An
ambitious smallpox vaccination program should be
put on hold before it is expanded to a large pool
of emergency responders, the influential Institute
of Medicine said Tuesday.
Right now,
the program is still in its so-called phase one,
principally dedicated to nurses and doctors. Phase
two, which states are expected to roll out this
summer, includes first responders, such as
firefighters, police officers and other emergency
personnel.
In its
ongoing review of the national smallpox
vaccination program, the Institute of Medicine, a
branch of the National Academy of Sciences that
advises the government on health care policy, said
the pause is necessary to consider changes to the
strategy.
The Bush
administration launched the program in January. It
was the first time in 30 years that the vaccine
was administered in the United States. The World
Health Organization officially declared the
disease eradicated in 1980. But fear of a
bioterrorism attack led administration officials
to revive the vaccination program.
The
strategy calls for voluntary armies of smallpox
response teams in every state. These would consist
of nurses, doctors and emergency responders
inoculated against the disease. They could sweep
into areas of an outbreak and administer the
vaccine.
As many as
450,000 health care workers have been identified
as potential participants in the first phase of
the program. Another 10 million workers could be
included in the second phase. To date, 36,000
health care workers have been vaccinated.
Administration officials had wanted to have
roughly 50,000 health care workers vaccinated by
now.
Between
January and early May, more than 40 cases of side
effects among vaccinated workers, including
inflamed hearts, were reported to the Centers for
Disease Control and Prevention. Three people have
died. It is unclear if there is a direct link to
the vaccine. The IOM wants the CDC to get a better
handle on the medical complications before
offering the vaccine to a broader universe of
health care workers.
In
addition, the IOM, in a May 23 letter to CDC
Director Julie Gerberding, said it is “imperative”
that national and state public health officials
determine the number of people they need
vaccinated. Health and Human Services officials
have consistently said that they do not have a set
target. Rather, they are leaving it up to the
states to come up with their own goals.
“We are
not pausing the program,” Jerome Hauer, head of
public health preparedness at the Health and Human
Services Department said during an interview
Friday. “The IOM has its opinions. We certainly
understand that. It doesn’t mean that we follow
them. [Secretary Tommy Thompson] has a host of
experts and there is no pause … if health
departments want to vaccinate police and firemen,
they are free to do that.”
The IOM
recognizes that a pause comes with some risks.
“A pause
implies slower vaccination of the number of
responders a jurisdiction may require for
preparedness, a loss of momentum, and perhaps
vulnerability in the event of a potential smallpox
event,” the group’s letter said. “However, given
that the smallpox threat level, as it is publicly
described, has not changed, the committee
continues to believe that the benefits of the
pause likely outweigh the risks. The committee is
aware that some jurisdictions have already begun
offering the vaccine to a wider population of
potential vaccinees, but reaffirms the need for a
pause.”
