Panel struggles with question of who should get smallpox vaccine

By

Posted 8:26PM on Wednesday, June 19, 2002

ATLANTA - Forced to make scientific policy based on an unclear threat, a government panel struggled Wednesday with whether to make smallpox vaccine available to more people to guard against a bioterror attack. The Advisory Committee on Immunization Practices, which makes vaccine recommendations to the federal government, appeared to favor offering anti-smallpox shots to teams that would respond first to an outbreak. The shots are given now only to federal scientists assigned to work closely with the virus. But exactly who qualifies as a first responder such as specialists at hospitals or federal, state and local bioterrorism authorities remains unclear. The panel is expected to make a final decision Thursday. It appears unlikely the panel will choose to offer smallpox vaccine to any member of the general public who wants it. The vaccine can cause hideous, sometimes deadly side effects. In an informal vote Wednesday, none of the panel's 15 members favored making the vaccine available nationwide. Figuring out exactly who should get the vaccine is difficult because health officials say they don't have any way to gauge exactly how likely a smallpox attack might be. ``We know we have enemies with the intent to inflict harm,'' said Dr. John Modlin, the panel's chairman. ``We know we are vulnerable. What we don't know is what the capability of these individuals may be.'' Plans to have enough smallpox vaccine to cover every American by the end of this year are on track, said Dr. James LeDuc of the Centers for Disease Control and Prevention. If terrorists did release smallpox, current policy calls for ``ring vaccination'' a search-and-contain plan of isolating the victims and giving shots to people who came in contact with them. The panel could vote Thursday to change that part of the policy, too, recommending citywide or nationwide vaccinations after an attack. Dr. Don Millar, a former CDC smallpox official who was asked to make the case for widespread vaccines to the panel, said the public is frustrated because it is receiving mixed messages about the bioterrorism threat. ``You should demand that the administration should put up or shut up on smallpox bioterrorism,'' he told the panel. If the threat is real, he said, ``the current policy to withhold vaccine from the public makes no sense.'' Health officials have been extremely wary of doing that because the vaccine can cause severe side effects, especially in children and people with immune diseases. If the entire U.S. population were vaccinated, hundreds of people could die from the side effects. Thousands more could develop brain swelling and widespread rashes. Smallpox experts who spoke before the panel stressed that the virus is fairly easy to recognize, and that health officials would have plenty of time up to several weeks to contain an outbreak. If a case of smallpox were confirmed, widespread media attention would make possible exposures easy to track down, said Dr. Mike Lane, a consultant to CDC's National Immunization Program. ``Cases would come, demanding, knocking on the doors of the health department,'' he said. Smallpox was declared eradicated more than two decades ago, and the virus is known to exist in only two places a government lab in Atlanta and a similar one in Russia. But experts fear it could fall into terrorist hands. The panel's decision will go to the Centers for Disease Control and Prevention and to Health and Human Services Secretary Tommy Thompson for approval. Those offices typically approve ACIP recommendations without asking questions, but members of the panel concede the bioterrorism issue makes this recommendation unpredictable.