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Smallpox Vaccinations
Considered For Entire US

By Julie Sevrens Lyons and Lisa M. Krieger
San Jose Mercury News
4-1-2

In a major shift in public health policy that underscores government concerns about bioterrorism, federal health officials are gathering enough smallpox vaccine to inoculate the entire country and are considering a widespread vaccination campaign.
 
By December, according to public health leaders in Washington D.C., the U.S. government will have more than 100 million doses of the vaccine in hand, an amount they say could be effectively diluted to make the shots available to everyone in the country. An inoculation effort using the sometimes risky vaccine would be new to millions of Americans born after the United States stopped offering the shots in 1972.
 
Public health leaders stressed Thursday that discussions of any vaccine campaign are preliminary, and that the decision to get the shots would be voluntary.
 
But the announcement represents a significant shift. Restarting vaccinations in advance of any outbreak, raised as a possibility in prominent medical journal articles and at a news conference, runs counter to current federal plans calling for using the vaccine stockpile only after an outbreak.
 
"There's an assumption the risks associated with the vaccine may not be worth it," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "But there might be a lot of people who feel they're willing to take that risk. It's important to hear that."
 
Risky Vaccine
 
Those risks are well-documented. Smallpox is deadly, and was largely eradicated worldwide only by a massive public health effort. But the current vaccine is also dangerous, expected to cause hundreds of deaths and sicken thousands more if it is offered on a large scale.
 
But top government health officials said Thursday that reinstating the smallpox immunization program after 30 years is something the country must consider -- and the decision should not be made in a vacuum. Nor is the United States alone. The Russian Health Ministry said Tuesday it was also considering resuming vaccinations against smallpox.
 
For months, the government has been debating internally whether the public should have access to the vaccine once there are sufficient supplies, sources said.
 
But Thursday, the government's top health officials said the discussion should be taken to congressional hearings and town hall meetings across the nation, to get public input on a topic with sweeping implications.
 
"I think it would be productive and healthy to have an open dialogue," Fauci said.
 
The Sept. 11 attacks and the anthrax mailings have heightened worries about a bioterrorist releasing smallpox. Because many people have never been vaccinated, it would be an attractive bioweapon.
 
Although there is no evidence that such an attack is imminent, government officials have been seeking to secure a civilian stockpile of 286 million doses -- enough to vaccinate the entire U.S. population in the event of an outbreak.
 
Vaccine Available
 
The government already has 15.4 million doses, which can be diluted up to five times, producing 77 million effective doses, according to two studies published Thursday by the New England Journal of Medicine.
 
The stockpile will include a 155 million-dose order from BioReliance of Rockville, Md., and an earlier 54 million-dose order with the company, which Fauci said should all be available by year's end.
 
The government is also negotiating to buy at least 70 million doses recently discovered in a drug company's freezers. If that supply can be acquired quickly, and holds up to dilution, it is conceivable there will be enough vaccine for every American soon.
 
"Now we have to have the discussion of how aggressive we recommend vaccinating this country," said Dr. Martin Fenstersheib, Santa Clara County's health officer. "And we have to be very cautious."
 
While the smallpox vaccine rarely produces severe side effects, when it does, they can be fatal. People with AIDS, eczema or organ transplants would be most likely to suffer serious consequences and would be encouraged not to receive vaccination.
 
But even in healthy adults, headaches, fever, muscle aches, chills, nausea, fatigue and rashes are common during the first two weeks after inoculation, according to one of the new studies, carried out by researchers at Saint Louis University. While those side effects were considered minimal, a third of the more than 675 people who got the vaccine missed work, school, sleep or recreational activities because of it.
 
"This is a particularly dangerous vaccine compared to those we use routinely," said Dr. Edward W. Campion, senior deputy editor of the New England Journal of Medicine.
 
Death Estimate
 
The death rate for smallpox vaccination in healthy adults is about one per million, meaning an estimated 180 people would die if all American adults were vaccinated. Many more people with compromised immune systems such as AIDS patients would also die if they received the vaccine.
 
