Nov. 27 — The
Bush administration is on the verge of one of the most
fateful public health decisions ever made by any president:
determining which Americans should be vaccinated against
smallpox. There’s little controversy over vaccinating
members of the military and “first responders,” such as
emergency medical workers and police. But given the
possibility of an epidemic triggered by terrorists, would it
be wise to vaccinate the entire population?
IT’S NEITHER A SIMPLE nor
an easy decision for Bush and his advisers because smallpox is such
a terrifyingly contagious disease — each infected person transmits
the disease to 10 to 20 more people.
But the smallpox vaccine itself can cause serious and even
fatal complications in some people.
VACCINE’S RISKS
The vaccine contains another live virus called vaccinia,
which can spread to other parts of the body or to other people from
the vaccination site — the person’s arm.
The vaccinia virus may cause rash, fever and body aches and
cause potentially life-threatening ailments in a small percentage of
people, about one in every million vaccinated, according to studies
conducted in 1968.
In weighing the risks of administering the smallpox vaccine,
Bush must decide how large is the threat of an outbreak in the
United States.
NBC News White House Correspondent Campbell Brown reported
Wednesday that the administration has devised a compromise plan.
The president is expected
to announce that the government will vaccinate 500,000 military
personnel who are at heightened risk because of a possible war with
Iraq along with 510,000 emergency health care workers, those most
likely to be exposed to smallpox patients if there were an attack.
Some lawmakers argue the vaccine should be accessible to
everyone.
“I know there’s some risk with the vaccine but we ought to
make it available and let individuals make the choice,” said Sen.
Joseph Lieberman, D-Conn.
Advisors say the president is leaning toward giving anyone
who wants it access to the vaccine, but not for at least a year, so
researchers have time to study the effects on those who will soon
get the vaccine.
SMALLPOX, IRAQ AND
AL-QAIDA Would Iraqi leader Saddam Hussein send agents to
the United States to launch a smallpox attack in response to a U.S.
campaign to topple him? Might al-Qaida agents in the United States
have already obtained the virus from Saddam’s laboratories and be
ready to strike?
Experts on terrorism and Iraq can’t answer those questions
with any certainty and that’s what worries them.
The Bush administration is soon expected to announce its
policy on smallpox vaccinations, in light of concerns that
terrorists might seek to trigger a smallpox epidemic in the
United States. At first, only police, emergency medical
workers and members of the military are likely to be
vaccinated. Here are some questions and answers about
smallpox and the vaccine.
What is
smallpox?
Smallpox is a contagious and sometimes fatal disease caused
by a virus and marked by fever and a distinctive progressive
skin rash. It is thought to have killed more people
throughout history than any other epidemic disease. In 1980,
the World Health Organization declared the disease
eradicated following vaccination programs, but the Soviet
Union maintained an active smallpox weapons development
program and other countries such as Iraq may have similar
programs.
How is
smallpox spread?
Smallpox spreads from contact with infected persons.
Generally, direct and fairly prolonged face-to-face contact
is required to spread smallpox. It also can be spread
through contact with infected bodily fluids or contaminated
objects such as bedding.
When do
symptoms appear?
After exposure, it takes between seven and 17 days for
symptoms to appear. During this time, the infected person
feels fine and is not contagious.
Why not
vaccinate everyone right now?
The smallpox vaccine is very effective, so the Bush
administration is planning to offer it widely. But many are
urging caution because the vaccine itself, made with a live
virus called vaccinia, carries rare but serious risks.
Can the
vaccine hurt anyone?
Based on studies from the 1960s, experts estimate that 15
out of every million people vaccinated for the first time
will face life-threatening complications, and one or two
will die.
Who is at
risk of vaccine side effects?
According to the Centers for Disease Control, those who have
any of the following conditions, or live with someone who
does, should not get the smallpox vaccine unless they have
been exposed to the smallpox virus.
The conditions are:
Eczema or atopic dermatitis.
Skin conditions such as burns, chickenpox, shingles,
impetigo, herpes, severe acne, or psoriasis.
Weakened immune system.
Pregnancy or plans to become pregnant within one month
of vaccination.
