Smallpox concerns trump other basic health needs

Houston Chronicle ^ | 4-20-2003 | By REBECCA COOK

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SEATTLE -- The high cost and heavy demands of being ready for a possible smallpox attack are squeezing basic public health services, state health officials say, forcing cutbacks in such areas as childhood vaccinations and tuberculosis prevention.

"It has forced trade-offs in everything we do," said Dr. Alonzo Plough, public health director for Seattle and King County, which is battling its worst tuberculosis outbreak in 30 years.

But federal health officials have some advice: Get used to it.

"We are never going to get back to the days when we did `regular' public health," said Dr. Ed Thompson, of the Centers for Disease Control and Prevention. "For the rest of all our careers in public health, we're going to do the emergency crises and the daily work side by side."

Some state and local health agencies warn that the result could be more outbreaks of preventable diseases such as TB and hepatitis. Seattle officials blame a shrinking budget and the emphasis on smallpox for contributing to the TB outbreak.

Federal officials say local health workers simply need to get better at juggling daily duties with emergency demands.

"That's the nature of public health -- things come up," said Thompson, deputy director for public health services at the CDC. Public health workers need to adapt to emergency interruptions in their routines, he said.

He agrees, though, that more money is needed for all the demands. "Support of protection of the public health is going to have to become a priority," Thompson said.

While Seattle's TB outbreak may be the most dramatic example, many state and local health departments say they are cutting bread-and-butter services.

In Memphis, Tenn., some childhood immunizations and diabetes screenings have been put on hold. Health officials in Camden County, N.J., near Philadelphia, have canceled family planning clinics. In Wake County, N.C., home of Raleigh, workers have delayed some programs and canceled client visits to meet the demands of smallpox planning.

"This situation has led to questionable preparedness, poor response to community requests for service and an overextended staff -- not a good combination," said Gibbie Harris, community health director for Wake County, N.C.

The smallpox campaign began last December, when President Bush ordered the voluntary vaccination of 450,000 civilian health workers.

Most of the burden for carrying out the plan fell to state and local health departments. County health officials in Washington state said they had to shelve preparations for other bioterrorism threats, such as anthrax, to meet federal expectations for smallpox.

But the attitude toward the smallpox plan seems to differ in East Coast urban areas that believe they are more likely targets of bioterrorism. Few complaints are heard in the Maryland Department of Health and Mental Hygiene.

"There really hasn't been a discernible impact on day-to-day operations," said J.B. Hanson, spokesman for the Maryland agency. He said health workers seem committed to the vaccination plan.

"The locale obviously has something to do with it," Hanson said. "We're very aware that we border the nation's capital."

But in Seattle, the more pressing need seems to be TB -- a disease that is at an all-time low nationally.

Plough, Seattle's health chief, said the TB response could have been "faster and more focused," if they had more money or fewer smallpox mandates.

To make up for the slow start the county health department now is doing X-ray screenings in homeless shelters, sleuthing out the identities of people who may have been exposed and tracking the outbreak with DNA fingerprinting.

But the smallpox vaccinations will take attention, too.

"We should be the first responder for bioterrorism, no question," Plough said. "But we can't stretch ourselves that much. We're not that elastic. You can't do more with 50 percent less budget."

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My daughter saw a soldier's smallpox scab the other day. She said it was huge. The soldier had been really really sick from the shot, but was recovering. Will be OK.