While tragic, this is fewer than the number of Americans killed in car wrecks every two days. And it is far fewer than the hundreds of thousands of people who would likely die if an outbreak occurred in America and the population wasn't immunized.
 
"I see many benefits and small risks," said Dr. Bill Bicknell, a professor of public health at Boston University School of Public Health, who is calling for a nationwide vaccination campaign.
 
Every person infected with smallpox could conceivably spread the disease to as many as 20 or 30 other people, who would in turn quickly spread it to others, Bicknell said. Containing the disease by vaccinating the public only after an outbreak occurs would be chaotic, short-sighted and nearly impossible, Bicknell said.
 
Bioterrorism experts believe smallpox would be a weapon of choice because it is so easily spread, undetectable until days after an attack with no known cure.
 
While health departments across the country have been scrambling to prepare for such a possibility, only one-fourth have bioterrorism preparedness plans in place, according to Tom Milne, executive director of the National Association of County and City Health Officials.
 
Administering hundreds of thousands if not millions of doses on an emergency basis would be a logistical nightmare if a smallpox outbreak were to occur now. Many experts believe administering the vaccine over time on a voluntary basis would be much easier.
 
"We're not ready, although the degree of readiness varies from community to community," Milne said.
 
Contact Julie Sevrens Lyons at jlyons@sjmercury.com or (408) 920-5989.
Contact Lisa M. Krieger at (408) 920-5565.
http://www.bayarea.com/mld/bayarea/news/nation/2957038.htm
 
 
 
Comment
 
From Alan Ritter
4-3-2
 
I just finished reading the article on the impending smallpox vaccinations and the possible fallout from this. I would like to point out, in fairness of course, that the "threat" comes from two places and two places only (according to the U.S. government): the U.S. Government and the Russian Government. According to the US government, the two governments are the only people or places that have the virus at all, in large quantities I might add. HUGE. So, it stands to reason that if an "outbreak" occurs it is either our own people that are responsible or the Russians. No Al Queda zealot has it. They just can't have it, where would they have got, Walgreens?
 
This fact was not covered in the article at all? Why did they not report that the only stockpiles of the "eradicated" virus are stored within the confines of the Military Industrial Complex (no conspiracy stuff here, this is their own propaganda spewed forth after last September)? Why do they have it, and a lot of it? If we wiped it out over the last 30 years, ( I personally have a scar to prove I was hit with the vaccine) why do we suddenly, now, need to protect us against it? Why not simply just take our STOCKPILE and trash it, and ask the Russians to do the same? And end it all like civilized people.
 
The answer to this question might be found if one digs a little deeper then the press releases coming from the government itself. MONEY. Look there first. Who stands to profit from a mass vaccination and how much will they stand to make? It won't be free, either we will be forced to pay for it on our own, 100 million doses at say 50 dollars a piece for "life saving piece of mind" or some propaganda like that, do the math. That is all profit. You also mentioned that many will die, check to see who will die (add up those who are at risk, elderly and AIDS folks and others, how about cancer stricken folks on heavy chemo therapy who's immune systems are shot to pieces already), your total will be a lot more than 180 and whose parents or children are going to be the ones chosen to die for the good of all? Who, knowing they are at risk from taking the vaccine, will be asked to do it anyway? Further, who is going to deal with all the sickness resulting from this? A standard flu outbreak taxes the local hospitals and Dr.'s offices' as it is, this will positively break the system.
 
"Reporters" need to do a bit more "reporting" and less shilling for the pentagon. This is what I came up with, just reading what was logically missing from the article. I didn't look into anything. Please people, do a bit more leg work here. The rule you reporters seem to ignore, which should be the first rule followed these days is, "Who Stands To Profit From This." After that is established, then things will be clear. The next rule should be, get off your ass and do some real leg work.
 
Cheers, ADR


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