Can vaccine
help someone exposed to smallpox?
Vaccination within three days of exposure will completely
prevent or significantly modify smallpox in the vast
majority of persons. Vaccination four to seven days after
exposure likely offers some protection from disease or may
modify the severity of disease.
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Are there
other treatments?
Cidofovir, a drug currently used for treatment of
opportunistic infections in AIDS patients may be an
effective treatment against smallpox, European researchers
recently reported.
Sources: Centers for Disease
Control, The Associated Press, American Society for Microbiology
‘The probability of an outbreak of smallpox needs to be high enough
to justify the risk (of vaccination).’
— DR. RONALD ATLAS
American Society for Microbiology
“A few
hundred thousand is about right, assuming that the vaccine is
administered in a way that doesn’t present an undue risk to those
not vaccinated,” Dr. Ronald Atlas, a professor of biology at the
University of Louisville and the president of the American Society
for Microbiology, told MSNBC.com last week.
A group of scientists who make up the Advisory Committee on
Immunization Practices to the federal Centers for Disease Control
and Prevention has not recommended vaccination of the general
population.
Last June, the committee recommended vaccinating smallpox
response teams — at least one in each state and U.S. territory —
that would include epidemiologists, laboratory scientists, doctors,
nurses and police.
ISOLATION AND LIMITED
VACCINATION The panel urged a strategy of using intensive
surveillance to identify infected people and isolate them, and then
vaccinating people who had been in contact with the sick.
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Atlas
said individuals at risk from the vaccination’s side-effects, such
as pregnant women and those with compromised immune systems, must
not be vaccinated.
“First responders would be vaccinated on a voluntary basis,”
he said. “The plan is to have enough vaccinated so that they would
not stay home from work in case of a smallpox bioterrorism attack.
Not all first responders need be vaccinated.”
But Atlas said the advisory committee’s strategy, known as
“ring vaccination,” could merge into mass vaccination if there were
multiple attacks and widespread outbreaks.
He noted that in 1947 in New York City and later in Europe,
smallpox outbreaks were successfully contained by ring vaccination
and limiting travel.
A key question is how the American public might react. Would
people try to flee Denver or Atlanta if a smallpox case were
reported there? Would the federal and state governments have to
impose military roadblocks, as the Yugoslav government did when a
smallpox epidemic broke out in that country in 1972?
GENETICALLY
ENGINEERED VIRUS? Even though the smallpox virus has killed humans
for thousands of years, there’s a worrisome new twist.
Researchers have inserted a gene called interleukin-4 into
the mousepox virus, a relative of smallpox that is harmless to
humans. The engineered virus became more deadly than the natural
strain, killing mice that had been vaccinated against mousepox.
If terrorists had a genetically engineered smallpox weapon,
would the existing stockpile of smallpox vaccine be useless?
“I do not know if placing interleukin-4 into smallpox would
create a smallpox virus that circumvents vaccine,” Atlas told
MSNBC.com. “That is what occurred when IL-4 was placed into mousepox
virus. We do not know if that result in mousepox is extrapolatable
to human smallpox virus, but that certainly is a fear. If that were
the case, the vaccine might not be effective.”
Such a scenario, said Atlas, forces policy-makers to consider
alternate means of containing smallpox. “It means trying to develop
new antivirals like cidofovir and having in place a strong
quarantine policy,” he said.
WEIGHING RELATIVE
RISKS Atlas emphasized the need to educate Americans
about the relative risks of vaccination as compared to the risks of
an outbreak of smallpox itself.
“We are used to safe vaccines,” he said. “The smallpox
vaccine is not as safe as the others in use today. When it was used,
infectious disease and death were far more common and hence higher
risks were perfectly acceptable. Today, the public would have a
negative reaction to severe side effects and deaths far outnumbering
the anthrax attacks, as are predicted if we go to mass vaccination.”
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
"What's the point of vaccination if it doesn't protect you from the unvaccinated?"
-- Sandy Gottstein
"Who gets to decide what the greater good is and how many will be sacrificed to it?"
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Two
attacks target Israelis in Kenya
