EXPERT DEFENDS SMALLPOX VACCINE PLAN
10 Feb 2003
Source: Minneapolis Star Tribune, February 10, 2003
Minnesota bioterrorism expert defends smallpox vaccine plan
Maura Lerner, Star Tribune
Prof. Michael Osterholm says he's not surprised that some hospitals and health workers are getting cold feet about the smallpox vaccine.
But as one of the architects of the national smallpox plan, he thinks the critics are a bit shortsighted -- especially hospitals that want to wait until there's an outbreak to vaccinate their employees.
"I can guarantee you that if smallpox were to hit anywhere in the world today, there would be a mad rush for smallpox vaccine," said Osterholm, a University of Minnesota professor who is now a leading bioterrorism adviser to the Bush administration.
Osterholm has watched in frustration as a growing number of hospitals nationwide have opted out of the first phase of the vaccine program, scheduled to begin in Minnesota in the next two weeks.
What began as a resistance movement at few hospitals has spread across the country, largely because of concerns about the vaccine's side effects and the possible risk to employees and patients.
As of Thursday, only 687 volunteers in 16 states had been vaccinated, according to the U.S. Centers for Disease Control and Prevention.
In Minnesota, officials expect up to 2,700 volunteers to be vaccinated -- a fraction of earlier predictions; and 24 of 66 eligible hospitals have said no.
Osterholm, though, says many underestimate the risk of not offering the vaccines to hospital workers.
"I don't care if the only smallpox case in the country is in New York City," says Osterholm, the former Minnesota state epidemiologist. "Tens of thousands of people will rush into emergency rooms . . . thinking they have it."
If no one there is vaccinated, he warns, hospitals could be overwhelmed. "It will be the perfect storm," he said.
For years, Osterholm has been trying to mobilize the medical world to prepare for the threat of terrorist attacks with smallpox or other deadly agents. In 2000, he published a book called "Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe."
Now, he has the federal government on his side. He's been an adviser to Tommy Thompson, U.S. secretary of Health and Human Services, since shortly after the Sept. 11 attacks. He also heads the Center for Infectious Disease Research & Policy at the University of Minnesota.
He helped design the three-phase smallpox plan -- to vaccinate up to 500,000 health workers now, up to 10 million others at a later date and eventually to offer the vaccine to the entire population, all on a voluntary basis.
But as the starting date has neared, the voices of dissent have grown louder. The big fear is that the vaccine, while it cannot cause smallpox, can have serious side effects, from flulike symptoms to potentially deadly infections. Even those who haven't been vaccinated can get sick through close contact with someone who has.
Last month, North Memorial Medical Center in Robbinsdale became the first large Minnesota hospital to announce that it was opting out of the vaccine plan.
"This was a medical decision," said Dr. Mark Berg, medical director of employee health services at North Memorial. A team of doctors, nurses and administrators decided that the vaccine posed an unnecessary risk to both patients and staff, Berg said.
"It didn't seem to offer us a lot of advantages to go ahead with this," he said. The vaccine, he noted, works even if it's given after someone has been exposed to smallpox. So the hospital has concentrated instead on preparing staff members to handle a possible outbreak.
"Let's say smallpox showed up in the community today," Berg said. "What would we do?" Staff members would put patients in isolation rooms and do "whatever was appropriate medically." And then? "Everybody who was potentially exposed would be immediately vaccinated," he said. "We vaccinate all our staff within a couple of days."
Osterholm says that's easier said than done. "I believe in a situation where you have many people coming in with possible smallpox, there will be people who are literally running from the facility," he said. That will include some unvaccinated employees, he predicts.
"That's human nature," he said. During that first 48 hours, he said, every hospital in Minnesota will have its hands full even if the closest case of smallpox is 1,000 miles away.
"We're going to need everyone we can who's willing to stay on the front lines," Osterholm said. "Make no mistake, even if we vaccinate all these health care workers ... we are still going to have a catastrophic event. But it's an event we now can manage [better] than if we had no preparedness at all."
Berg, of North Memorial, sees it differently. Even if dozens of people were vaccinated ahead of time, he said, "we'd still be faced with the same issue. We'd have to vaccinate everybody [else] post-event."
He adds that smallpox isn't the only type of bioterrorism hospitals have to worry about. "This is just one of many potential threats," he said. "It doesn't seem we should be spending all of this attention on one potential threat."
What happens next, both sides agree, will depend on how well the first group of volunteers tolerates the vaccine.
So far, no side effects have been reported by any of the 687 health workers who have been vaccinated so far this year, according to the CDC.
At the same time, tens of thousands of military personnel have been vaccinated since December. Last week, the Defense Department reported the first two possible cases of serious reactions; both individuals are said to have recovered.
"I salute those people who are going to be vaccinated. It's a sacrificial act," Berg said. "Once people can see how it goes, everybody's going to re-evaluate, for or against."
Said Osterholm: "We've got to do it safely. At the same time, we are up against the tension of time. Every day we don't have a smallpox case somewhere in the world is a gift. But I don't know that it couldn't be tonight."