Smallpox Smallpox Vaccine Guidelines Readied
Emergency Plan To Cover All of U.S.
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___ Guide ___
Personal Preparedness Guide
Dirty
bombs, anthrax and smallpox: An informative guide for to
understanding the threat and protecting you and your family.
By Ceci Connolly
Federal health officials will issue detailed guidelines today for
vaccinating the entire U.S. population against smallpox within five days of
an outbreak of the dreaded disease.
Intended as a blueprint for state and local health officials nationwide,
the unprecedented move reveals a growing belief within the Bush
administration that even one case of smallpox anywhere in the Western
Hemisphere would signify a terrorist assault and should therefore trigger a
far more massive response than officials had previously suggested, said two
experts involved in the planning.
The manual being sent to health commissioners in the 50 states and the
District of Columbia offers advice on how to operate mass vaccination
clinics -- from logistical issues such as parking to the medical challenge
of treating severe side effects. It offers suggestions on utilizing the
National Guard, recruiting translators, building intricate data systems and
contending with extreme weather conditions.
For now, the Bush administration does not anticipate inoculating the
nation's 288 million residents -- partly because the threat of an attack is
unknown and partly because the vaccine can cause severe, sometimes fatal,
side effects. The vaccination plan would be activated only if an outbreak of
the deadly disease occurred, an event administration officials characterize
as unlikely but not impossible.
"This is a very detailed, thoughtful recipe for response" to a bioterror
incident, said Michael Osterholm, a public health expert at the University
of Minnesota who is advising the federal government. Using the template,
states and cities should be able to devise plans "for vaccinating the
largest amount of people in the shortest time possible," he said.
Smallpox has not been seen in the United States for decades, and the
disease was declared eradicated worldwide in 1980. Still, it is perhaps the
most feared biological weapon because it is contagious and often incurable,
and can kill at least one-third of its victims. Since routine vaccination
was halted in this country in 1971, there is little immunity left in the
population and little expertise in dealing with the disease or vaccine.
Only the United States and Russia are known to possess stocks of the
virus, but security experts fear a hostile nation such as Iraq may have
acquired a cache of the virus. Vice President Cheney has contended the risk
of attack may necessitate inoculating every American as a protective
measure.
"One of the real concerns about Saddam Hussein, as well, is his
biological weapons capability," he said recently on NBC's "Meet the Press."
"The fact that he may, at some point, try to use smallpox, anthrax, plague,
some other kind of biological agent against other nations, possibly
including even the United States."
Ten months ago, Health and Human Services Secretary Tommy G. Thompson
signed a $428 million contract to buy a dose of vaccine for every American.
Production is under way, and the United States already has stockpiled nearly
100 million doses.
Federal experts since have been working furiously on two tracks: a
vaccination program for the emergency medical workers most likely to see an
initial case of smallpox, and a mass vaccination plan if an attack occurs,
said Julie L. Gerberding, director of the federal Centers for Disease
Control and Prevention.
"We have to be able to do both," she said in a recent interview.
Pre-vaccination, as it is known in public health, would be targeted to
medical personnel, who could respond to an attack knowing they are
protected. Plans are underway to begin vaccinating tens of thousands of
"first responders," perhaps by the end of this year.
There have been no plans to make the vaccine available to the public in
the absence of any cases. But officials have been debating what would be the
best response to an outbreak. Last winter, the CDC released a blueprint for
containing a smallpox outbreak based on the "ring vaccination" strategy used
during the campaign to eradicate the disease. Ring vaccination involves
starting with the people closest to an exposure and working out in
concentric circles.
There is growing recognition, however, that although that approach worked
well for a naturally occurring outbreak during a time when air travel was
rare, it would be no match for a terrorist with the ability to release the
virus in several locations simultaneously, said Jerome M. Hauer, acting
assistant secretary for HHS's Public Health Emergency Preparedness.
"You begin with ring vaccination, but in a big outbreak obviously mass
vaccination would be part of the plan," he said. Federal officials are
requiring states to develop plans for vaccination within five days, he said,
because it is widely believed that even if a person has been exposed to the
virus, a vaccine given in that time frame will provide immunity.
Administration officials refused to release the manual until state health
commissioners receive it. But in interviews with The Washington Post,
several described the scenario for responding to a smallpox attack.
At the first hint of a smallpox case, the CDC in Atlanta would begin
dispatching emergency teams to the area to confirm the outbreak and begin
vaccination.
Yet the suspicion that terrorists would strike more than one location
"would require us to be in many, many places simultaneously," one federal
planner said. "That would completely deplete our assets."
Instead of sending its staff to every corner of the country, the CDC
plans to ship the vaccine and let states handle inoculation, Osterholm said.
The National Pharmaceutical Stockpile, he said, "can be at any hamlet in
this country in 12 hours." Officials have not said how much it would cost or
how it would be paid for.
HHS has received assurance that even if air traffic were halted, as it
was immediately after the Sept. 11 attacks, planes transporting vaccine
would have clearance. Vaccine would be delivered in waves much the way a
grocery store receives its weekly shipment of milk in batches.
The manual, which is almost 100 pages, was developed in consultation with
local health officers, medical societies, the military and businesses such
as UPS and Federal Express that have logistical expertise, said an adviser
to Thompson. Much of its contents was based on previous large-scale
vaccination programs, such as the 1995 meningitis outbreak in Mankato,
Minn., in which 26,000 people were inoculated in four days.
Each state must determine where vaccination clinics would be located, who
would staff them, how to counsel people on the potential risks of
vaccination and, most important, how to move hundreds of thousands of people
through the process calmly and quickly. Some communities might select large
shopping malls or sports arenas because of parking availability;
metropolitan centers might rely on buses and subways to bring people to
clinics.
States will need provisions for everything from inclement weather to the
person who faints at the sight of a needle, Osterholm said. "Are you going
to have a line stretching 21/2 blocks in the snow or blistering heat?" he
said, describing one challenge.
The guidelines urge states to address the need for bathrooms,
transportation, a media strategy and a medical questionnaire, as well as how
to separate and treat potential smallpox cases. They also include sample
consent forms if states must administer an unlicensed vaccine. Two
administration sources said they hope the vaccine soon will be re-licensed.
Although bioterrorism is a new challenge, large vaccination campaigns are
not, Osterholm said. "The public health system delivers vaccine to our
nation's children every day, overcoming language, transportation and
financial hurdles," he noted.
Aside from an assumption that some health care workers will be vaccinated
before an attack, the document does not resolve enormous questions
surrounding that issue.
Last month, Thompson sent recommendations to the White House on how many
people should be inoculated in advance. Although a CDC advisory panel has
recommended vaccinating about 20,000 medical personnel, several
administration sources said President Bush is weighing a proposal on the
order of 500,000 people.
"Until a decision is made on pre-vaccination," Hauer said, "our efforts
continue to focus on bioterrorism detection and response."
© 2002 The Washington Post Company
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