World Health Organization Director General Gro Harlem Brundtland told the organization's Smallpox Advisory Group last week to review whether governments should once again start mass vaccinations against smallpox amid concerns of biological terrorism.  The WHO has urged governments to ensure they could produce enough vaccine for their populations. 

"The unthinkable is no longer unthinkable, and we need to prepare for that.  There has been a lot of concern about a smallpox outbreak.  The numbers it would kill are scary," said a WHO representative (Anthony Browne, London Observer, Oct. 21).

There are, however, no immediate plans to resume mass vaccinations, according to WHO officials.  Medical services already have the capability to contain smallpox outbreaks by isolating victims and inoculating people who come into contact with them, said David Heymann, the WHO's executive director for communicable diseases.  The organization estimates there are 90 million smallpox vaccine doses in the world for civilian use and an unknown amount for militaries.

Vaccinations could help prevent vast casualties in the event of a biological attack but carry dangerous side effects, including the statistical risk of one fatality in 13,000 inoculations.

The WHO eradicated smallpox in 1980, and civilian inoculation programs ended worldwide in the early 1980s (Frances Williams, Financial Times, Oct. 22).

U.S. Responds to Threat

The United States has begun work to increase the quantities of vaccinia immune globulin, which is used to treat people who have adverse reactions to the smallpox vaccine.  The country's current rules require that the medicine be available before patients receive smallpox vaccinations.  Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said yesterday that Washington has a small supply of vaccinia immune globulin and has begun asking medical companies to check their supplies. 

The U.S. Food and Drug Administration said two years ago that the small U.S. stockpile acquired before the mid-1970s had mysteriously turned pink and banned its use.  The medicine is obtained from people who received smallpox vaccinations (Keith Bradsher, New York Times, Oct. 22).

Meanwhile, the U.S. Centers for Disease Control and Prevention have sent a preliminary plan to respond to a smallpox case to state health departments.  The response would be initiated when a doctor notified state or federal health officials that a patient should be tested for smallpox.  If smallpox was confirmed, the patient would immediately be quarantined and would receive vaccine sent to the area from the U.S. stockpile.  The CDC would notify the FBI and White House and begin tracking down and vaccinating all people who had contact with the infected person. 

The plan would not include citywide vaccinations unless several other cases appeared.  “You’re always hesitant to immunize people against the disease unless you’re fairly certain that there is going to be a risk,” said U.S. Surgeon General David Satcher (Associated Press/New York Times, Oct. 19).

Researchers said they hope a new study on the effectiveness of diluted smallpox vaccines would allow an opportunity to test cidofovir, an antiviral drug that prevented death and disease from a pox disease in primates.  Scientists expressed hope the drug, sold under the brand name Vistide, could be the first treatment for smallpox (Rita Rubin, USA Today, Oct. 22).

Washington and London Cooperate

The United Kingdom and United States have been pooling expertise and considering "joint purchase" of smallpox vaccine and antibiotics to fight anthrax for civilians, U.K. Health Secretary Alan Milburn announced.  Meanwhile, according to a document leaked this weekend, the civil contingencies secretariat of the British Cabinet has told U.K. emergency services to prepare for large casualties in the wake of a biological or chemical attack (Sarah Womack, London Telegraph, Oct. 22).

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