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CounterPunch
January
30, 2003
Bush's Smallpox
Boondoggle
by MARIA TOMCHICK
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 4 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 from
the vaccine alone.
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 a usable
weapon.
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 is 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 to vaccinate
for smallpox 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've
already been exposed to the disease if they're given the vaccine
within four days of exposure to the disease.
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.
Maria Tomchick
is a co-editor and contributing writer for Eat
The State!, a biweekly anti-authoritarian newspaper of political
opinion, research and humor, based in Seattle, Washington. She
can be reached at: tomchick@drizzle.com
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