http://seattlepi.nwsource.com/national/99573_smallpox12.shtml
Thursday, December 12, 2002
Smallpox vaccine will be available to all, Bush says
Voluntary shots for civilians will follow orders for
military to be inoculated
WASHINGTON -- President Bush said yesterday he will make the smallpox vaccine available to all Americans on a voluntary basis to guard against a bioterrorist attack.
As a first step, the president will order military personnel to begin getting smallpox vaccinations and will launch a plan to offer the vaccine to emergency medical workers and response teams within weeks, senior administration officials said.
Health officials in Washington state yesterday said they will ask about 7,000 hospital and public health workers to get the vaccine and be prepared to serve on the front line in the event of an outbreak.
"We want to vaccinate the smallest number of people needed to get the job done," said Dr. Maxine Hayes, state health officer.
Because of the complex safety requirements for administering the vaccine and the risk of serious side effects, Hayes said, the idea is to strike the best balance between preparedness and protecting individual safety.
Though many public health officials have argued against widespread general vaccination, the White House said the public will be offered the vaccine as soon as large stockpiles are licensed, probably early in 2004. Bush will announce his plan tomorrow.
Smallpox was declared eradicated in 1980, but experts fear that it could be used by hostile nations or terrorist groups in an attack. Intelligence experts believe that four nations, including Iraq, have unauthorized stocks of the virus.
Bush, who struggled with the decision for months, had to weigh the dangers of the disease against the risks associated with the vaccine.
He talked about the broad outlines of his plan yesterday on ABC's "World News Tonight."
"I think it ought to be voluntary," Bush said of the civilian part of the plan. "It's going to be very important for us to make sure there's ample information for people to make a wise decision."
First lady Laura Bush, asked whether she would want her 21-year-old twin daughters inoculated against smallpox, replied:
"If the vaccine were available, which I think it will be, I would feel like that was certainly safe for them to do. . . . I know there's a slight risk -- that's what people will weigh when they make the decision whether or not to have their children vaccinated."
The decision represents remarkable progress since summer, when federal health advisers were recommending a much more limited vaccination program, perhaps totaling 15,000 to 20,000 people. Those plans scaled up quickly amid concerns about war with Iraq.
Bush is expected to recommend smallpox vaccinations for about 500,000 emergency workers and smallpox-response teams that would investigate suspected cases. The White House officials said a similar number of military personnel would be ordered to get the shots.
Hayes and other Washington state public health officials met with reporters to describe some of the details of the plan and the rationale behind it. What nobody could answer was why the federal government, after about a year or studying the issue, suddenly demanded all the states submit smallpox vaccination plans. Just before Thanksgiving, the federal Centers for Disease Control and Prevention told states they had a week to submit their plans.
"Nobody's been told why the rush," said Dr. Jeff Duchin, communicable disease officer for Public Health -- Seattle & King County.
But thanks to an already established dialogue on disaster planning involving the public health community, hospitals, emergency-response teams and the military, all involved were able to submit a plan.
The next step will be to ask for volunteers and screen people for vaccine-related health risks.
Federal health officials are considering a national television ad campaign as part of an effort to help people decide whether to be vaccinated against smallpox.
Polls, including one released yesterday, show most people would get the vaccine if given the chance. But health officials fear that many people do not adequately understand the risks.
"This is not like the flu vaccine," Hayes said.
It has more serious risks, she said, and people who get vaccinated will have to restrict their contact with others to avoid the possibility of infecting them with the vaccine.
The smallpox vaccine uses a live vaccinia virus, a relative of cow pox, that can cause serious health problems in people with skin disorders or compromised immune systems.
"The success of a vaccination program is going to depend on our success in communicating with people accurately and openly," said Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention. That includes explaining the risks of the disease -- and of the vaccine.
Once the vaccination program is announced, officials will begin targeting information to the public. Among the options are TV ads, Gerberding said.
It wasn't clear whether all military personnel being deployed to the Gulf region for possible war with Iraq would receive the shots.
Eventually, the vaccine will be made available to all Americans, though the government will probably not encourage them to get it, according to senior officials.
Unlike for most vaccines, the smallpox vaccine can be given up to four days after exposure to the virus. This is largely what allowed for the eradication of the disease -- a strategy called "ring vaccination" in which all of those in proximity to a person with smallpox are vaccinated to stop the spread.
Routine smallpox vaccinations ended in the United States in 1972, meaning nearly half the population is without any protection. Health officials aren't sure whether those vaccinated decades ago are still protected from the disease.
The new vaccine would be offered in stages, beginning with those most likely to encounter a smallpox patient. That includes people on state response teams, who would investigate cases, and people who work in hospital emergency rooms.
In a second phase of vaccination, the shot could be offered to other health care workers and emergency responders such as police, fire and emergency medical technicians. Federal officials probably will recommend the shot for these roughly 10 million people, too.
The officials are working with states and hospitals to identify those who most need to be inoculated.
The vaccine has risks. Based on studies from the 1960s, experts estimate that 15 of every 1 million people vaccinated for the first time will face life-threatening complications, and that one or two will die.
Reactions are less common for those being revaccinated.
Using these data, vaccinating the nation could lead to nearly 3,000 life-threatening complications and at least 170 deaths.
P-I reporter Tom Paulson contributed to this report from The Associated Press.
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PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.