UF professors dispute need for vaccinations |
Beginning in January, county and state public health
officials will begin to carry out the Bush administrationŐs plan to
vaccinate 10.5 million medical personnel and emergency responders against
smallpox.
Should the federal government decide to proceed with the final stage of
those plans, scheduled for 2004, as many as 10 million Floridians might be
eligible for voluntary vaccination against smallpox.
The question will then become: Should they get vaccinated? While some say we
need to aggressively prepare and move forward with the vaccinations due to
the current state of global affairs, two University of Florida researchers
argue that people may want to hold off before getting the shot.
"We conclude that vaccinating the general public should not
occur until after a smallpox attack has been documented, and even then
limited to those who have been exposed to the patients infected in the
initial incident," said John Paling, a courtesy scientist of environmental
toxicology at UF.
The perceived need to vaccinate any private citizen is basically,
fundamentally flawed, according to Dr. Parker Small, a professor in the
department of pathology, immunology and laboratory medicine in UF's College
of Medicine.
Small was a charter member of the national vaccine advisory
board appointed by President Reagan. He has spent over three decades
researching and teaching about vaccines.
"People living outside of a major metropolitan area will have more chance of
winning the Florida Lottery than of getting infected with smallpox," Small
said.
And that's assuming that there has been a terrorist attack, he said.
Small has joined forces with Paling to assess the relative risks of dying
from smallpox and of dying from the vaccination, both in those under the age
of 30 who have never been vaccinated, and those over 30 who were probably
vaccinated before.
"We already have people in our lives who are scared of
smallpox," Paling said. "They are concerned about two conflicting risks, and
each has to make their own decision about getting the vaccine.
"One question is can I possibly be infected directly, and the other, if I
volunteer for the vaccination, what if I suffer or perhaps die because of
it? That's why this information on risk is so valuable; it is balancing fear
from the gut with solid numbers."
A former junior professor of biology at Oxford University
and an Emmy Award-winning wildlife filmmaker, Paling has devised what he
describes as "a Richter scale for risks" that has been widely used in
different settings, including health care. In assessing the risks from
smallpox, he has applied Small's data to his own perspective scale.
Small explains that if somebody is exposed to smallpox in an initial attack
of bioterrorism, they will not know it until about two weeks later, when
they develop a fever, profound malaise, headache and backache. After about
three days, they begin to develop a facial rash characteristic of the
disease.
"That first wave we expect to occur in a major metropolitan
area or an airport," Small said. "Other than those caught in that first
wave, everybody else will know when they have been exposed and will have
ample time and opportunity to be totally protected by post-exposure
vaccination.
"They will know that they have been exposed because they have been a
caretaker for a bedridden, very sick person who has begun to develop the
facial rash," he said.
With smallpox, patients are not infectious until after the
rash has begun to appear.
Smallpox is not so easy to catch, even if you have been exposed, he said.
Only about two-thirds of the unvaccinated people living in the same room or
caring for a smallpox patient will come down with disease.
The next issue to be considered, Small said, is a question of whether you
have been previously vaccinated. If you are over 30, you have been
previously vaccinated. If you are under 30, you almost certainly have not.
If there's any question, you can look for the characteristic smallpox scar,
usually on the left upper arm.
If you have been previously vaccinated, you have seven days
after exposure to get revaccinated and still be totally protected. If you
have not been vaccinated, you will have two or three days after exposure to
be vaccinated and be totally protected.
Dr. John Agwunobi, secretary of Florida's Department of Health, said state
public health officials have prepared plans "to protect Floridians against
the potential threat of smallpox and mitigate the consequences that could
result from an intentional release of this disease."
"Given the current status of the war on terrorism and other
potential global events, we continue to believe it is prudent to
aggressively prepare," he said.
As Alachua County health director, Tom Belcuore has the responsibility of
carrying out the vaccination program.
"I support the process that we are taking. As the operations unit, we are
going to provide the services," Belcuore said.
Belcuore points out that with any vaccination program, you have a balance of
seeing live disease and its outcomes as opposed to the consequences of
vaccination.
But that's not the case with smallpox, which has been
eradicated worldwide.
"No one remembers the consequences of the disease, so as a result, what you
are concentrating on are adverse reactions to the vaccine," Belcuore said.
If you are confronted with smallpox being unleashed in an act of
bioterrorism, then all discussions of the pros and cons of vaccination
become moot, the health director added.
Fifty or a hundred years ago, there was a tremendous benefit that more than
exceeded the risk of vaccination, Small contends. Now there is no risk of
smallpox until there is an attack, Small said, "but the risks involved in
mass vaccination are very real.
"Two or three people per million will be expected to die,
and between 15 and 50 will have life-threatening illness. At least 30
percent will miss a day's work because of fever and malaise. Those are real
risks, and where there is no benefit, the risk/benefit ratio is shifted
totally," he said.
The physician concludes, "One of my biggest fears is that a mass vaccination
program will decrease the appropriate faith that this nation has in our
current safe, effective vaccines. That will ultimately lead to more
morbidity and mortality than smallpox.
"The bottom line is very clear," Small said, "especially if you are one of the 200 million people living outside of the major metropolitan areas that might be targeted -- don't get vaccinated."
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