Bush's Smallpox Boondoggle

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http://www.alternet.org/story.html?StoryID=15044

 

 

Bush's Smallpox Boondoggle

 

By Maria Tomchick, AlterNet

January 28, 2003

 

Health experts predict that if 10 million Americans are vaccinated

against smallpox, 20 will die outright from the vaccine alone. What

gets neglected is the 60-million-plus Americans with weakened immune

systems who will be put at risk by widespread vaccination.

 

 

The national smallpox vaccination plan rolled out with a whimper last

week. Part of the Bush administration's effort to stave off a

bioterrorism attack, the vaccination plan was to begin with a strong

start in the state of Connecticut by vaccinating 20 or more first-

line medical responders who would then fan out and vaccinate

thousands of other doctors, nurses, and emergency room personnel

around the state. In the coming weeks, other states will join in and

inoculate 500,000 first-line medical personnel in all major medical

centers in the country against smallpox. Eventually 10 million more

healthcare workers, firefighters, police, and emergency medical

personnel will receive the vaccine.

 

 

But in Connecticut, only four people showed up to get the shot, and 3

of those were administrative personnel – the state epidemiologist and

2 administrators at the University of Connecticut's Health Center.

The numbers willing to volunteer for the shots had been dwindling all

week, as hospital associations, nursing unions, and other

professional groups balked at the risk of the smallpox vaccine itself

and raised important questions about the true potential for a

smallpox terrorist attack. At last count, more than 80 hospitals

around the nation, including major teaching hospitals and medical

centers in urban areas, have opted out of the vaccination program.

 

 

What's going on here?

 

 

The smallpox vaccine is made from a live virus, vaccinia or cow pox,

which is a cousin of smallpox. It can cause illness in a significant

number of vaccine recipients. Experts estimate that about 1,000 out

of every every 1 million who receive the vaccine will experience

serious side effects, about 40 of those will be life-threatening

illnesses, and 1 or 2 of those people will die from it. So, of the 10

million expected to get the shots, 10,000 are expected to get sick,

400 will be threatened with death, and 20 are expected to die

outright.

 

 

But, as critics have pointed out, this is a gross underestimate of

the risks. People who are vaccinated carry an open wound in their

arm, which sheds the live vaccinia virus for up to three weeks.

Certain people who come in close contact with them can become quite

ill. At particular risk are infants under a year old, pregnant women,

elderly people, folks with eczema and skin disorders (who can absorb

the disease through breaks in their skin – an estimated 7 to 20

percent of the general population has had such skin disorders) and,

most ominously, people with lowered immune system response.

 

 

There are an estimated 60 million people in the U.S. today living

with weakened immune systems, and most of them are suffering from

HIV/AIDS or undergoing a medical treatment that didn't exist 35 years

ago when smallpox vaccinations were routine. People with AIDS, cancer

patients undergoing chemotherapy or radiation treatments, burn

patients, and organ donor recipients would all be put at an

unacceptably high risk of death if their nurses and doctors are

vaccinated for smallpox.

 

 

It's a peculiar form of torture to ask a medical person who has

dedicated his or her life to saving other peoples' lives to risk

killing patients because of vague fears of a bioterrorist attack.

Doctors and nurses, in particular, have a good sense of the potential

threat various diseases pose to their patients. As William Schaffner,

head of preventive medicine at Vanderbilt University Medical Center

in Nashville, said: " The thing that stops you from doing this is the

complexity of the smallpox vaccine, which is not a safe vaccine.

There's a real disease that kills people unnecessarily: the flu. Mr.

President, I would love to see you endorse a national flu vaccine

campaign with the same vigor. " Medical centers around the country,

however, have had to deal with recent flu vaccine shortages. Smallpox

is simply not high on their list of concerns.

 

 

Some officials caution that a smallpox attack is a real possibility.

All it would take is one person to infect himself, travel to a major

metropolitan area, and hang out a nearby shopping mall, sports arena,

or other crowded public place to begin infecting people, they argue.

