If outbreak strikes, state will vaccinate thousands in days

By Bill Scanlon, Rocky Mountain News
November 16, 2002

With Colorado and the nation on heightened terrorism alert, health officials here are making plans to vaccinate hundreds of thousands of people within four days of a smallpox outbreak.

Money is short and training isn't completed, but Colorado could survive a dump of weaponized smallpox with minimal casualties, said Colorado's chief medical officer Dr. Ned Calonge.

Colorado's plan for mass vaccination will be delivered by next month's deadline to the Centers for Disease Control and Prevention, Calonge said.

Some 7,000 nurses have volunteered to be trained to inoculate residents in the event of a smallpox outbreak, Calonge said.

If the outbreak happens before they're trained, "We'll train them on the run," he said.

Here's how the scenario might play out:

• Smallpox, which hasn't been seen in Colorado since 1948, is detected in one or a handful of residents here. It sparks a national alert, because it can easily be passed from person to person and can have a mortality rate as high as 30 percent.

• The National Pharmaceutical Stockpile is alerted and within 24 hours a 747 airliner brings enough vaccine to inoculate hundreds of thousands of people.

• Local health officials start vaccinating the victims' contacts and the contacts of those contacts, but there's a good chance that they'll decide that they'd better vaccinate a whole town or a whole county.

• If so, people will be told to gather in a gymnasium or at a fairgrounds - not at a hospital.

• Residents also will be told they don't all have to rush - that they have four days to get the vaccine. That's because the virus grows in the body more slowly than do the antibodies that the vaccine sparks into action.

In addition to nurses, the state is looking into asking paramedics, retired doctors, dentists and veterinarians to volunteer to administer the vaccines. "There's no rocket science behind giving this," Calonge said.

Smallpox poses the greatest challenge because it can be transmitted person to person, he said.

"If we can get smallpox done, we'll be prepared for other potential agents, whether it's anthrax or something else," said Calonge.

President Bush will decide in the next few months whether to call for vaccination-after-outbreak or a pre-outbreak vaccination program for all 280 million Americans.

Dr. Steve Cantrill, emergency physician at Denver Health, prefers the pre-outbreak plan.

"But many health care providers are completely opposed to it," Cantrill said. Smallpox vaccines can cause serious complications in about three people per million, and doctors worry that if 280 million Americans are vaccinated, hundreds could die.

Cantrill argues that vaccines before the outbreak can be given in a more organized fashion.

The federal government has asked for bioterrorism control help from hospitals and health departments, but "not much money has come to the bottom level," Cantrill said. "I hope that can be rectified."

So does Larry Wall, executive director of the Colorado Health and Hospital Association.

Wall estimates that Colorado's 70 acute-care hospitals need a combined $200 million to prepare for bioterrorism. So far, the feds have given $1.9 million to Colorado hospitals and might give about $3 million next year.

Hospital officials have told Wall they especially need federal help with protective equipment, decontamination facilities, drugs, education and training and reliable communication systems.

"Hospitals will absolutely be there and respond as well as they can," Wall said.

But there are problems, he said. If Denver hospitals get an influx of 500 victims of bioterrorism, it would be very taxing. "The capacity just isn't there," he said.

For one thing, there aren't anything near 500 vacant hospital beds in metro Denver.

scanlon@RockyMountain News.com or (303)892-2897