States' Smallpox Vaccine Plans Vary

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States' Smallpox Vaccine Plans Vary

Tue Dec 10, 3:48 PM ET

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By LAURA MECKLER, Associated Press Writer

In Georgia, health officials sketching plans for smallpox vaccinations are

starting small ‹ fewer than 500 people will be offered the shots at first.

But in nearby Louisiana, officials plan to offer it to as many as 20,000.

Weighing the risks of the shot against the risk that the disease will

return, states vary widely in their planning for smallpox, an Associated

Press survey finds. Yet all of them face the same challenge: educating

people about a vaccine not given in this country for three decades.

States, cities and territories were supposed to submit their plans for the

first stage of smallpox vaccinations by Monday to the federal government,

and 44 of 62 projects met the deadline. Others are expected in coming days.

Variations among the states stem partly from the fact that each state is

making its own guess about the chances of smallpox reappearing more than 20

years after it was declared eradicated, said Dr. Rex Archer, director of the

Kansas City, Mo., health department.

The vaccination plans were ordered because of concern that hostile nations

and possibly terrorist groups have the virus and could unleash it in an act

of bioterrorism.

Immunizations will begin soon after a presidential announcement, which could

come this week. After that, states have been told they'll have 30 days to

deliver the shots.

The first group to be offered the vaccine will include those most likely to

encounter a highly contagious smallpox patient: people on special smallpox

response teams ‹ who would investigate suspicious cases ‹ and workers in

hospital emergency rooms.

Nationwide, about a half million people are expected in this group, but the

AP survey of states suggests that these shots are not likely to be evenly

distributed across the country.

In the Louisiana plan, the vaccine would be offered to one in every 220 to

300 residents. In South Carolina, New Jersey and West Virginia, officials

would wind up vaccinating twice that ‹ about one in every 500 to 600

residents. At the same time, in Georgia, the vaccine would be offered to

just one in every 17,000 to 28,000 residents.

" We want to start small and make sure we do it right, " said Dr. Blake,

the Georgia state epidemiologist. State officials fear that if they move too

quickly, they might wind up vaccinating people with compromised immune

systems, skin problems or other factors that make the vaccine particularly

risky. People also shouldn't get the vaccine if they live with others who

have these conditions because the live virus in the shot can spread to

people who come into close contact with the person vaccinated.

Overall, experts estimate that the vaccine will kill one or two out of every

million people being vaccinated for the first time, and 15 will suffer

life-threatening side effects.

" The more people you immunize, the more chances you are going to have for

serious reactions, " Blake said.

In Michigan, the state plans to offer the vaccine at only about 30

hospitals, whereas twice that are expected to participate in Montana. " We

don't necessarily need it in every corner or at every hospital, " said

Geralyn Lasher of the Michigan Department of Community Health.

In North Dakota, the state's vastness and lightly populated rural areas make

it important that all hospitals are capable of helping a smallpox victim,

said Tim Wiedrich, bioterrorism coordinator for the North Dakota Health

Department.

" We really believe that it's likely that smallpox patients could present

themselves at any of our hospitals, " he said.

Federal officials plan to review each plan and make sure it is

comprehensive, said Jerry Hauer, the top bioterrorism official at the

Department of Health and Human Services (news - web sites). He said he's not

concerned by the variation.

" We wanted to give them that flexibility, " he said.

Some say the variation among the states is likely to even out after

vaccinations begin, with some states asking for more vaccine and others

winding up with extra.

Plans being submitted to the Centers for Disease Control and Prevention

(news - web sites) address a wide range of details about the first phase of

smallpox vaccinations. States were asked to explain who would be offered the

shots, timelines and locations for delivering them and a plan for ensuring

that those at particular risk of severe side effects do not get vaccinated.

Once the vaccinations begin, states will be required to keep detailed track

of how many people suffer reactions, with reports due twice a week to the

CDC.

The major question being debated within the White House is how fast to

proceed in offering the shot to the general public.

There is widespread agreement, though, on the first stage of vaccinations.

Federal officials had said that about a half million people were expected in

this first group, though they now expect the numbers to be slightly lower.

They now estimate that up to a half million will be offered the shots, but

that some of them will decline to be vaccinated and others will be screened

out because of conditions that make them susceptible to dangerous side

effects.

A second stage is likely to cover other health care workers and first

responders, totaling as many as 10 million people nationally.

As they begin vaccinating, federal and state authorities will mount an

education campaign to help people decide whether to get the shot.

In the end, each person will be forced to consider the same questions Bush

and other top federal officials have been struggling with for months, said

Dr. Jimmy Guidry, state health officer for Louisiana.

" It boils down to an individual perception, " he said. " Is this risk real or

not? "