Smallpox Vaccine Decision Ahead

ATLANTA- The question carries critical weight in the new age of bioterrorism: Who should have access to vaccine against deadly smallpox?

The killer has not infected a human in more than two decades, and the federal government's current policy is to vaccinate only the handful of lab workers and scientists who work with the virus in high-security laboratories.

But Sept. 11 and the anthrax attacks heightened fears that terrorists could somehow get their hands on smallpox and release it, potentially killing thousands of people.

This week, a panel of 15 health experts meets to debate whether to expand the vaccinations - and then decide who would be included. The Advisory Committee on Immunization Practices, which sets vaccine policy, is expected to make a decision Thursday. The panel's recommendation will go to Health and Human Services Secretary Tommy Thompson.

In rare cases, the vaccine itself causes devastating side effects - including brain damage and even death. If every American were vaccinated, hundreds of people could die from side effects.

"I would not give that vaccine to my children now," said Dr. Paul Offit, a member of the panel and chief of infectious diseases at Children's Hospital of Philadelphia.

At a smallpox conference Saturday in Washington, Dr. Anthony Fauci, chief of infectious diseases at the National Institutes of Health, told scientists and health officials the vaccine is one of the least safe around, although clearly a lifesaver if smallpox makes a comeback.

Wild smallpox was eradicated in 1980. Samples of the virus are known to exist in only two places - the headquarters of the Centers for Disease Control and Prevention in Atlanta and a similar lab in Russia.

The United States ended routine smallpox vaccinations in 1972, and current U.S. policy calls instead for "ring vaccination" if a smallpox case is confirmed. The victim would be isolated, and disease detectives would track down and vaccinate people who had been in contact with the patient.

The advisory committee could decide to recommend changing that part of the plan, expanding vaccinations to the entire community near an outbreak or to the entire nation.

But the main question before the panel this week is what precautionary steps to take. And that question is a riddle because no one knows for sure the exact risk of a bioterror attack.

"We're dealing with a disease that's been eradicated," said panelist Dr. Natalie Smith, immunization chief for the California state health department. "It makes it hard for us to weigh the benefits of a vaccine."

A Gallup poll released this month found 77 percent of Americans believe everyone in the nation should have a smallpox shot. But health officials fear the public doesn't fully understand the risks of the vaccine.

"The vast majority of people immunized would only suffer a sore arm," said the panel's chairman, Dr. John Modlin of Dartmouth Medical School. "But everyone would put themselves at risk of extraordinary but real serious adverse events."

Whatever the panel decides, by early 2003, the government expects to stockpile enough doses of smallpox vaccine to protect every U.S. citizen in the event of a biological attack.

"Five or 10 years now, it'll be easy to look back and know what we should have done," Offit said. "What is really the risk? I'm not sure anyone knows that right now."

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On the Net:

CDC information: http://www.bt.cdc.gov/Agent/Smallpox/SmallpoxGen.asp

Advisory Committee: http://www.cdc.gov/nip/acip

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