States Urged To Revise Smallpox Plans

May 2, 2003

WASHINGTON(AP) -- Federal health officials, acknowledging they will fall short of initial goals for smallpox vaccination, want states to revise inoculation plans to take into account budget pressures and people's reluctance to be vaccinated.

The updated plans are to integrate the immunizations into larger efforts to prepare for a possible bioterrorism attack. Congress has approved nearly $1 billion to help states put their plans in place; that money will go out after the state blueprints are approved.

States are supposed to figure out what is needed to handle an outbreak of the contagious, fatal disease, including new calculations of how many front-line workers should get the vaccine now, a top federal health official said Thursday.

The federal government had a goal of vaccinating about 450,000 health care workers in hospitals and public health departments during the first 30 days of the program, which began in January. In the second stage, some 10 million other people, including emergency responders and other health care workers, would get the vaccine.

"The bottom line is we're not at 450,000" people, said Joe Henderson, who heads the Centers for Disease Control and Prevention's bioterrorism preparedness effort. "That just can't be seen as a realistic target at this point," he told an Institute of Medicine committee that is reviewing the vaccination program.

After three months, fewer than 35,000 people have been inoculated.

Ever since President Bush announced the aggressive immunization plan in December, officials at the state and local level have questioned whether the threat of a smallpox attack was serious enough to risk the vaccine's rare but serious side effects.

In a comment typical of local officials, one member of the panel, Dr. Russell Alexander of the University of Washington, derided the Bush plan as "not being driven by science but by political considerations."

Now, with the war in Iraq essentially over and no biological weapons yet discovered in that country, many people are more skeptical about the need for large-scale vaccination.

"Isn't it time to make a strong statement that there is no credible threat and work toward ending this vaccination campaign before further physical and financial harm are done?" said Dr. Franklyn Judson of the Denver public health department, where just 39 people have been vaccinated.

The federal government has no intention of ending the program, but the CDC is asking states to reassess their plans. Henderson outlined those plans, which are being sent to states by Monday.

States are supposed to develop comprehensive programs for controlling a smallpox outbreak including surveillance systems designed to catch the first case, reporting systems to keep track of an outbreak, staff training, materials to communicate with the public and plans to practice the entire system.

As is, fewer than half the states say they are ready to vaccinate their entire populations within 10 days should the virus return, according to a survey released Thursday by the Association of State and Territorial Health Officers.

States also are supposed to recalculate the number of vaccinated health care workers for smallpox response teams needed during the first stage of the program.

Despite the lukewarm response during the first stage, states are being asked to move ahead with the next phase. It targets emergency responders and doctors, nurses and other health care workers outside hospitals.

States have complained they lack the money to vaccinate all these people. But now that the vaccinations are being folded into the larger bioterrorism program, which is funded with federal dollars, it will be up to states to balance their financial needs, Henderson said.

The more people they choose to vaccinate, he said, the more it will cost.

"The vaccination component may be downsized," he allowed. "It's up to them to tell us how many individuals they need."

States and local health officials welcome the shift.

"It's a matter of recognizing that one size does not fit all," said Mary Selecky, president of the state health officers' group and health secretary for Washington state. "There's a natural tension between goals and plans and actuality."

The institute is part of the National Academy of Sciences, a private organization chartered by Congress to advise the government of scientific matters.