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U.S. Health Officials, Experts, Debate Smallpox Vaccination Response By David McGlinchey GENEVA — During a biological security conference here yesterday, top U.S. health officials sparred over U.S. vaccination policy in the event of a smallpox terrorist attack (see GSN, Oct. 16). Smallpox was eradicated more than a quarter century ago, but the United States is now leading an effort to defend against the potential spread of the disease by terrorist groups. Key to those biological defense efforts is the issue of a post-strike vaccination program. D.A. Henderson — who led the smallpox eradication effort and is now a top adviser to the U.S. Health and Human Services Department — was the senior voice in favor of the current search and containment theory. Henderson was joined by Emory University professor Michael Lane and World Health Organization official David Heymann in supporting the policy, which emphasizes ring vaccinations around smallpox outbreaks and “contact tracing” of those who have been in close proximity with infected individuals. Ring vaccinations, supporters say, would prevent hundreds of nationwide deaths by inoculating fewer patients with the sometimes dangerous and always controversial vaccine (see related GSN story, today). Peter Jahrling, the principal scientific advisor at the U.S. Army Medical Research Institute and Infectious Disease, argued for mass vaccinations after a smallpox attack, citing research findings from a team headed by Yale University professor Edward Kaplan as well as the results of the 2001 Dark Winter biological terrorism simulation (see GSN, Jan. 10). Jahrling said that if terrorists spread smallpox, health officials will not be able to know every place the virus has been released and ring vaccinations would be ineffective. “If TV [targeted vaccination] is optimal, choosing MV [mass vaccinations] would lead to a few incremental deaths,” Jahrling wrote in his slides. He said, however, that choosing small-scale vaccinations when mass vaccinations are needed “could lead to a disaster with many incremental deaths.” The debate was mostly good natured and restricted to speeches, but Lane — of Emory University — lashed out at the Kaplan study, calling the effort “weird.” “Mass vaccination, unless you get very close to 100 percent, does not” stop the spread of smallpox, according to Lane. He said that “naturally occurring smallpox does not spread like wildfire,” and “mass vaccination is wasteful and dangerous, and diverts scarce resources.” Jahrling said, however, that the Dark Winter exercise proved that once a smallpox attack has been detected health officials cannot assume that they know the size or scope of the outbreak. Yesterday’s debate continued today with Jahrling asking, “Why are we so timid about pre-event vaccinations? If we had herd immunity, it would take smallpox bioterrorism right off the table.” Lane countered, “To use the vaccine for a disease that does not exist seems unwise.”
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