunization
      but also the public.

      If the peacetime group suffers a couple of deaths, "there will be a lot of
      publicity and concern," Dr. Henderson said. "It's a question of how people
      are going to respond."


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