http://www.nytimes.com/2001/10/18/national/18SMAL.html
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October 18, 2001 U.S. Seeks to Stock Smallpox Vaccine for Whole Nation
By SHERYL GAY STOLBERG
While there are no immediate plans for vaccination, Tommy G. Thompson, the
secretary of health and human services, said today that he was asking
lawmakers for $509 million so that the government could stockpile enough
vaccine to protect everyone in the nation against the potentially lethal
smallpox virus. "I can report to you that it looks very promising that we will have
the 300 million doses by sometime next year," Mr. Thompson told
reporters this evening. He said that he had met with representatives of two
drug companies today, and that he would meet with two others on Thursday. The decision to pursue more stocks of smallpox vaccine came as fears of
attack with another biological agent, anthrax, spread across the country. Mr.
Thompson did not say whether the recent spate of anthrax- laced letters,
including one mailed to Tom Daschle, the Senate majority leader, influenced
his decision. Nor did he say whether the government was aware of any specific threat
involving smallpox. Asked what prompted the policy shift, Mr. Thompson simply
replied, "We thought we should go and see if we could get some other
companies interested in the 300 million doses." The health secretary and President Bush have been discussing bioterrorism
preparedness since the Sept. 11 attacks on the World Trade Center and
Pentagon, said Kevin Keane, a spokesman for Mr. Thompson. Sometime within the
past week, Mr. Keane said, the White House gave Mr. Thompson the go-ahead to
ask Congress to pay for the 300 million doses, so the country could be
prepared for "the worst-case scenario." Unlike anthrax, which is not transmitted from person to person, smallpox
is highly contagious, and Mr. Thompson is clearly aware that it poses a
potential menace. After the Sept. 11 attacks, he named Dr. Donald A.
Henderson, who led the global effort that resulted in the eradication of
smallpox in 1979, to lead a new advisory council on bioterrorism. In June, a war game with the code name Dark Winter showed what chaos could
erupt from a bioterrorist attack involving smallpox. The exercise, at Andrews
Air Force Base, outside Washington, began with a report of a single case of
smallpox in Oklahoma City. By the time it was over, the imaginary epidemic
had spread to 25 states and killed several million people. As it unfolded,
growing grimmer and grimmer, the government quickly ran out of vaccine. Smallpox vaccine can be used not only to prevent infection with the
smallpox virus but also to treat people exposed to the virus, and thus
contain an epidemic. But the United States abandoned smallpox vaccinations in 1972, because the
disease had been virtually wiped out here. The vaccine itself carries serious
health risks: It produced adverse reactions in roughly 1 in 13,000 vaccinated
people, ranging from severe rashes to brain inflammation, which killed about
one person in one million. So experts said that the risk of vaccination was
greater than the risk of getting the disease. On Oct. 3, Mr. Thompson said his agency had negotiated with Acambis Experts say that the chances that terrorists could lay hands on the
smallpox virus — which officially exists now only in government laboratories
in the United States and Russia — are remote. "It's impossible to quantify but I would assess it to be quite
low," said Jonathan B. Tucker, an expert in bioterrorism and the author
of "Scourge: The Once and Future Threat of Smallpox," (Atlantic
Monthly Press, 2001). But smallpox, which kills about one of three people infected with it, is a
particularly worrisome threat because it is easily transmittable. Even those
Americans who have been vaccinated are at risk, because the vaccine's
protection is believed to last only 15 or 20 years. And unlike anthrax, which would require that spores be prepared according
to precise specifications to infect large numbers of people, a smallpox
epidemic could begin with a single infected person — a "smallpox
martyr," in the terminology of bioterrorism experts — simply walking
through a crowd. The two official laboratory repositories for smallpox, one at the Centers
for Disease Control and Prevention in Atlanta and the other at a Russian
government facility in western Siberia, are monitored by the World Health
Organization, and are generally thought to be secure. But, Dr. Tucker said, there are "suspicions that there are undeclared
stocks of smallpox virus in Russia," particularly at a top-secret
virology laboratory under control of the Russian Ministry of Defense. A
federal intelligence report completed in 1998 concluded that clandestine
stocks of smallpox virus probably existed in Russia, as well as in Iraq and
North Korea. The growing fear of bioterrorism has renewed the question of whether
Americans should be vaccinated. Today, a higher proportion of the population
than in the past may run the risk of being harmed by the vaccine. It could
cause serious illness in people whose immune systems are suppressed,
including organ transplant recipients and people with AIDS, a disease that
was not even known the last time Americans were vaccinated for smallpox. So a decision to vaccinate Americans would not be made lightly, and Mr.
Thompson emphasized today that there are no plans to do so. But he did suggest that the government would revisit the question, a
startling comment in and of itself. "Sometime in the future there may be
a discussion that may lead to voluntary vaccination for the smallpox
bug," he said. Should that happen, it would constitute a huge shift in public policy.
Mohammad N. Akhter, executive director of the American Public Health
Association, has been publicly urging the administration to reopen the question
of smallpox vaccination. "My worry is that there will be a case in the U.S., we will rush to
contain it, we will immunize some people but the level of public concern and
the demand will be such that we will not be in a position to make a thoughtful
decision," Dr. Akhter said today. He said the scientific community
needed to "rethink the immunization priority for our people against
smallpox." The renewal of the immunization debate, said Dr. Irwin Redlener, president
of a children's hospital at Montefiore Medical Center in the Bronx,
"makes us really all pause in terms of what has happened to our
country." Dr. Redlener added, "If we have to go back to vaccinating people for
smallpox, we are really about to turn back the hands of time." |
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