Posted on 07/06/2002 11:15:21 AM PDT by GeneD
The federal government will soon vaccinate roughly a half-million health care and emergency workers against smallpox as a precaution against a bioterrorist attack, federal officials said. The government is also laying the groundwork to carry out mass vaccinations of the public — a policy abandoned 30 years ago — if there is a large outbreak.
Until last month, officials had said they would soon vaccinate a few thousand health workers and would respond to any smallpox attack with limited vaccinations of the public. Since 1983, only 11,000 Americans who work with the virus and its related diseases have received a vaccination, according to the Centers for Disease Control and Prevention.
The plan to increase the number of "first responders" who receive the vaccination to roughly 500,000 from 15,000 and to prepare for a mass undertaking of vaccinations in effect acknowledges that the government's existing program is insufficient to fight a large outbreak.
The government's new vaccination safeguards come amid continued talk in Washington of war against Iraq, which terrorism experts suspect of maintaining clandestine stocks of the virus, as well as growing criticism of the government's limited plan. Only Russia and the United States have declared stocks of the virus.
A highly contagious disease, smallpox was declared eradicated globally in 1980, eight years after the United States stopped routine vaccinations.
Until its eradication, smallpox killed roughly one in three people who were not vaccinated. Because immunity is believed to diminish with time, most people alive today are considered vulnerable to smallpox. But federal officials have long resisted the resumption of mass smallpox vaccinations, citing the probable risk of serious side effects, even death.
Last month, a federal advisory panel backed a plan for "ring vaccinations," in which health workers would isolate infected patients and vaccinate people in close contact with them, forming a ring of immunization around an outbreak and a barrier to its spread. In theory, such a strategy can work because the vaccine, if given within four days of exposure to the virus, protects people from the disease.
Some experts on infectious disease said the plan's main virtue was that it required little smallpox vaccine.
The government's more aggressive plans are possible because vaccine supplies are rapidly increasing as a result of crash manufacturing and stockpiling efforts begun soon after last fall's terrorist strikes, officials said. Also, studies have found that existing vaccine doses can be diluted without loss of effectiveness.
"Now we can act differently because we have more vaccine," Dr. Donald A. Henderson, senior science adviser to Tommy G. Thompson, the secretary of health and human services, said in an interview. Dr. Henderson, who led the global smallpox eradication effort, added that in a crisis "we can make vaccine available on request throughout the community."
Officials said that about 100 million doses of the smallpox vaccine (160 million if diluted) are in hand and that by late this year or soon thereafter enough will be available for every American, more than 280 million people.
Health and military experts, citing new models of how the contagion can spread and new disclosures about how the weaponized virus can sail on the wind, have recently argued that limited, local vaccinations could produce thousands if not millions of needless infections and deaths. Most critics of the ring vaccination plan advocate mass vaccinations of the United States population — but often before a smallpox attack, not after, as the government is now planning.
In addition to vaccinating more "first responders," the government plans to develop ways to speed vaccine deliveries around the country and help states plan how to carry out mass vaccinations after an attack.
Officials said the vaccinations of hospital workers and smallpox response teams, to begin fairly soon, would help train health professionals in smallpox vaccination and educate the public to the attendant risks.
The White House, Defense Department and other federal agencies are involved in the vaccination planning. "Everyone is aware," an administration official said.
Jerome M. Hauer, acting assistant secretary for emergency preparedness at the Department of Health and Human Services, said the agency hoped to send planning documents on how to best conduct mass vaccinations to cities and states in the next week or two. Mr. Hauer added that logistics changes to that end were under way at the Centers for Disease Control and Prevention in Atlanta, which oversees the production, safekeeping and distribution of the nation's stockpile of smallpox vaccine.
Other details of the plans, such as who would receive peacetime vaccinations, have yet to be approved by Mr. Thompson, officials said.
