Smallpox vaccination grinds to halt

August 20, 2003

A PLAN to vaccinate nearly half a million healthcare workers in the US against smallpox in case of a bioterrorist attack has ground to a halt. Only 38,257 people have accepted vaccination, less than a tenth as many as planned.

But the failure may run deeper. In a damning report released last week, the US Institute of Medicine, an independent advisory body, says the problem is not that so few have been vaccinated, but that so much time and money has been spent on the vaccination programme. It argues that this should have been spent on more important defensive measures such as disease surveillance and response plans.

"There are many things more important than vaccinating people," says Brian Strom of the University of Pennsylvania, lead author of the report. "We have no idea if we're prepared for a bioterrorist attack." He cites the failure by doctors in Wisconsin to report cases of a disease similar to smallpox until 13 days after they saw the first rash (New Scientist, 21 June, p 12). Luckily, it turned out to be monkeypox.

The vaccination programme was announced by President Bush last December. The first phase was to be mandatory smallpox vaccinations for half a million military personnel, and voluntary vaccinations for another half a million "first responders"- the healthcare workers needed to carry out emergency vaccination and treat victims during an outbreak. That number was derived by multiplying the 2000-odd emergency rooms in the US by the staff needed to run them, says D. A. Henderson of Johns Hopkins University in Baltimore, who led the successful worldwide smallpox eradication campaign in the 1970s and helped devise the US plan. "State health officers counted 420,000 people they would want to vaccinate to provide some reasonable standard of emergency care."

But doctors and nurses stayed away in droves. The vaccine is a live virus that can spread from person to person and might have harmed patients, especially those with impaired immunity. Major hospitals, such as the Virginia Commonwealth University Health System and the Children's Hospital of Philadelphia, refused to have any of their staff vaccinated. It was also not clear whether there would be any compensation for staff needing time off or medical care due to vaccine complications. Such compensation has been approved in principle but the details have still not been published.

Add to this mounting scepticism about the likelihood of a smallpox attack, and it now seems clear there will be no flood of volunteers, Strom predicts. "The CDC calls it a natural pause," he says. "But the first phase of the plan is now functionally over."

The second phase, in which the vaccine was to be offered to millions more healthcare workers and the public, was quietly shelved by the CDC in June, after recently vaccinated soldiers and civilians developed complications. There were 52 cases of pericardial or heart inflammation. There were also other heart problems, including 8 heart attacks, 3 of them fatal, though this was in the normal range.

"Where we go from here remains to be decided," Henderson says. "It would be desirable to have more vaccinated, but this is, after all, a voluntary programme."

However, says Strom, with half a million vaccinated military personnel, there may already be enough people to carry out emergency vaccination. What's lacking, he says, is any detailed plan for calling on them after an attack.

Author: Debora MacKenzie

New Scientist issue: 23rd August 2003

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