UF PROFESSORS DISPUTE NEED FOR VACCINATION
30 Dec 2002
Source: Sarasota Harold-Tribune (Florida), December 30, 2002
UF professors dispute need for vaccinations
BY DIANE CHUN, NYT REGIONAL NEWSPAPERS
Beginning in January, county and state public health officials will begin to carry out the Bush administrations's plan to vaccinate 10.5 million medical personnel and emergency responders against smallpox.
Should the federal government decide to proceed with the final stage of those plans, scheduled for 2004, as many as 10 million Floridians might be eligible for voluntary vaccination against smallpox.
The question will then become: Should they get vaccinated? While some say we need to aggressively prepare and move forward with the vaccinations due to the current state of global affairs, two University of Florida researchers argue that people may want to hold off before getting the shot.
"We conclude that vaccinating the general public should not occur until after a smallpox attack has been documented, and even then limited to those who have been exposed to the patients infected in the initial incident," said John Paling, a courtesy scientist of environmental toxicology at UF.
The perceived need to vaccinate any private citizen is basically, fundamentally flawed, according to Dr. Parker Small, a professor in the department of pathology, immunology and laboratory medicine in UF's College of Medicine.
Small was a charter member of the national vaccine advisory board appointed by President Reagan. He has spent over three decades researching and teaching about vaccines.
"People living outside of a major metropolitan area will have more chance of winning the Florida Lottery than of getting infected with smallpox," Small said.
And that's assuming that there has been a terrorist attack, he said.
Small has joined forces with Paling to assess the relative risks of dying from smallpox and of dying from the vaccination, both in those under the age of 30 who have never been vaccinated, and those over 30 who were probably vaccinated before.
"We already have people in our lives who are scared of smallpox," Paling said. "They are concerned about two conflicting risks, and each has to make their own decision about getting the vaccine.
"One question is can I possibly be infected directly, and the other, if I volunteer for the vaccination, what if I suffer or perhaps die because of it? That's why this information on risk is so valuable; it is balancing fear from the gut with solid numbers."
A former junior professor of biology at Oxford University and an Emmy Award-winning wildlife filmmaker, Paling has devised what he describes as "a Richter scale for risks" that has been widely used in different settings, including health care. In assessing the risks from smallpox, he has applied Small's data to his own perspective scale.
Small explains that if somebody is exposed to smallpox in an initial attack of bioterrorism, they will not know it until about two weeks later, when they develop a fever, profound malaise, headache and backache. After about three days, they begin to develop a facial rash characteristic of the disease.
"That first wave we expect to occur in a major metropolitan area or an airport," Small said. "Other than those caught in that first wave, everybody else will know when they have been exposed and will have ample time and opportunity to be totally protected by post-exposure vaccination.
"They will know that they have been exposed because they have been a caretaker for a bedridden, very sick person who has begun to develop the facial rash," he said.
With smallpox, patients are not infectious until after the rash has begun to appear.
Smallpox is not so easy to catch, even if you have been exposed, he said. Only about two-thirds of the unvaccinated people living in the same room or caring for a smallpox patient will come down with disease.
The next issue to be considered, Small said, is a question of whether you have been previously vaccinated. If you are over 30, you have been previously vaccinated. If you are under 30, you almost certainly have not. If there's any question, you can look for the characteristic smallpox scar, usually on the left upper arm.
If you have been previously vaccinated, you have seven days after exposure to get revaccinated and still be totally protected. If you have not been vaccinated, you will have two or three days after exposure to be vaccinated and be totally protected.
Dr. John Agwunobi, secretary of Florida's Department of Health, said state public health officials have prepared plans "to protect Floridians against the potential threat of smallpox and mitigate the consequences that could result from an intentional release of this disease."
"Given the current status of the war on terrorism and other potential global events, we continue to believe it is prudent to aggressively prepare," he said.
As Alachua County health director, Tom Belcuore has the responsibility of carrying out the vaccination program.
"I support the process that we are taking. As the operations unit, we are going to provide the services," Belcuore said.
Belcuore points out that with any vaccination program, you have a balance of seeing live disease and its outcomes as opposed to the consequences of vaccination.
But that's not the case with smallpox, which has been eradicated worldwide.
"No one remembers the consequences of the disease, so as a result, what you are concentrating on are adverse reactions to the vaccine," Belcuore said.
If you are confronted with smallpox being unleashed in an act of bioterrorism, then all discussions of the pros and cons of vaccination become moot, the health director added.
Fifty or a hundred years ago, there was a tremendous benefit that more than exceeded the risk of vaccination, Small contends. Now there is no risk of smallpox until there is an attack, Small said, "but the risks involved in mass vaccination are very real.
"Two or three people per million will be expected to die, and between 15 and 50 will have life-threatening illness. At least 30 percent will miss a day's work because of fever and malaise. Those are real risks, and where there is no benefit, the risk/benefit ratio is shifted totally," he said.
The physician concludes, "One of my biggest fears is that a mass vaccination program will decrease the appropriate faith that this nation has in our current safe, effective vaccines. That will ultimately lead to more morbidity and mortality than smallpox.
"The bottom line is very clear," Small said, "especially if you are one of the 200 million people living outside of the major metropolitan areas that might be targeted -- don't get vaccinated."