In interviews last week, health officials said the government had not abandoned its longstanding plan for ring vaccinations of people near a smallpox outbreak, the approach health workers used decades ago to eradicate the highly contagious disease from human populations. But the added steps, officials said, will make it possible to move far more aggressively if a terrorist attack ends up infecting more than 100 people or so.
Critics had said the ring approach, while useful in battling natural outbreaks, would do little or nothing against a moderately skilled enemy intent on mayhem.
"Unless the initial attack is very small and the infectiousness of the agent is quite mild, ring vaccination is not going to do much good," said Edward H. Kaplan, a Yale public health specialist who questioned the method's value at a federal meeting in Washington three weeks ago.
In a report, the Cato Institute, a policy group in Washington, called ring vaccination "woefully inadequate for countering a direct attack."
Critics argued that a number of factors had diminished the method's effectiveness since the disease was eradicated in 1980: populations are now increasingly mobile, levels of immunity are very low and advanced technologies have become commonplace, raising the odds that a smallpox attacker would be at least moderately skilled.
"Today it's a totally different scenario," said William J. Bicknell, an international health expert at Boston University who recently faulted federal smallpox policy at a Cato meeting. The ring plan, he declared flatly in an interview, "will not work."
Federal officials said the rising criticism played no direct role in shaping preparations for mass vaccinations.
"The key to responding to any public health emergency is flexibility," Mr. Hauer said. "You listen to critics, but you can't let that drive policy. You have to do what's best for public health and national security."
Ring vaccination, he added, was envisioned as simply a first line of defense that could quickly expand to much wider immunizations if necessary.
Mr. Hauer added that the ring strategy was inherently small-scale because it required health professionals to carefully trace the whereabouts and contacts of infected people. Such work is so hard and time consuming, he noted, that ring vaccination is unsuitable as the only means of fighting a wide epidemic.
He said another complication could arise if the disease broke out simultaneously in multiple cities, suggesting a strike of unknown size and danger. In that case, he said, "the forces pressing you to mass vaccinate become greater."
Dr. Henderson, the chairman of the Secretary's Council on Public Health Preparedness at the Department of Health and Human Services, said critics have falsely portrayed the government as relying exclusively on ring vaccination.
"Let me be clear," he said. "If there is an emergency, and if we have to vaccinate widely, we need to be ready for it. That's what we're doing."
Mass vaccinations are not without risk because the smallpox vaccine uses a live virus, vaccinia, a cousin of smallpox, that on occasion can cause brain damage or even kill. In the days of wide vaccination, roughly one person in a million died.
The risk may be greater for people with weakened immune systems, like AIDS patients or people undergoing chemotherapy.
The government is seeking more supplies of vaccinia immune globulin, a substance now in short supply that can prevent severe reactions in people with immune problems as well as the healthy. Officials said 700 doses are in hand and 3,000 will be available by the year's end.
Despite the vaccine's well-known dangers, federal critics have increasingly called for various styles of mass vaccination — including doing it on a voluntary or mandatory basis, before or after a smallpox attack.
At a June 15 public forum in Washington on federal smallpox vaccination policy, Dr. Kaplan, of Yale, presented a study done with colleagues from the Massachusetts Institute of Technology that described how a smallpox attack could affect a crowded metropolitan region like New York City. What began as 1,000 infections at a train station or airport, he said, would spiral over weeks and months into 97,000 deaths if fought with ring vaccination alone.
"By contrast," he said, "post-attack mass vaccination would result in only 525 deaths" from the smallpox virus, which takes about two weeks to develop in the body before symptoms become obvious.
Some federal officials call this study unrealistic. But at the meeting, such ideas gained force as new evidence came to light on how powdered smallpox can be used as a biological weapon.
Dr. Alan P. Zelicoff, a smallpox expert at the Sandia National Laboratories, reported that he and experts from the Monterey Institute of International Studies had linked a 1971 outbreak in the Kazakh Republic to a Soviet field test of weaponized smallpox.
