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Smallpox: U.S. Immunization Plan Reformed in the Face of DissentBy David McGlinchey By Tuesday, 432 people in 11 states and Los Angeles County had received the inoculation, according to Joe Henderson, the Centers for Disease Control and Prevention associate director for terrorism preparedness, who spoke yesterday at a bioterrorism conference hosted by the National Governors Association. The first phase of the plan began Jan. 24 and was to be finished by the end of this month but that schedule has now been extended, Henderson said. “We know it’s more than 30 days and we hope it’s less than six months,” he said. In a sharp departure from earlier Bush administration statements that emphasized the importance of immunized first responders, Henderson said that CDC officials are not concerned about the number of medical personnel vaccinated in the first phase as long as the vaccine is widely offered and the public is well informed. “It would be a success if no one receives the vaccine, but we offered this opportunity to all the right people,” he said. In December, Bush called for 500,000 medical emergency workers to be inoculated in the first phase of the plan, but concerns about patient compensation, screening, vaccine costs and public education have hindered the effort, state and federal health officials said. Only one-third of U.S. states are slated to begin their immunizations by mid- to late February — when the first phase of the program was scheduled to be complete — and several health departments will delay much further. New York City might wait several months before beginning immunizations, according to a U.S. official. The “issues remaining as of this morning are considerable,” said William Raub, the deputy director of the Health and Human Services Department’s Office of Public Health Preparedness. Henderson said he expects another 400 people to receive immunizations by the end of the week. These numbers “don’t look like a raving success,” Henderson said. The effort should not be measured in numbers, however, but rather in readiness and in terms of “standing up a program that is safe,” he added. Henderson said the CDC smallpox education program had reached 800,000 U.S. medical care workers. Some U.S. hospitals and medical workers’ unions have refused to support the immunization campaign until compensation issues and other sticking points are resolved. Medical officials are concerned that people who are sickened by the vaccine will not be compensated because they took the vaccine voluntarily. While administration officials continue to investigate the concerns, there are no firm solutions on the table right now, according to Raub. Henderson said the problem is being addressed but Congress must deliver the solution to the compensation dilemma. “I think in the coming weeks we will see some remedy,” he said. Many state and local officials have urged the administration to slow the immunization campaign until those remedies are delivered. “Slow down, get it right. Understand what it is we are doing,” National Association of County and City Health Officials Executive Director Patrick Libbey said. The original plan called for the first phase of immunizations to be complete by the end of this month and a second phase to inoculate up to 10 million emergency workers. After the second phase is complete, officials had said they would look to offer the vaccine to the general public. The lines between those phases are blurring and the process is more of a continuum, Henderson told the conference. He maintained, however, that by mid- to late summer the United States would have a safe program in place to offer the vaccine to members of the public who insist upon immunization. Several state health officials told Henderson that many medical workers, health departments and hospitals were concerned about the plan. Officials said that unless the United States addresses a number of issues, turnout might remain low. “What if the federal government threw a vaccination party and nobody came?” asked David Engelthaler, bioterrorism coordinator for the Arizona Department of Health Services.
From February 6, 2003 issue.Iraq: Powell Presents BW Evidence to Security CouncilBy Mike Nartker During the last year’s council debate on U.N. Resolution 1441, which established the current inspections regime, an Iraqi missile unit deployed outside Baghdad was ordered to hide its missiles and biological warheads at various sites in western Iraq, Powell said. Many of the unit’s launchers and warheads have been hidden in groves of palm trees and have been ordered to move every one to four weeks to avoid detection, he said. Powell also presented the council with satellite photographs taken in November 2002 that showed Iraqi crews moving items out of a biological-related facility shortly before inspections were set to resume. In his presentation, Powell detailed Iraq’s efforts to develop road- and rail-mobile biological weapons laboratories. “The trucks and train cars are easily moved and are designed to evade detection by inspectors,” Powell said. “In a matter of months, they can produce a quantity of biological poison equal to the entire amount that Iraq claimed to have produced in the years prior to the Gulf War,” he said. The United States has evidence showing that Iraq has at least seven mobile biological laboratories, Powell said. The road-mobile laboratories use up to three trucks each, meaning Iraq might be able to base them in as few as 18 trucks, he said. “Just imagine trying to find 18 trucks among the thousands and thousands of trucks that travel the roads of Iraq every single day,” Powell said. The United States has learned about the existence and technical specifications of these mobile laboratories through several Iraqi defectors, including a former Iraqi major, Powell said. One such defector was a former Iraqi chemical engineer who supervised one of the mobile laboratories, and was even present during a 1998 accident that killed 12 technicians, he said. According to the defector, during previous rounds of inspections, Iraq ordered biological agent production to begin on Thursday at midnight because officials believed that inspectors would not operate on the Muslim holy day of Friday. The mobile biological laboratories are sophisticated enough to produce a number of biological agents, including anthrax and botulinium toxin, Powell said. In addition to researching numerous other diseases, including gas gangrene, plague and typhus, Iraq also worked to develop sophisticated spraying devices, he added. Powell presented to the council video obtained several years ago that showed an Iraqi F-I Mirage jet aircraft outfitted with a device to spray biological agents. “Iraq admitted to producing four spray tanks,” Powell said. “But to this day, it has provided no credible evidence that they were destroyed, evidence that was required by the international community,” he added (White House release, Feb. 5). For further information, see: Powell’s presentation slides (U.S. State Department)
From February 5, 2003 issue.Smallpox I: Millions of Personal Computers Might Find Smallpox CureThe U.S. Defense Department, research universities and leading computer companies are launching a program today to develop a cure for smallpox using the power of millions of idle personal computers, the New York Times reported. The computers, attached to a central grid, will test how a range of chemical compounds interact with an enzyme found in smallpox, called topoisomerase. Researchers hope to find a compound that blocks the enzyme and stops the smallpox virus from spreading. Volunteers can visit the project’s Web site, www.grid.org, and download a screen saver that will add that computer’s power to the smallpox effort when the machine is turned on but not in use (Steve Lohr, New York Times, Feb. 5). The combined effort of 2 million personal computers is 30 times more powerful than the world’s fastest supercomputer, the Associated Press reported. IBM servers are powering the effort and the results will be given to U.S. defense officials (Paul Elias, Associated Press/Washington Post, Feb. 5). Oxford University and the United States Army Medical Research Institute of Infectious Diseases will also be working on the project (Lohr, New York Times).
