Health officials to churn out smallpox vaccine

© St. Petersburg Times,
published October 28, 2001

WASHINGTON -- Federal health officials, spurred by last month's terrorist attacks and by the recent dissemination of anthrax spores through the mail, are mounting an unprecedented effort to produce enough smallpox vaccine for every American by the end of next year.

"Every man, woman and child will have a vaccine they can say has their name on it," Health and Human Services Secretary Tommy Thompson said last week.

Most experts agree that existing smallpox vaccine stocks must be expanded. The smallpox virus, which some experts fear might be in the arsenal of rogue nations and terrorist organizations, is the most dreaded potential biological weapon. Smallpox can't be cured with drugs, kills about one-third of victims and spreads easily from person to person. Because most Americans have no immunity to the virus, isolating those infected and vaccinating everyone who came into contact with them would offer the only hope of halting a potentially devastating epidemic.

"If this were to occur, it would be a disaster and you'd better have your most powerful ammunition out there, ready to go," said D.A. Henderson, director of the Johns Hopkins Center for Civilian Biodefense Studies, who led the worldwide campaign to eradicate smallpox in the 1970s.

But the crash program is raising some questions: Will it divert resources and imperil worldwide supplies of other vaccines, especially for infectious diseases that kill children in developing countries? Should some medical workers be vaccinated immediately? And will the decision to produce so many doses of the vaccine fuel public demand for a hazardous mass immunization campaign?

The vaccine is rare but serious side effects make it far too risky to administer preventively in a national immunization campaign. When all U.S. infants were vaccinated routinely, a practice that ended in 1971, about five children died of vaccine-related complications for every 1-million immunized. The risk of death is lower, but still present, in adults.

"This is a vaccine that has real, known adverse reactions, and that's why it's not to be given out lightly en masse," said Myron Levine, director of the Center for Vaccine Development at the University of Maryland School of Medicine. "I hope we'll never get back to having to use it in large numbers of people again."

The frequency of serious complications with the old smallpox vaccine was higher than for any vaccine now on the market, and vaccine experts assume the risks will be similar with the new version, which contains the same live virus -- called vaccinia or cowpox -- but is made by a different process.

In a child with eczema, for example, the virus in the vaccine can spread quickly to produce a life-threatening rash. In rare instances, especially in people with weakened immune systems, it can cause encephalitis (brain inflammation).

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