There are many problems with this scenario, including the fact that

smallpox has effectively been eradicated, with no new cases reported

since 1977. The only known laboratory stocks of the disease exist in

highly quarantined labs in the U.S. and Russia. And if smallpox

cultures were smuggled out of Russia or the U.S., it's not at all

certain that terrorist groups could get their hands on them or turn

them into usable weapons.

 

 

Even in the lone, kamikaze, infected terrorist scenario, the outbreak

might not be as bad as Bush administration advisors assume. Leading

smallpox experts say that nowadays we have conditions that are less

conducive to the massive outbreaks of the past, when people lived in

extended families in crowded rooms, with multiple family members

sharing the same bedrooms and the same beds. People wash their hands

more and more people travel alone in cars and live in less crowded

conditions. We use strong disinfectants more often, and air and water

are filtered and treated for contaminants. A realistic scenario of

one person falling ill and then going through his or her day – even

visiting a shopping mall and going to work – shows that only one or

maybe two other people would be infected with smallpox before the

sick person was sent to a hospital. In that kind of scenario,

quarantine and area-specific vaccination would work well to contain

the disease.

 

 

Joining the critics of the Bush administration's smallpox vaccination

plan is Bill Foege, former chief of the Centers for Disease Control

and consultant to the National Academy of Sciences' Institute of

Medicine panel on bioterrorism preparedness. Foege is a global health

adviser to the Bill and Melinda Gates Foundation, which is spending

hundreds of millions of dollars on major vaccination initiatives in

Africa and helping to fund the search for an AIDS vaccine.

 

 

In other words, Foege is definitely not a foe of vaccination in

general. In the 1960s, when he worked for the CDC in Africa, Foege

developed a specific plan of smallpox vaccination that minimized the

exposure to the vaccine and yet helped to wipe out the disease in

that part of the world. His method, called " ring vaccination, " relies

on a special property of the smallpox vaccine: It can protect people

who have already been exposed to the disease if they're given the

vaccine within four days of their exposure.

 

 

Foege argues that ring vaccination should be used here in the United

States, and other medical administrators are beginning to agree with

him. Richard Wenzel, chairman of internal medicine at Virginia

Medical College at the University of Virginia, was faced with a

crisis in the fall of 2001. During the height of the anthrax attacks,

he received word that a patient with smallpox had been found and was

being sent to his hospital. He quickly formulated a plan that would

quarantine the patient and assign specific personnel to treat him who

had been vaccinated as children. Wenzel located some smallpox vaccine

for his hospital staff. As it turned out, the patient didn't have

smallpox. But Wenzel now believes that it would be safer and more

cost-effective for hospitals to draw up quarantine plans, stockpile

smallpox vaccines, and use them only in the face of a real outbreak.

In the city where I live (Seattle), the major public hospital,

Harborview, is currently considering this approach.

 

 

Cost is also a major issue. The federal government is not providing

funds to hospitals to help them deal with staff shortages if and when

their nurses and doctors fall ill from the vaccinations. Some

hospitals are worried about lawsuits from patients' relatives if

they're exposed to the live vaccine and fall ill. And the cost to

vaccinate alone is expected to be between $600 million and $1

billion, and cash-strapped state governments are expected to pay that

bill on their own.

 

 

In addition, Bill Foege is worried about public perception in the

face of a real threat. If large numbers of people are vaccinated now,

when a threat doesn't exist, and many fall ill or die, then the

public may be resistant to the vaccine when a real outbreak occurs.

That could be disastrous.

 

 

The speed with which the Bush administration is pushing the

vaccination plan seems based on political necessity and not public

health concerns. There is currently a safer vaccine being developed

and tested in Europe that doesn't involve the use of live vaccinia.

It will be about a year before that vaccine is made available here in

the U.S., but the Bush administration is pushing ahead with the

older, more dangerous vaccine anyway.

 

 

In part, it's to prove that the government is doing something about

the threat of terrorism. It's also in response to pressure from

vaccine manufacturers, who want to sell their old stock before the

new vaccine hits the market. In either case – cynical political

opportunism or a drive for corporate profits – expediency should

never trump sensible public health policy. Too many lives are at

stake.