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http://www.nytimes.com/2002/12/10/international/middleeast/10ISRA.html?tntemail0

Israel Vaccinates Soldiers and Health Workers

By JUDITH MILLER

EL AVIV, Dec. 7 — Israel has successfully vaccinated more than 15,000 soldiers and public health workers against smallpox on a voluntary basis since July with virtually no severe side effects, senior Israeli officials say.

In interviews, Israeli military and public health officials said the immunizations had been carried out under a crash program to protect the country from a possible Iraqi attack with smallpox or other lethal germs. As a result, thousands of the country's public health professionals are now prepared to immunize the entire country against the deadly virus within four days should a single smallpox case be diagnosed anywhere in the world.

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The Israeli experience has encouraged vaccination advocates in the Bush administration, which has been debating a similar program for months, American officials said.

The Bush administration is expected to announce this week a decision to begin vaccinating up to 500,000 troops and an equal number of public health workers, law enforcement officials and others who respond to emergencies against the highly contagious virus. Before the World Health Organization declared smallpox eradicated in 1980, it killed about a third of those infected.

"The United States has much to learn from Israel's experience," Leonard J. Marcus, the director of the health care negotiation and conflict resolution program at the Harvard School of Public Health, concluded in a recent report on Israel's medical response to bioterrorist threats.

Israel has traditionally been extremely secretive about its defenses against biological weapons. But officials said in recent interviews that they had decided to discuss their program in some detail so that Israel's actions would not be misinterpreted and to allay public fears at home and abroad about the safety of the vaccine.

"After Sept. 11, there was a profound change in our psychology," said Boaz Lev, the director general of Israel's Ministry of Health. "Although there was no new information on which to base our vaccination decision, the potential terrorist threat increased dramatically, especially in the minds of doctors."

Dr. Lev said that while Israel's decision to begin revaccinating its population was initially spurred by reports that the United States was contemplating such a step, Israel had now "jumped far ahead" of the American biodefense effort.

He declined to say how many soldiers had been vaccinated, but he said that for soldiers and civilians alike the program was now voluntary.

Israel uses the Lister vaccine strain, different from the strain used by the United States. Dr. Lev said that Lister was less virulent than the American strain and has fewer side effects. He said Israeli doctors and health professionals had screened out those with health conditions that precluded safe inoculation, like pregnant women and people with ailments that suppress the immune system.

Though as many as 30 to 50 percent of potential volunteers initially resisted being vaccinated, experts said, volunteer rates rose sharply after public health officials began discussing the program's risks and benefits, and after medical professionals began being vaccinated.

Dr. Marcus concluded in an October report that after being inoculated, 5 percent of those vaccinated reported side effects like fevers, headaches, muscle pain, fatigue and weakness. Medical literature suggests that one in a million people is likely to die from the smallpox vaccine, and one in roughly 250,000 is likely to suffer serious side effects.

There were only two problematic cases in Israel so far — one a woman with an immune disorder. She was not vaccinated but was infected by her husband, who was. She responded quickly to treatment and recovered fully, Dr. Lev said.

Israel ended its vaccination program later than most countries. Until 1980, Dr. Lev said, smallpox vaccination was mandatory. Inoculations of soldiers continued until 1996.

Israel ended vaccinations partly to dispel the perception that it had turned the virus into a weapon, as had the former Soviet Union.

Some Israeli doctors and public health experts contend that Israel's $2 million vaccination program should be even more ambitious and comprehensive. Aryeh Eldad, the leader of a team that advised the Health Ministry on epidemiological control in its vaccination program, resigned this summer to protest the ministry's rejection of his recommendation that all Israelis be immediately inoculated.

Dr. Lev hinted that a broader program might be in the offing. He added that even if the threat posed by Iraq receded, terrorist groups and other states could continue to threaten Israel.

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