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Smallpox I: Officials Watch, Experts Debate What Israeli Vaccinations Can Teach By David McGlinchey Since Israeli first responders began receiving the vaccine in September, there have been no reported complications from the vaccine, according to an Israeli Defense Ministry spokeswoman. As many as 10,000 have been inoculated so far, Israeli Health Ministry director-general Boaz Lev said Tuesday. The immunized first responders come from all corners of Israel, including “health organizations, hospital emergency rooms, health clinics, and emergency forces, the IDF [Israeli Defense Forces], the police force,” the spokeswoman said. “There were two cases [of side effects], but when we checked them, one was the flu, one was allergic to a cat.” Jerome Hauer, director of the U.S. Office of Public Health Preparedness, recently said the United States is keeping an eye on the Israeli vaccinations. The U.S. Health and Human Services Department is in contact with the Israeli government, according to department spokesman Bill Pierce. Data Can Help U.S. Plan Some experts are saying that the Israeli results could provide the best-known data on the smallpox vaccine, which might give U.S. officials invaluable guidance to develop an immunization plan. The United States faces questions on everything from medical side effects, to the scope of potential inoculations, to compensation for those sickened or killed by the vaccine (see related GSN story, today). “This is real life, better than any clinical study,” said Charles Pena, a defense policy analyst for the Cato Institute. “We need to look at their experience,” said Mohammad Akhter, executive director of the American Public Health Association. “To see what kind of complications they have, what kind of additional medical assistance they need, what kind of side effects, how they do it.” The data gathered from Israeli inoculations could provide statistical support for vaccinations in the United States. Current information on the vaccine is drawn from data sources that are too small, according to Pena. “If the Israelis don’t encounter huge problems with side effects and deaths, we ought to use that as a sample database,” he said. “What a lot of people don’t understand is that the data for [smallpox vaccinations] is based on very small sample sizes.” Pena said that studying results from Israel does not necessarily support a wide availability of the vaccine, a position he supports (see GSN, June 26). “If it turns out that lots of people die and the side effects are much worse than expected,” Pena said he would withdraw his support for wide vaccinations, but “assuming people aren’t dropping like flies after they are vaccinated, you make the vaccine available.” Not all experts agreed, however, that the number of Israeli inoculations will be large enough to draw any statistically meaningful conclusions. U.S. health officials already understand that side effects do not occur often, according to Paul Offit, chief of the Philadelphia Children’s hospital’s infectious diseases section and a member of the Advisory Committee on Immunization Practices which advises the U.S. Centers for Disease Control and Prevention. The medical community is still concerned about administering a vaccine that they know will cause fatalities, even if it is only a few per million. It is doubtful whether a sample size under 200,000 people would add much data of scientific value, he said in an interview yesterday. “I think that there is enough data on this vaccine to give us a pretty good idea of the side effect rate it is going to have. It’s rare,” said Offit. A lesson that can be learned, he said, was the effect of the vaccine on those who had not received it years ago; the United States stopped vaccinations in 1972. If a person has already been vaccinated it is “much less likely” that they will suffer side effects, “so, I think here we’ll learn something,” Offit said. The inoculation of healthy, young, emergency first responders, however, might limit the information the United States can gain, according to Akhter. It is important to get significant data for inoculations “with women, with different age groups,” he said. The lack of sickness to this point, no matter the sample group, was nevertheless a good sign, according to Akhter. “It is very encouraging,” Akhter said. “It should give our people a little more courage to go forward.” How to go forward, however, is the subject of a debate that has occupied public health experts for months. U.S. health officials, the Centers for Disease Control and the Advisory Committee on Immunization Practices have been debating who will receive the vaccine in the United States. Last week the committee recommended that 500,000 first responders receive pre-emptive inoculation (see GSN, Oct. 17). What Does Israel Know? Lev told a committee of the Knesset — the Israeli parliament — that a campaign to vaccinate the entire population should begin soon, according to a report yesterday in the Jerusalem Post. The debate and lack of action in the United States is frustrating, Pena said. “If the Israelis are potentially worried about smallpox being used as a bioweapon, we ought to be — we seem less concerned,” Pena said. “We’re debating the problem, the Israelis are doing something about it.” “Israeli intelligence is generally very good,” Akhter said. “We should heed the warning and proceed, we simply cannot sit and wait.” Some medical professionals — including Offit — have noted that the risks of vaccinations are significant, especially without knowing all the repercussions or even the threat of an attack. Others say that waiting only increases the time a potential biological terrorist has to plan an attack. Israeli officials, meanwhile, are willing to help the U.S. learn more about the vaccine in order to build a plan. Without discussing specifics, an Israeli official said this week that the two countries have an excellent record working “issues of mutual concern.” “Israel is open to the Americans to learn from the experience,” said the official. “It would be conceivable to learn from a country that has had that experience.”
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