- WASHINGTON (Reuters Health)
- Several experts urged federal officials on Tuesday to implement a broad
shift in government policy that would include voluntary, preemptive smallpox
vaccination for most US citizens.
-
- The plan would also include federal laws requiring healthcare
workers and other 'first responders' to a biological attack to be vaccinated
against smallpox.
-
- The comments come as federal officials prepare to decide
later this month how to use the hundreds of millions of doses of smallpox
vaccine the government is stockpiling. The government is currently purchasing
massive amounts of stored and newly-manufactured vaccine from private companies
and is also busy making diluted vaccine from existing stores.
-
- In all, officials say they expect to have more than 300
million vaccine doses available by the end of the year. The Advisory Committee
on Immunization Practices at the Centers for Disease Control and Prevention
(CDC) is scheduled to meet at the end of June to help the agency finalize
a program for how and when the vaccine will be distributed.
-
- The CDC is expected to endorse its current policy of
withholding vaccination from the public unless smallpox cases begin to
surface. In the event of a biological attack with smallpox, health officials
would identify and vaccinate anyone who came into recent contact with an
infected person, forming a "ring of immunity" around cases.
-
- The method was effective in eradicating naturally occurring
smallpox during the mid-20th century. The policy today could go one step
further, calling for mass vaccinations of entire metropolitan areas where
cases occur, but not vaccinations of whole states or regions.
-
- But experts speaking at a forum on smallpox vaccination
hosted by the Cato Institute, a conservative think-tank, said it would
fail miserably against a human-engineered attack.
-
- "In brief, it's a plan that probably cannot work,"
said William J. Bicknell, a professor at the Boston University School of
Public Health. The US population is too mobile and too densely packed to
allow the ring vaccination method to work, he said. Assailants could easily
spread the virus in several cities simultaneously, distributing smallpox
in a way that might overwhelm hospitals and health systems, he said.
-
- Bicknell urged officials to consider allowing adults
to opt for the vaccine voluntarily before an attack occurs. The policy
would allow millions of Americans to be immunized against smallpox and
would help prevent panic if an attack occurs, he said.
-
- "I think (the government) can do a lot better than
sitting on the stockpile," said Charles Pena, a senior policy analyst
with the Cato Institute.
-
- The argument against preemptive vaccination centers on
the risk of side effects. For every million people that are vaccinated,
scientists expect about three persons to die from complications--mainly
children and people with weakened immune systems. The risk could be reduced
by barring such individuals from obtaining the vaccine, experts suggested,
and those that do take it could be required to sign informed consent agreements
stating that they accept the risks.
-
- These measures did reassure Dr. Jonathan Tucker, of the
Monterrey Institute for Nonproliferation Studies. Tucker warned that even
a few deaths blamed on voluntary smallpox vaccination would turn millions
of frightened people against the idea of vaccination in the event of an
actual attack.
-
- "Doing it too early would result in a political
backlash that would make it impossible to vaccinate at a later time when
the threat is clear and present," he elaborated. "The general
public is just not used to that level of risk."
-
- Tucker pointed out that a smallpox threat has been "conspicuous
in its absence" from the recent rash of government terrorist alerts,
suggesting that the overall risk of an attack is lower than the known risk
of vaccination.
-
- Still, at least one expert argued that neither voluntary
inoculations nor government-run ring vaccinations would work against a
sophisticated attack using smallpox virus modified to increase infectivity.
"Immunize everyone as soon as possible," said Dr. Richard Levinson,
of the American Public Health Association.
-
- He believes that an education campaign needed to inform
people about the risks of voluntary vaccinations would be "marked
with massive disinformation" on the Internet and on television. Relying
on ring vaccination is risky because terrorists are likely to exploit regional
or organizational weaknesses in America's public health infrastructure.
-
- The CDC is currently holding public forums on the issue
in four US cities. After that, the agency plans to release its proposals
for how to use the vaccine in the event of an attack. Experts agreed that
a final decision is unlikely to rest with the physicians and public health
experts who usually set vaccine policy.
-
- "Unfortunately, this is a political decision that
will be made at a high political level," Tucker said.
-
- Copyright © 2002 Reuters Limited. All rights reserved.
Republication or redistribution of Reuters content is expressly prohibited
without the prior written consent of Reuters. Reuters shall not be liable
for any errors or delays in the content, or for any actions taken in reliance
thereon.
|
