U.S. Divided
on Smallpox Policy
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Oct 5, 12:17 PM (ET)
By LAURA MECKLER
WASHINGTON (AP) - The Bush administration plans to offer the smallpox
vaccine to the general public, but officials weighing the risk of the
vaccine against the risk of bioterror remain divided over how quickly to
act.
Top federal health officials want a staged process in which the vaccine
would not be offered to the public until it is fully licensed, probably in
early 2004. Some top Bush administration officials, including Vice President
Dick Cheney, are pushing for a more aggressive policy, to include
vaccinating much of the nation quickly, even while the vaccine remains an
experimental drug.
The White House will make the final decision but has not done so yet.
The first batch of shots will be licensed in November, but it will be
more than a year before enough licensed vaccine is available for mass
inoculation.
Health officials who direct the bioterrorism preparedness program said
Friday they support a staged process whereby the vaccine would be offered
first to those facing greatest risk of encountering a highly contagious
smallpox patient, mostly staff in hospital emergency rooms.
Other health care workers, police, fire and eventually the general public
would follow.
A senior White House official, speaking on condition of anonymity,
confirmed that plans are to offer the vaccine to the general public and said
that might happen on a quickened schedule, within weeks.
The official said the program would be accompanied by a massive education
program to convince people that the vaccine's benefits outweigh its risks,
which are rare but serious, sometimes fatal.
A second White House official reflected the views of the health
officials, saying the vaccinations would be offered, but much more slowly.
The smallpox decision is a difficult one. An attack could be devastating:
the virus kills one-third of its victims. But the vaccine's risk must be
weighed against the possibility that no attack will come.
Just a few months ago an advisory committee said shots should go only to
a handful of people working in state smallpox response teams and at select
hospitals.
Since then, the possibility of war has increased with Iraq, which experts
fear has smallpox germs that could be released in an act of bioterror.
Smallpox has not occurred naturally in the United States for a
half-century, and routine vaccinations ended 30 years ago. Officials aren't
sure how much protection remains for adults vaccinated as children.
Using the those-most-at-risk-first preference of health officials, about
500,000 people would take the vaccine in the opening phase.
In the next phase, the vaccine would be offered to about 10 million,
including all other health care workers plus emergency responders such as
police and fire who would be involved in responding to attack.
At some point after that, the vaccination would be offered to the public.
Just a year ago, the nation had only 15.4 million doses of vaccine, but
there now is enough for every American. None of the new batches has been
licensed by the Food and Drug Administration. Absent that, vaccinations
would require a lengthy procedure ensuring that people understand and accept
the risks.
Dr. Julie Gerberding, director of the Centers for Disease Control and
Prevention, said Friday that health officials "very much" favor waiting
until the vaccine is licensed, though they will support whatever final
decision is made.
Dr. Anthony Fauci, director of the National Institute for Allergy and
Infectious Diseases, noted that it's possible that Bush will opt to speed up
the timetable.
Studies from the 1960s suggest that 15 of every million people getting
vaccinated for the first time will have life-threatening complications, and
one or two will die.
The smallpox vaccine is effective for a few days after exposure to the
disease. Officials also are preparing plans for mass vaccination within a
few days should an attack occur, a prospect considerably more complicated
than vaccinating people in advance.
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On the Net: Centers for Disease Control and Prevention smallpox page:
http://www.bt.cdc.gov/agent/smallpox/index.asp |