AFTERMATH OF TERROR

Health Officials Support Smallpox Shots for Public

By SARAH LUECK, Staff Reporter of THE WALL STREET JOURNAL

WASHINGTON -- Top federal health officials have come out in favor of allowing Americans worried about bioterrorist threats to receive smallpox vaccinations voluntarily.

In their first public comments about who should be vaccinated in advance of any possible smallpox attack, officials on Friday outlined one scenario: Starting as soon as next month, roughly 500,000 health-care workers could be offered vaccinations, with as many as 10 million police, firefighters and other emergency personnel next in line for the shots.

Then, after the inoculation of those viewed as having the greatest chance of coming into contact with smallpox cases in an emergency, "our thinking is in favor of making the vaccine available for the general public" sometime in 2004, said Julie Gerberding, director of the Centers for Disease Control and Prevention.

The final decision about who should be vaccinated in advance of a smallpox outbreak hasn't been announced by the White House, and the health officials who spoke about the issue Friday were careful to say they didn't know what it would be. The scenario they laid out would provide enough time to use smallpox vaccine licensed by the Food and Drug Administration because using unlicensed vaccine would be logistically more complex and present difficult liability issues. In an emergency, they said, there is already enough unlicensed smallpox vaccine to protect the public, and they could use unlicensed vaccine before an outbreak if the White House called on them to do so.

Health experts have struggled with how to balance the risk of the smallpox vaccine with rising concern about the possibility that smallpox could be used as a biological weapon. Dr. Gerberding said there might be 15 serious, life-threatening complications per one million people who get the vaccine, including one to two deaths. But, "we won't know until we do it," she said, because the data are old and may not reflect the current U.S. population. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, said about 30 million to 50 million people in the U.S. are at greater risk for adverse reactions to the vaccine.

The Defense Department requested enough smallpox vaccine from the national stockpile for one million troops. Those doses are expected to be available by the end of the month or early November, said Jerome Hauer, assistant secretary for emergency health preparedness at the Department of Health and Human Services. Defense Department officials are "coordinating" a vaccine policy with the White House, HHS and the State Department, said Defense Department spokesman James Turner. He wouldn't give further details.