Last Updated

06 Dec 2002

Source: Wall Street Journal, May 9, 2002.

HEALTH

Smallpox Vaccine: Who Gets It Is the Subject of Current Debate

By CHAD TERHUNE, Staff Reporter of THE WALL STREET JOURNAL

ATLANTA -- A federal advisory panel is debating whether smallpox vaccinations should be made available to emergency workers and the entire U.S. population in light of the general terrorist threat and an expanded vaccine supply.

Public health officials are revisiting smallpox policy after Sept. 11 and last fall's anthrax attacks raised the possibility that the deadly disease could be used as a biological weapon. National smallpox vaccinations ended in 1971.

Mass vaccinations aren't currently recommended, even if an outbreak occurs. But there has been growing interest in making vaccine available to people who want it and who recognize the vaccine's possible complications, such as serious illness and death.

The advisory panel, made up of about 30 public health officials, researchers and scientists, is meeting in Atlanta through Thursday. The group is expected to file a report to the federal Advisory Committee on Immunization Practices in June on the various steps government may take. Federal health officials are expected to make a decision in the coming months after taking public comment.

Current policy calls for "ring vaccination" that emphasizes isolation of infected patients and vaccinating their families and contacts. Officials at the U.S. Centers for Disease Control and Prevention stressed in the meeting Wednesday that this strategy was successfully used in the global eradication of smallpox by 1980 and proved more effective than mass vaccination. But some worry that an intentional release of smallpox by terrorists would create panic and warrant a more-aggressive action.

"With smallpox, because of its capacity to spread and because of the very low level of immunity in this country, we could face a very serious catastrophe," said D.A. Henderson, an adviser to Health and Human Services Secretary Tommy Thompson and leader of the earlier smallpox eradication effort.

Dr. Henderson said an estimated one million or more emergency-room workers are perhaps most worthy of vaccination now because they would treat highly contagious patients before they are diagnosed.

The CDC has vaccinated about 160 of its staff members who would respond to an outbreak. Researchers have projected anywhere from 285 to 1,437 deaths from widespread vaccinations in the U.S., according to Michael Lane, retired director of the CDC's smallpox eradication program and member of the working group.

Health officials warn that vaccine complications could run higher than previously thought because more people today have weakened immune systems from HIV, cancer treatment and other conditions. Absent a more credible threat of smallpox attack, Dr. Lane said mass vaccination seems "dangerous and silly."

Dr. Henderson said an estimated 10 million police and fire-rescue workers may want vaccination as well as high-ranking government officials. Some in the general public will argue "this is taxpayers' money buying all this vaccine. I should have the right to decide for myself to take this risk or not," Dr. Henderson said. "Where does one stop?"

The government stockpile contains 15 million doses of vaccine that can be diluted to 75 million doses and be effective. The government soon will have an additional 80 million doses that were donated by Aventis Co.'s Aventis Pasteur unit. An additional 220 million doses are being made under a contract with Acambis PLC and Baxter International Inc., and as many as 170 million of those should be available by late September, Dr. Henderson said.

--Sarah Lueck contributed to this article.