Federal Health Officials Address Questions About Mass Vaccination for Smallpox
HHS Secretary Tommy Thompson and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, at a press conference yesterday addressed the debate over whether the smallpox vaccine should be made available to the public for mass vaccinations, the New York Times reports. According to the Times, Thompson noted that current plans call for "ring containment" in the event of a bioterrorist attack -- a process of vaccinating only those people who have come in contact with the disease or with others who have been exposed. According to Fauci, ring containment, which was endorsed by the CDC in November, is a "proven method" of stopping the spread of smallpox. Furthermore, Fauci said ring containment is preferable to mass vaccinations because of the risks inherent in taking the vaccine, including death and "serious side effects" such as fevers, headaches or "extensive" rashes (Grady, New York Times, 3/29).
However, the Los Angeles Times reports that Thompson, while noting that he still supports the CDC's recommendations, said, "There is certainly discussion [concerning mass vaccinations] going on ... and that discussion will continue as further doses of the vaccine (are) made available." Fauci added, "Any time you do have an open discussion [on mass vaccinations], you almost by definition open the door for reconsideration as things evolve" (Ornstein/Garvey, Los Angeles Times, 3/29). Furthermore, in a New England Journal of Medicine editorial released yesterday, Fauci wrote, "Despite the fact that mass voluntary vaccination is not recommended in the CDC plan, there are many who would like to have the opportunity to make their own decision about smallpox vaccination." Fauci continued, "[T]he strongest argument for preemptive mass vaccination is that it would eliminate smallpox as an agent of bioterrorism. Accordingly, it would eliminate the disarray, confusion and panic that would most likely accompany simultaneous attacks at multiple locations" (Fauci, New England Journal of Medicine, 3/28). Fauci, at the press conference, said "If there was absolutely no toxicity to the smallpox vaccine, there would be very little debate about having people vaccinated, because you could essentially eliminate the threat. That, unfortunately, is not the case" (New York Times, 3/29). The Boston Globe reports that naturally occurring smallpox was eradicated from the human population more than 20 years ago. However, U.S. intelligence officials fear that some "terrorists or authoritarian regimes," including North Korea, Iran or Iraq, may have "weaponized" supplies of smallpox, prompting fears about a "global bioterror threa[t]" (Mishra, Boston Globe, 3/29). Fauci's editorial is part of a group of eight articles in the New England Journal of Medicine outlining the risks and benefits of mass smallpox vaccination. All eight articles can be found online. Note: You must have Adobe Acrobat Reader to view these articles.
Meanwhile, the CDC's current stockpile of 15.4 million doses of smallpox vaccine retains its potency even when diluted fivefold to tenfold, a study released yesterday in the New England Journal of Medicine indicates. USA Today reports that NIAID sponsored the study involving 680 volunteers who received doses at full strength, in a one-to-five dilution and in a one-to-10 dilution. According to USA Today, 97% of volunteers, "regardless of the strength of the vaccine" they received, developed a blister and a scab, indications that the vaccine "took." According to Fauci, health officials recommend the one-to-five dilution, "because they know it really works." He added, "When you get to one-to-10, you don't know when the potency drops off" (Manning, USA Today, 3/29). However, Fauci said, "If this were an absolute emergency that we needed 150 million doses, I wouldn't have any hesitation in recommending that we go with the one-to-10 dilution." According to the Washington Post, the possible 150 million doses that could be created with the CDC's current stockpile -- along with the 70 million to 90 million doses the government announced yesterday that Aventis Pasteur had found and the 209 million doses HHS has ordered and expects to receive "before the year is out" -- means "the country is in far better shape" to handle a smallpox attack than it was last fall. "We will have enough vaccine to save and protect every American should there be an outbreak," Thompson said (Gillis, Washington Post, 3/29).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.