Dr. Zelicoff, a physician, quoted a former Soviet official as saying the accident occurred when a plume of smallpox germs sailed about nine miles on the wind.
By the meeting's end, medical experts were questioning not only the ring plan but also federal assertions that the smallpox threat is low.
Dr. Kenneth I. Berns, president of the Mount Sinai Medical Center in New York City, said he judged the probability that Iraq possessed weaponized smallpox as "reasonably high" and that Saddam Hussein would use such germs in a war against the United States as "quite high."
"That's the confounding issue that we all face," Dr. Berns told the forum, according to a transcript.
Frank public discussion of the Iraqi threat, he added, "is absolutely essential."
In interviews, officials of the Department of Health and Human Services declined to comment on federal threat assessments but detailed wide contingency planning for mass smallpox vaccinations.
On June 20, a federal panel known as the Advisory Committee on Immunization Practices backed the idea of immunizing some emergency workers before any attack. Experts estimated that the immunizations would go to some 15,000 health care and law enforcement workers who would be most likely to respond to a biological attack and come in contact with victims.
But Dr. Henderson, the health department's senior adviser on bioterrorism, said the tentative new plan was for many more to be vaccinated. "We could easily be at a half-million without too much difficulty," he said.
Wide peacetime vaccinations, he said, would help educate not only the nation's medical community on the practical aspects of smallpox immunization but also the public.
If the peacetime group suffers a couple of deaths, "there will be a lot of publicity and concern," Dr. Henderson said. "It's a question of how people are going to respond."
Iraq warnings prompt rush to order vaccine
By David Bamber and Chris Hastings
Daily Telegraph, April 14, 2002TONY BLAIR rushed through an order for 16 million doses of the smallpox vaccine after Dick Cheney, the American Vice-President, warned him that a military attack on Iraq would be met by a biological terror onslaught on Britain.
The two leaders met at Downing Street on March 12 and exchanged intelligence about the possible threat from Iraq.
Mr Cheney told the Prime Minister that intelligence experts had warned that the United States and Britain would be the two main targets of biological warfare in the event of a conflict.
American security reports suggested that Saddam Hussein would use all the weapons at his disposal if he was attacked. Unlike the Gulf war, where he showed some restraint, this time he would know that the military action is intended to end in his death or capture.
Two days after Mr Blair and Mr Cheney met, six health ministers including Alan Milburn gathered in London and took the decision to order inoculations against smallpox.
Health ministers from Japan, Mexico, France, Germany and America met to share intelligence on vaccine stocks and methods of responding to a bioterrorism attack.
Three weeks later, the British Government placed a £32 million order for 16 million smallpox vaccines with PowderJect of Oxford.
It is believed that in the event of a war being launched by the West, Iraqi special agents will attempt to smuggle smallpox into Britain and release it in confined spaces such as the Tube or cinemas.
The worst case would be suicide terrorists infected with smallpox.
This would spread the virus throughout the population rapidly, causing the deaths of up to a third of the people infected.
Earlier this year, American scientists projected how smallpox infections would spread after a single terrorist strike.
They found that an attack on a train on April 1 would result in 15,000 cases of smallpox, including 2,000 deaths, by June. The disease would also spread to four foreign countries, they calculated.
Last year another computer model suggested that the introduction of smallpox in three American states during the winter would result in three million cases and one million deaths by the following February.
According to American intelligence, Iraq is believed to have developed stocks of the smallpox virus, which is highly contagious and cannot be cured once contracted, during the early Eighties.
During the Gulf war, Iraq prepared to use missiles tipped with smallpox and other deadly diseases against Allied troops and was only dissuaded by threats of nuclear retaliation.
It is believed that Saddam‘s dictatorship capitalised on a natural outbreak of smallpox disease in the Seventies, which happened when it was developing its own weapons of mass destruction.
