Smallpox:  Panel Warns Against Expanding Immunizations

An influential health advisory board yesterday cautioned against expanding the national smallpox immunization campaign to millions of emergency workers, the Washington Post reported (see GSN, June 19).

Meeting yesterday in Atlanta, officials from the Advisory Committee on Immunization Practices — which counsels the Centers for Disease Control and Prevention on vaccine issues — said it would be “unwise to expand beyond its current, pre-event smallpox vaccination recommendations.”

The move comes as many health officials are saying that the immunization program has effectively stopped well short of U.S. President George W. Bush’s goals, the Post reported.  In December, Bush said he wanted 500,000 civilian health care workers immunized by the end of February and another 10 million emergency workers immunized by this summer.  Approximately 37,000 civilian health workers have been immunized to date.

The committee cited “new and unanticipated safety concerns” in cautioning against expanding the program.  During the civilian and military immunization campaigns, an unexpected number of people experienced cardiac difficulties, particularly tissue swelling in and around the heart.

The CDC is reviewing the program at the six-month mark, according to Joseph Henderson, the top bioterrorism official there.

Henderson said that focusing completely on vaccinations “is not a practical approach right now,” but maintained that the centers are “committed to the president’s decision.”

CDC Director Julie Gerberding said U.S. health officials would review the committee recommendation, but it was doubtful that immunizations would stop.

“The more people we have vaccinated, the better off we’ll be, and the fact that we have almost 40,000 people vaccinated is, I think, a tremendous step forward compared to where we were just six months ago,” Gerberding said.  “So we’ve made enormous progress, but we have more to do,” she added (Ceci Connolly, Washington Post, June 20).

The committee said the heart inflammation issue needed further exploration before inoculations can continue.

“The committee has believed from the beginning that we need to put safety above and beyond any other issue,” said John Modlin, committee chairman and professor at Dartmouth Medical School.  “This will allow us to buy some time, and to perhaps better understand both sides of the equation,” he added (Catherine Shoichet, Atlanta Journal-Constitution, June 20).

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International Response:  Global Biological Security Guidelines Needed, Expert Says

By Mike Nartker
Global Security Newswire

WASHINGTON — Nations with scientific research facilities must develop new security guidelines to prevent terrorists from acquiring dangerous pathogens that could be used to develop biological weapons, a leading nonproliferation specialist said yesterday (see GSN, June 12).

Without improved security measures, terrorists could try to obtain pathogens by stealing them from research facilities or by purchasing them under false pretenses, according to Jonathan Tucker, a senior fellow at the U.S. Institute of Peace.  During a presentation at the institute’s Washington headquarters, Tucker cited several examples of poor security at research facilities, such as those found by a U.S. Agriculture Department investigation that found that many of the department’s 124 laboratories were vulnerable to theft (see GSN, May 13, 2002).

While the United States and other countries have sought to domestically improve laboratory security with new regulations (see GSN, Jan. 29), an international system of biological security guidelines is needed to avoid gaps of weak enforcement that terrorists might attempt to exploit, according to Tucker.  Such guidelines should address physical security, pathogen accountability and facility personnel concerns, he said. 

At a minimum, according to Tucker, a new system of international guidelines should include the registration and licensing of research facilities that work with an agreed list of pathogens.  The new guidelines should also include physical security requirements for facilities based on the perceived levels of theft risk, as well as pathogen inventory and collection audit procedures to prevent diversion, he said.  Tucker warned, however, that quantitative inventory control procedures would not fully guarantee security because a potential terrorist could steal a minute sample of a pathogen and use it to produce large amounts.

In addition, new security guidelines should also focus on facility personnel concerns, such as periodic background checks, Tucker said, adding that scientists and technicians should receive security education and training.  Regulations concerning the transfer and export of pathogens should also be included in the new system, he said.

Tucker said his proposal mainly focused on preventing terrorists from illegally obtaining pathogens for use in weapons.  It would do little to prevent state proliferation of biological agents or to prevent states from providing terrorists with such agents, he said.

An August meeting of the Biological Weapons Convention experts group, scheduled to be held in Geneva, could be used as a launching point for the development of new international security guidelines, Tucker said.  Convention members should create a technical experts group — which could include representatives from international organizations and scientific organizations — to develop the guidelines, which could then be individually implemented through national legislation, he said.  An international oversight mechanism may also be needed to ensure uniformity and to prevent security gaps, Tucker added.

New guidelines should be developed with a focus on the inclusion of those developing countries with the least secure research facilities into the system, according to Tucker.  To this end, a minimum-standards level should be created that countries could meet either through labor-intensive measures for developing countries and more capital-intensive measures for industrialized nations, he said.  Standards should also have an appropriate level of flexibility to be tailored to individual facilities, Tucker said.  The system should also focus on compliance via incentives, not through punishments, he said.

Once the guidelines are created, states that choose to implement them could also agree to participate in annual review meetings that could be organized by an international secretariat, Tucker said.  At these meetings, countries could report on the implementation of the guidelines at a national level, as well as participate in information exchanges to aid the implementation of new biological security standards, he said.

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Smallpox:  Smallpox Immunization Programs Stalled

U.S. officials said yesterday that the national smallpox immunization campaign had come to an effective halt, the New York Times reported (see GSN, June 13).

The civilian smallpox immunization program, which was intended to inoculate 500,000 civilian health care workers by the end of February, has so far immunized only 37,608 volunteers.  Health officials said 100 more are being immunized each week.

The U.S. Defense Department has immunized 454,856 military personnel, and is inoculating 1,000 each week as a “maintenance” effort, according to Col. John Grabenstein, who ran the defense immunization effort.

Raymond Strikas, who directed the civilian immunization program for the Centers for Disease Control and Prevention, said that volunteer interest had dropped off after March and the program was now paused.

The U.S. military victory in Iraq, a long delay in the compensation plan for sickened volunteers (see GSN, May 1) and other public health concerns hampered the program, according to Strikas.  U.S. President George W. Bush originally indicated the vaccine would eventually be available to the general public, “but there’s been relatively little clamoring for that,” Strikas said.  “We accept where we are, given the circumstances.  We can make this work,” he added (Donald McNeil, New York Times, June 19).

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Smallpox:  Many Decline Vaccine Despite Monkeypox Fears

Many people eligible to receive the smallpox vaccine, because of their potential exposure to the U.S. monkeypox outbreak, are choosing not to receive the vaccine, the Associated Press reported today (see GSN, June 12).

The U.S. Centers for Disease Control and Prevention last week recommended that the nation’s smallpox vaccine, stockpiled to defend against bioterrorism, be used to stem the spread of monkeypox.  There have been 82 reported cases of monkeypox nationwide, AP reported.

It is unclear how many people have come into contact with the monkeypox virus through infected animals or people.  Herb Bostrom, director of the Wisconsin Bureau of Communicable Diseases, said “the numbers are very, very small.”

Authorities in Wisconsin notified 90 people who were eligible to receive the smallpox vaccine at a clinic Saturday, but none of those people showed up, according to Milwaukee Health Commissioner Seth Foldy.

Ohio and Illinois, both states with suspected monkeypox outbreaks, have not offered the smallpox vaccine at all, according to AP (Jenny Price, Associated Press/ABCNews.com, June 17).

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