by Lee Bowman
Scripps Howard News Service
March 03, 2005
At the end of 2002, the government launched a voluntary smallpox vaccination program with a goal of inoculating up to 500,000 civilian doctors, nurses and other health-care workers. Once protected, these professionals could in turn vaccinate and care for the rest of the population if smallpox were used as a bioterrorism weapon.
Fewer than 40,000 have answered the vaccination call. But extensive training and planning have been done around the country to prepare for a smallpox threat, and the government continues to stockpile vaccine, including newer lines with fewer side effects.
Smallpox was eradicated worldwide by vaccination campaigns in 1979. The remaining known virus samples are kept under tight security in the United States and Russia. But bioterrorism experts have warned for years that terrorists might find a way to use the virus as a weapon by stealing a sample or tapping some unguarded natural source.
Even so, federal health officials cited no imminent specific threat when they made "an extraordinary policy decision to vaccinate people against a disease that does not exist with a vaccine that poses some well-known risks," said the Committee on Smallpox Vaccination Program Implementation in a final report. The panel was set up through the Institute of Medicine of the National Academies at the request of the federal Centers for Disease Control and Prevention.
As a result, "skepticism among key constituencies was followed by a lack of buy-in," the committee said.
Health officials already knew that the vaccine carried risks of adverse reactions, particularly an increased risk of heart problems, including heart attacks. In incidents linked to the vaccinations through April 2003, two women died from heart attacks, seven had heart attacks or angina and 25 others experienced lesser cardiac events.
Dr. Brian Strom, head of the committee and a professor of biostatistics and epidemiology at the University of Pennsylvania, said that questions were repeatedly raised about the vaccine's safety. But, he added, "the perception of state and local public health officials and the clinical community was that CDC was constrained from speaking from its usual sense of scientific authority and that ultimately hurt the perception of the program in that community."
While conceding that open communication may be difficult when classified information and national-security considerations are involved, "science has to be key and federal scientific agencies must be free to speak from science accordingly" in any future effort.
Strom said that "it's an unfortunate reality that similar efforts to prepare for bioterrorist threats may be needed in the future" and that the committee hoped the lessons learned from the smallpox campaign can help federal officials overcome the challenge of selling the need for public health measures without compromising security.
He stressed that the panel was not calling the smallpox campaign a failure. "Preparedness is not just about numbers. We do think preparedness was improved through these efforts. We have talked to hospitals around the country that could still be considered well-prepared to deal with a smallpox outbreak and still did not have a single worker vaccinated.
"The question is, has preparedness improved enough, and we don't know, because the government has never worked with state and local partners to set what accomplishments and markers should be used to determine what 'enough' is."
On the Net: www.national-academies.org
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