Last Updated

14 Jun 2003

Source: Washington Post, December 19, 2001.

VACCINATION EDITORIAL

Double Exposure

HAVING REPEATEDLY reassured postal workers and other nervous Americans that they were at no risk of contagion from anthrax, only to back away from those reassurances, health authorities are now rushing to err in the opposite direction. Yesterday Health and Human Services Secretary Tommy Thompson decided that about 3,000 people with direct or intensive known exposure to anthrax should have the opportunity -- though not the obligation -- to take an anthrax vaccine on top of the already recommended 60 days of antibiotics. This is a sharp departure not only from past recommendations but also from the vaccine's intended use: It was invented for preventive use well before exposure, not after, and has been used that way by veterinarians and the military. Victims of anthrax exposure thus are taking part in an experiment; those who choose to do so will be tracked in a study and will have to sign informed-consent agreements.

To ask people already struggling with the emotional fallout of anthrax exposure to make the complicated medical decision to join a clinical study is to impose a tremendous burden. It will fall most heavily on postal workers who, as union officials have pointed out, already suffer several disadvantages. They mostly fall outside the population of young, healthy males on whom most experience with the vaccine has been compiled. (A few studies suggest that the vaccine's side effects are worse in women, and no studies have been done on people with diabetes, transplants or other risk factors.) They also are less likely than congressional staffers to have access to the kind of top-notch medical care that could give them guidance on the decision whether to take the vaccine, continue the antibiotics or do neither and simply monitor their health closely. Fairness demands not only that postal workers at Brentwood or elsewhere get equal access to the available doses; even more important, the government must provide medical guidance and monitoring.

In deciding to offer the option of vaccination, public health officials are seeking to guard against a risk they admit is slim and theoretical: the risk that some exposure victims might have spores still dormant in their lungs that could germinate sometime after 90 days. No such case in humans has ever been seen, and only one monkey study suggests it's possible; in that study, the vaccine-plus-antibiotic combination did confer added protection. But of the 10,000 people put on antibiotics in October and November, not one has developed anthrax; nor has anyone who discontinued the antibiotics early, as many appear to have done. To enter an experiment as a human subject is not a decision to be taken lightly, even with a vaccine that, like this one, has shown no serious safety problems. Access to the vaccine option must not translate into pressure to take it. Otherwise, those on what turned out to be anthrax's front line are being twice victimized.