Officials Work to Meet Deadline for Smallpox Vaccinations

By DIANE CARDWELL

ew York City health officials are finishing proposals for giving smallpox vaccinations as a federal deadline for its plan approaches.

Earlier this year, states and some large cities received federal grants for bioterrorism-preparedness programs; they are to submit plans by Dec. 9 for dealing with any threat from smallpox. At the same time, the Bush administration has struggled to decide who should have access to the vaccine for smallpox, which was declared eradicated globally in 1980.

Advertisement

Some federal officials favor a blanket approach, in which the vaccine would be available to everyone, while others have suggested a staggered approach, in which health care workers and others most likely to be on the front lines of fighting a potential outbreak would be inoculated first.

Mr. Bush is widely expected to offer the vaccine to some members of the military and about 500,000 health care workers, but the issue of whether to offer it to ordinary Americans as a precaution is unresolved.

Bush administration officials said a few days ago that the president was nearing a decision and that it appeared likely that he would announce at least parts of the federal policy this month. That could occur as early as this week, according to city officials.

Tomorrow, New York health officials will submit a plan for responding to a smallpox outbreak, said the city's health commissioner, Dr. Thomas R. Frieden. The plan will include guidelines for health officials and for hospitals with any patient suspected of having smallpox. It will also include instructions for how to isolate those infected, how to investigate the source of infection and how to deal with laboratory specimens.

The Health Department plans to meet the Dec. 9 deadline for submitting its inoculation program.

"We continue to await an announcement from the federal government of what they will be recommending in detail," Dr. Frieden said, "but some of the broad outlines are clear."

One plan calls for the city to inoculate medical workers first, because they would treat smallpox patients, an official said. What remains to be determined is how many police officers and emergency medical technicians will be in that pool.

It has not been determined whether the vaccine will be available to the general public, but officials said it appeared unlikely that it would be included in the first wave.

The decision about whom to vaccinate is complicated by the small amount of the government's stockpile of the vaccine that is licensed by the Food and Drug Administration, which typically licenses any vaccine to be made available to the general public. In addition, the vaccine is not without health risks. It is potentially fatal, and is not recommended for pregnant women, eczema sufferers or people with suppressed immune systems, like those who are H.I.V. positive or receiving chemotherapy. And because it is a live vaccine, it is also not recommended for family members of people with those conditions, Dr. Frieden added.

"It's really a sad testimony to the world that we live in that here in the 21st century we are contemplating the reintroduction of smallpox as a bioterror weapon," Dr. Frieden said.