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The country might be in better shape to counter a smallpox outbreak than it appeared to be right after the attacks.
©Washington Post
March 29, 2002
If terrorists attacked the United States with smallpox, doctors would be able to dilute the nation's vaccine stockpile to create as many as 150-million doses, enough to vaccinate more than half the population, scientists reported Thursday.
The government also confirmed that 70-million to 90-million doses of smallpox vaccine have been found, unexpectedly, by Aventis Pasteur of Lyon, France, which has its U.S. operations in Swiftwater, Pa. The vaccine is being tested for potency and preliminary indications look positive.
Taken together, the two developments mean the country might be in far better shape to counter a smallpox outbreak than it appeared to be after the Sept. 11 attacks. Aside from the older stockpiles, the Department of Health and Human Services has reordered smallpox vaccine for the first time in decades and is expected to receive 209-million doses before the year is out.
"We will have enough vaccine to save and protect every American should there be an outbreak," Health and Human Services Secretary Tommy Thompson said.
A major study, sponsored by the government and unveiled Thursday by the New England Journal of Medicine, revealed that the existing stockpile of 15-million doses of smallpox vaccine retained its potency when diluted fivefold to tenfold. Thompson called this "great news for Americans."
If the vaccine must be used, the government would probably favor fivefold dilution to be on the safe side, but in case of smallpox attacks on many cities at once, government experts said the new research demonstrates they could dilute the vaccine even further.
"If this were an absolute emergency that we needed 150-million doses, I wouldn't have any hesitation in recommending that we go with the 1-to-10" dilution, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which sponsored the study.
The situation is improving so rapidly that political pressure is mounting on the government to permit the vaccine's broader use. States are lobbying for vaccination of some firefighters and health care workers who would be first on the scene of an outbreak. Fauci and Thompson Thursday stuck by the government's policy that vaccination should be employed only in a proven outbreak but they called for public discussion of whether that policy should be broadened once more vaccine is on hand.
Outlining the case for voluntary mass vaccination, William Bicknell, former health commissioner of Massachusetts, wrote in the medical journal that such a policy would discourage a terrorist attack using smallpox. The public, he said, is capable of understanding that the vaccine itself poses risks and might be willing to bear them.
Bicknell calculated that a policy of nationwide vaccination could be expected to result in 168 deaths from side effects. Other experts have estimated several hundred deaths. All agree that tens of thousands of people would be made seriously ill by the vaccine but would probably recover.
"It is time for a full and open debate about the best protection against the possible reappearance of smallpox," Bicknell wrote.
Routine vaccination against smallpox, a highly infectious viral disease that killed about a third of those who contracted it, was abandoned in the United States in 1972 and the disease was declared eradicated from the world in 1980. The only two official stocks of the virus are held by Russia and the United States. But many experts on terrorism say it is possible that stocks of the virus might exist in other hands.
Because much of the world's population has not been vaccinated against the disease and because the immunity from vaccination is believed to wane, the release of the smallpox virus could be catastrophic.
The Centers for Disease Control and Prevention said months ago that if an outbreak occurred it would isolate infected people and vaccinate those who had come in contact with them. This tactic, ring vaccination, was used by the CDC and the World Health Organization to eradicate the disease. The smallpox vaccine is expected to protect people if it is given in the first four days after they are exposed.
Dr. John Modlin, who heads an expert committee that advises the CDC on immunization, said the group was considering who should have access to the vaccine and expected to discuss the issue and possibly make recommendations at a meeting in June.
Modlin said he expected his group would not recommend vaccinating everyone because the vaccine was so risky. The most difficult question, he said, is deciding if some people should be offered the vaccine because they will help in an emergency.
-- Information from the New York Times was used in this report.