The United Nations Special Commission (Unscom), which was set up to inspect weapons in Iraq, has grown more concerned about the country‘s biological weapons programme.
Richard Sperzel, a specialist, told the US House of Congress committee on international relations in December that Unscom believed it was prudent to make the assumption that Iraq possessed the necessary necessary facilities, expertise and equipment for smallpox production, he said.
A number of other clues strongly suggested that it had an interest, if not an active programme, in such weapons development.
Iraq has also developed a vaccine for "camelpox", which is similar to smallpox, that will give its own population some protection in the event of military use of the virus.
The regime has admitted developing camelpox but has failed to say why. Roger Roffey, a former United Nations weapons inspector in Iraq, said in January: "The bioterrorism threat in the United States and also for the United Kingdom has increased since September 11.
"Experts estimate that Britain has stocks of about three million doses of smallpox vaccine, which was made in the Seventies. Routine vaccination stopped in 1971 when the number of cases declined to zero. Almost everyone over 35 will have been vaccinated.
Interesting times we live in friend.
During the Persian Gulf war, intelligence officials argued that Saddam Hussein would not use his stockpile of anthrax and other chemicals unless he and his regime were clearly threatened. The administration's recent statements about the need for "regime change" in Iraq, its inclusion of Baghdad in the "axis of evil," and President Bush's articulation of a pre-emption doctrine that would justify American military action against any hostile nation that makes unconventional weapons, however, have increased the threat that Mr. Hussein might use his large arsenal, some officials say.This is tantamount to saying that Saddam Hussein is still alive and in power today because he presented a credible, anthrax-based WMD threat against the Israeli civilian population in 1991. This time around, the provocation against the United States is on a whole different scale. Accordingly, Saddam's back-end security is to bring that anthrax threat home to the United States:
A recent analysis by the United Nations inspectors says there is compelling evidence that Iraq has large stocks of liquid anthrax that could be used at any time. The new policy clearly reflects the thinking that civilians in this country are as susceptible to anthrax attacks as soldiers in combat zones, as was demonstrated by the death of five people last year from anthrax spores sent through the mail.
You are given a prick of the vaccine under the skin. After a few days, a sore will form (a pox) and it looks pretty icky. The area around the sore (about the size of a penny for most people) is a little bit tender. Eventually the sore scabs over and falls off, most times leaving a small scar. You can see these scars on people over the age of 40. The formation of the sore indicates that your immune system has been engaged, and immunity is good a few days after you have received the vaccination.
It is nothing to be frightened of, and as I said they were required of all Americans who wanted to enter public school, the military, universities, or travel abroad until 1972.
The puzzle of the FBI's bungling investigation into the anthrax threats that followed 9-11 is no mystery in this light. There is method to the FBI's madness:
It is protection for Saddam to have biological and chemical weapons, because, in the final analysis, if pressed, if he is surrounded in Baghdad, he will threaten to use them. He's capable of that. This is a sort of Samson complex--if you push me too hard, I'll bring the house down, on myself and on everyone else. Washington realizes that this is a possibility. For obvious reasons, it's not talked about openly. No one in Washington wants to tell the American people that Saddam is still capable of blackmailing us. They're acting as if he is capable of blackmailing them, but they are not going to admit it openly.
They don't need to be vaccinated. They will benefit from so-called "herd immunity." If only 1% of the population, say, is not immune, the chances are small that the disease will spread far enough to get to any particular one of these vulnerable people.
These vulnerable people will, I suppose, be at some risk if they are exposed to people who have recently been vaccinated. But that problem could be solved by isolating people who are vaccinated for a couple of days.
Who the hell are Tommy Thompson or George W. Bush to tell anyone who can afford the vaccinations that they can't have them?
Mass vaccinations against smallpox have been conducted sinde the early 19th Century. Make the vaccine available first to those born since 1972 who've never been vaccinated, and then to those of who have older vaccinations later.
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