NYTimes.com Article: U.S. to Vaccinate 500,000 Workers Against Smallpox

[Guest guest]

This article from NYTimes.com

has been sent to you by mlmj75@....

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

July 7, 2002

By WILLIAM J. BROAD

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. A. , senior science adviser to Tommy G.

, the secretary of health and human services, said

in an interview. Dr. , 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 said.

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.

, 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 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 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. , 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 vaccination.

" 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. 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.

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

absolutely essential. "

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. , 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.

said. " It's a question of how people are going to respond. "

http://www.nytimes.com/2002/07/07/national/07SMAL.html?ex=1027056330 & ei=1 & en=bf3\

20b745594c8b4

HOW TO ADVERTISE

---------------------------------

For information on advertising in e-mail newsletters

or other creative advertising opportunities with The

New York Times on the Web, please contact

onlinesales@... or visit our online media

kit at http://www.nytimes.com/adinfo

For general information about NYTimes.com, write to

help@....

Copyright 2002 The New York Times Company