Health experts convene for critical smallpox decision

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Posted 6:45PM on Sunday, June 16, 2002

ATLANTA - A small group of health experts will gather in Atlanta this week to answer a question that carries critical weight in the new age of bioterrorism: Who should have access to vaccine against deadly smallpox? The killer virus has not infected a human in more than two decades, and the government's current policy is to vaccinate only the handful of lab workers and scientists who work with smallpox. But Sept. 11 and the anthrax attacks highlighted fears that terrorists could somehow get their hands on smallpox and release it into the public, potentially killing thousands of people and spreading panic. Now the government is debating whether to expand the vaccinations - and if so, who should get the anti-smallpox shots. The Advisory Committee on Immunization Practices, which sets vaccine policy, is expected to make a decision Thursday. In rare cases, the vaccine causes gruesome side effects - including brain damage, rashes and even death. If every American were vaccinated, hundreds of people could die from side effects. ``I would not give that vaccine to my children now,'' said Dr. Paul Offit, chief of infectious diseases at a Philadelphia children's hospital and a member of the panel. Current policy calls for ``ring vaccination'' if a smallpox case is confirmed in the United States. The victim would be isolated, and disease detectives would hunt down and vaccinate people who came in contact with that patient. The panel could vote this week to change that part of the plan expanding vaccinations to the entire community near the outbreak or to the entire nation. But the main question before the panel this week is what steps to take just in case. And that question is a riddle for health officials because no one knows for sure the exact risk of a bioterror attack. ``We're dealing with a disease that's been eradicated,'' said panelist Dr. Natalie Smith, immunization chief for the California state health department. ``It makes it hard for us to weigh the benefits of a vaccine.'' One option is to vaccinate so-called first responders - emergency room doctors and local authorities pre-designated to handle an attack. Another is to offer vaccine to the general public nationwide. A new Gallup poll shows 77 percent of Americans believe everyone in the nation should have a smallpox shot. But health officials fear Americans don't fully understand the risks of the vaccine. ``The vast majority of people immunized would only suffer a sore arm,'' said the panel's chairman, Dr. John Modlin of Dartmouth Medical School. ``But everyone would put themselves at risk of extraordinary but real serious adverse events.'' By early 2003, the government expects to stockpile 286 million doses of smallpox vaccine enough to protect every U.S. citizen in the event of a biological attack. Smallpox was eradicated in 1980. Stockpiles of the virus are known to exist today in only two places at the headquarters of the Centers for Disease Control and Prevention in Atlanta and a similar lab in Russia. Before the 15 members of ACIP make their decision, they will hear two days of presentations on smallpox, the vaccine and the options before them. Their recommendation then goes to Health and Human Services Secretary Tommy Thompson. ``Five or 10 years now, it'll be easy to look back and know what we should have done,'' Offit said. ``What is really the risk? I'm not sure anyone knows that right now."