Four days before the unveiling of U.S. President George W. Bush’s smallpox immunization program, U.S. health officials visited Vice President Dick Cheney in an attempt to sway the White House from advocating mass public vaccinations, Science magazine reported today (see GSN, Dec. 16).

“Had we not reassured Cheney on that day that we really did know what we were talking about, I think the vaccine would have been offered more widely to the general public,” said a scientist who was present at the Dec. 9 meeting.

Bush laid out a plan in which 500,000 military personnel and up to 10 million health care workers are to be immunized.  Members of the public who insist on being vaccinated will have that opportunity, but many government officials are discouraging that.

Health officials, including the heads of the Centers for Disease Control and Prevention and the Office of Public Health Preparedness, detailed a plan in which emergency response teams would administer millions of smallpox inoculations within 12 days of a biological attack while disease experts would search for smallpox exposure, Science reported.

Members of Cheney’s staff and Tom Ridge, the White House nominee to head the Homeland Security Department, were also present at the meeting, according to Science.

Much of the public health community was relieved that mass vaccinations were averted, according to Science.

Ronald Atlas, head of the American Society for Microbiology, said that Bush’s plan is “prudent.”

Tara O’Toole, of the Center for Civilian Biodefense Strategies at Johns Hopkins University, said she is concerned that members of the public who are vaccinated will pose a threat to those near them.  Police and firefighters likewise do not need the vaccine, O’Toole said, because they will most likely not be exposed to the smallpox virus (Cohen/Enserink, Science, Dec, 20).

Medical Experts Weigh in

Meanwhile, the New England Journal of Medicine published several articles this week on their Web site — www.nejm.org — supporting immunizing emergency workers but warning against widespread public vaccinations in the absence of a biological attack, the New York Times reported today (see related story).

One of the articles, from the RAND Center for Domestic and International Health Security, concluded that if 60 percent of U.S. residents were immunized, 482 people would probably die — too high a toll without credible evidence of a imminent smallpox attack, RAND researchers said.

The researchers supported immunizing health care workers but concluded that 25 people would probably die if 10 million medical personnel receive the vaccine.

“Vaccinating health workers presents a modest risk, and could pay many benefits,” said Samuel Bozzette, the lead author on the study.  “In contrast, a public vaccination campaign is certain to entail significant harm, so it should only be contemplated if the government concludes that the chances of a widespread attack are considerable,” he added.

Another article on the Web site notes the difficulty in managing a smallpox victim.  In May, a Cleveland hospital diagnosed a man as a possible smallpox patient and encountered extreme difficulty in testing the hypothesis.  Officials at the CDC in Atlanta requested a sample of the man’s sores, but it was difficult to find a delivery service that was willing to handle biological samples, according to the report from MetroHealth Medical Center in Cleveland.

The sample was eventually diagnosed as an unusual case of herpes, the article reported.  The hospital is now equipped, however, with a digital camera to send pictures to the CDC and a typewriter to fill out special shipping forms, the Times reported.

Kent Sepkowitz, director of infection control at Memorial Sloan-Kettering Cancer Center in New York, authored another article in the series, contending that the vaccine does not spread as easily as has been reported.  Immunized hospital workers are unlikely to spread live vaccine to at-risk patients if they keep inoculation sites covered and wash their hands regularly, he said.

“My main mantra is that if we go slowly we’ll do fine,” Sepkowitz said.  “But if hospitals are asked to vaccinate quickly and we don’t have time to figure out what we’re doing and deal with surprises that are in store, we could make a mess,” he added (Denise Grady, New York Times, Dec. 20).

During testimony to a panel established by the Institute of Medicine, however, several medical groups criticized Bush’s immunization plan, saying that it could strain hospital resources, the Los Angeles Times reported today.

“As critical as it is that we be prepared to respond to a smallpox attack, it cannot come at the expense” of other hospital functions, said George Hardy, executive director of the Association of State and Territorial Health Officials.

Hospitals are already strained and facing nursing and funding shortages, officials testified.

“Tuberculosis, E. coli and measles are not taking a furlough,” warned Patrick Libbey, executive director of the National Association of County and City Health Officials.

Medical groups said that the federal government should slow its plan.  The American Hospital Association and the American Nurses Association both called on the government to protect workers from liability and create a federal fund to compensate victims of the vaccine, the Times reported (Kemper/Mestel, Los Angeles Times, Dec. 20).

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