From February 5, 2003 issue.Smallpox II: Canada Reaffirms Pledge to Buy Vaccine for Entire CountryA Canadian health official yesterday said Canada would buy enough smallpox vaccine for everyone in the country, the Ottawa Citizen reported today. Ron St. John, director general of Health Canada’s Center for Emergency Preparedness and Response, said last year that Canada would purchase enough vaccine for every Canadian and he reaffirmed those comments yesterday in Winnipeg (see GSN, June 12, 2002). Canada is expected to receive 10 million doses of the vaccine by the end of 2003 but St. John did not say how long it would take to acquire the remaining 21 million doses. Canadian officials plan to vaccinate 500 epidemiologists who would be sent to the scene of a smallpox outbreak (Maria Cook, Ottawa Citizen, Feb. 5).
From February 3, 2003 issue.U.S. Response I: Bioterrorism Cramps Other Federal ResearchNonterrorism research funded by the National Institutes of Health will fall next year — only the second time since 1989 — as U.S. President George W. Bush steps up funding for bioterrorism vaccines, the Washington Post reported yesterday (see GSN, Jan. 30). “It will be shocking,” said Donald Poppke, NIH’s acting associate director for budget. “The response will be fairly negative,” he predicted. For the last five years the NIH has enjoyed annual growth in federal funding of 14 to 15 percent (see GSN, Feb. 4, 2002). However, in fiscal 2004 it is expecting only a 2 percent increase to $27.9 billion, according to officials. Meanwhile, the still unfinished 2003 budget will fall about $1 billion short of a 1998 goal of doubling the NIH budget over the subsequent five years, according to the Post. The typical 4 percent “cost-of-doing-research” annual increase for ongoing grants — which officials said usually grows faster than inflation — will fall to 1 percent. “Two or three years of 2 or 3 percent increases, and you’ve pretty much lost what you’ve gained,” said Dave Moore, associate vice president at the Association of American Medical Colleges. “And you’ve certainly lost the morale of investigators who can’t help but be demoralized by trying to compete for funding under those circumstances,” he said. Both the five-year doubling of the NIH budget and the higher annual increases enjoyed popular support in Congress, the Post reported. Senators Arlen Specter (R.Pa.) and Tom Harkin (D-Iowa) have proposed a resolution to triple the NIH budget, from its 1998 level, by 2008 (Rick Weiss, Washington Post, Feb. 2).
From February 3, 2003 issue.U.S. Response II: Regulations Slow Bioterrorism Medicines, Expert SaysRequired U.S. procedures for testing new drugs are slowing the development of medicines that could potentially be used to counter bioterrorism threats, according to a leading expert (see GSN, Dec. 18, 2002). Ken Alibek, former head of the Soviet Union’s chemical weapons development who is now a U.S. researcher, recently encountered such delays from the U.S. Food and Drug Administration and the National Institutes of Health, he said. Alibek’s team combined a protein with antibiotics and the result proved 100 percent effective against anthrax in animals, he said. “We said to NIH, ‘Here is a product. Do you have any fast, accelerated way of organizing production, testing and so on?’ They said, ‘No, we don’t,’” according to Alibek. He said officials told him that before testing and production, the anthrax treatment must first be presented in a proposal and then pass through several levels of review before they would consider directing additional funding to the effort. “I said I don’t care if I am going to get money. Here is the product — take it. We’ve already gotten our government money to develop this product,” Alibek said. However, Alibek said officials responded, saying the treatment would not be available to the public for another five or six years. The FDA has special programs to accelerate drugs that can save lives, according to Dianne Murphy, director of the FDA’s Office of Pediatric Drug Development and Program Initiatives. It is important, however, to ensure that the drug is safe for human use, she added. “You can’t do studies on a few mice and say it looks good,” according to Murphy. A U.S. biological defense program, supported by Washington, could solve many problems in creating needed vaccines and treatments, Alibek said. “In all senses this would be best — in terms of funding, in terms of quality — this would be preferred,” he said (Divis/Horrock, United Press International, Jan. 31).
From February 3, 2003 issue.Anthrax: FBI Ends Maryland Forest Search in Anthrax InvestigationThe FBI Friday wrapped up a second search of a section of forest near Frederick, Md., related to the bureau’s investigation into the autumn 2001 anthrax attacks, the Associated Press said Saturday (see GSN, Jan. 28). Investigators left the area Wednesday night after scuba divers used video equipment to search three ponds in the area, near the former home of Steven Hatfill. The anthrax letter attacks left five dead and infected 13 others. Hatfill, a former U.S. Army biologist, has been the public focus of the FBI’s investigation, said bureau spokeswoman Debra Weierman. She refused to comment on what, if anything, investigators found during the search (Associated Press/Yahoo.com, Jan. 31). For further information, see: CDC Frequently Asked Questions About Anthrax Journal of the American Medical Association Background on Anthrax GSN Anthrax Attack Chronology (Dec. 12, 2001)
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