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Last Updated

14 Jul 2003

Source: Washington Post, July 14, 2003


Smallpox Fiasco

TO DATE, THE ADMINISTRATION'S biggest commitment to biodefense has been its smallpox vaccination campaign. Launched last December with great fanfare, the first phase of the campaign aimed to vaccinate about 450,000 health workers, all volunteers. As many as 10 million people were to have been vaccinated in a second phase. The initial goal was to have enough immune people on hand to care for the ill and to vaccinate -- quickly -- those who were not yet sick, in case of a smallpox outbreak. The administration collected and distributed enough vaccine for every American in a remarkably short period.

But that feat, as it turned out, was not enough. Although a spokesman for the Department of Health and Human Services insists on describing the vaccination program as a "success," fewer than 40,000 civilians have been vaccinated. This is not due to technical or logistical difficulties: In a far shorter period, the military managed to vaccinate 450,000 people while simultaneously preparing many of them to fight a war in Iraq. Nor was the vaccine itself at fault: The military experience revealed the vaccine to be less dangerous than the decades-old evidence had suggested.

Analyzing what went wrong with the civilian program, insiders and outsiders point in part to the government's mistakes and in part to the political and even psychological resistance of the doctors and nurses who were meant to carry out the vaccinations. Health workers say the government failed to consult widely enough with hospital administrators and doctors, who, short-staffed already, feared the vaccination program would prove too costly and take staff away from other tasks. The administration's initial failure to propose compensation for health workers who were made seriously ill by the vaccine helped fuel a union-led revolt against the program. And because the program was launched on the eve of the Iraq war, many concluded that it was part of a Bush administration propaganda campaign and declined to participate on political grounds.

At base, the problem was one of priorities: The administration, wrapped up in its war with Iraq, did not convey a sense of urgency about the possibility of a smallpox outbreak (and has been even less vocal about the threat since the war ended). The medical community did not take on board the real possibility of a smallpox outbreak. The result, in the words of Michael Osterholm, an independent epidemiologist who has served as an HHS adviser, is that the nation is not at a level of even "minimal preparedness." In the event of a smallpox outbreak, unvaccinated health workers and others might flee hospitals -- as their Chinese counterparts did during the SARS outbreak -- and panic could break out as the public demanded immediate vaccinations.

Is this scenario a real possibility? If government officials think so -- and some say they are convinced that smallpox remains a threat -- then they need to educate the public, and the medical community in particular, with more dedication. Stockpiling vaccines is not enough if people are not willing to use them, and 40,000 volunteers are not enough if 10 times as many would be required to provide even minimal protection.