Buying enough smallpox vaccine doses for the U.S. population will cost more than the previously requested amount of $509 million (see GSN, Nov. 6), U.S. Health and Human Services Secretary Tommy Thompson said yesterday, and added that the cost could be four times that amount, about the equivalent of the department’s entire $1.9 billion bioterrorism budget (Ceci Connolly, Washington Post, Nov. 7).

The prices drug companies have proposed in negotiations have exceeded the $1.70 per dose the government estimated earlier, Thompson said. 

The government might award a contract to a potential vaccine manufacturer by the end of this week, Thompson said.  Ten companies originally applied to produce the smallpox vaccine (see GSN, Oct. 25), and HHS is considering three finalists.  Last week, GlaxoSmithKline, Merck & Co., American Home Products Corp. and a collaboration including Baxter Healthcare Corp. and Acambis remained in the running.  Thompson would not say which company had dropped out of the negotiations.

The United States already has a contract with Acambis to produce 54 million smallpox vaccine doses by next year (see GSN, Oct. 18).

A U.S. federal commission last week recommended the U.S. government create its own facility to produce anti-bioterrorism vaccines, saying, “The private sector is unlikely to be the answer to some of the more difficult vaccine issues” (Charles Ornstein, Los Angeles Times, Nov. 7).

Diluting the Current Vaccine Stockpile

Meanwhile, researchers are beginning a 2 1/2 month study to test the efficacy of diluted smallpox vaccines to learn if the current U.S. stockpile of 15.4 million doses could be stretched to inoculate many more people.  Researchers at four institutions will test diluting the vaccine by one-fifth and one-tenth of the original concentration.

In a pilot study last year on 20 people, researchers discovered that vaccines diluted by one-tenth had a significant number of positive results, but doses diluted 100 times offered little protection against infection.

If the experiment works, the diluted vaccine could be ready by the end of this year, said Anthony Fauci, head of the National Institute of Allergy and Infectious Disease, which is funding the research, adding, “It’s a very quick way to markedly expand the amount of vaccine that we already have, which on face value in the undiluted form would not be a lot.  It’s prudent to be prepared.”

Diluting the U.S. stockpile would be only a temporary measure to provide a response to a potential smallpox terrorist attack until millions more doses could be produced, experts said.  “This is a stopgap measure to make more doses available until that new vaccine is developed,” said Sharon Frey, lead researcher on the smallpox study at St. Louis University.

Anything to increase the number of doses is an improvement, said Neal Halsey of Johns Hopkins University, adding, “I am sure there is nowhere near enough smallpox vaccine to provide it to everyone in the country and even those who would be exposed in a large incident” (TB & Outbreaks Week, Nov. 6).

Canadian Response

Health Canada is considering following a U.S. decision last week to vaccinate some medical personnel who would investigate suspicious smallpox cases, Paul Gully, director general for Health Canada’s Center for Infectious Disease Prevention and Control, said Monday (Ian MacLeod, Ottawa Citizen, Nov. 6).

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