Vast Uncertainty on Smallpox Vaccine

[Guest guest]

" In the meantime, the government is also paying for research into safer

smallpox treatments. Dr. Mark Buller, a virologist at St. Louis University,

is part of that effort. Because he studies viruses in the pox family, he is

one of the few Americans who have recently been immunized against smallpox.

" I would not even consider having my family vaccinated, " Dr. Buller said.

" I feel I'm more likely to be hit riding my bike to work than to be hit by

a smallpox episode in my own life. "

http://www.nytimes.com/2001/10/19/national/19SMAL.html

October 19, 2001

Vast Uncertainty on Smallpox Vaccine

By SHERYL GAY STOLBERG

ASHINGTON, Oct. 18 — Dr. Marjorie Barnett, a pediatrician in Silver Spring,

Md., is accustomed to talking to parents about immunization. These days,

amid growing fear of bioterrorism, those conversations center not on

hepatitis or polio, but on a disease that was wiped out decades ago: smallpox.

" I'm getting 5 or 10 calls a day from parents who want the vaccine, " said

Dr. Barnett, who believes that smallpox vaccinations, suspended in this

country in 1972, should resume. " I have to tell them it's just not

available. What I am telling them now is, `Call your Congress people, call

the White House, call everybody you know and tell them to look into this.' "

One day after the federal government announced that it was laying plans to

stockpile enough smallpox vaccine, 300 million doses, to protect every

American if necessary, questions are quickly emerging about how that

stockpile would be used.

The vaccine carries risks. A recent analysis of six million people who

received their first smallpox vaccinations in 1968 found that six had died

as a result, mostly of encephalitis, an inflammation of the brain. Other

adverse effects can be far more common. Even so, some patients argue that

they should be allowed to decide for themselves.

But public-health experts maintain that a mass vaccination program is

unwise. Smallpox vaccine, they say, should be used only in the event of a

smallpox outbreak.

" The recommendation right now is no, " said Dr. S. Fauci, director

of the National Institute of Allergy and Infectious Diseases, adding that

the complications of smallpox vaccine were greater than for those

vaccinations that are still given in childhood. " And the reason those

complications were accepted was because of the extraordinarily devastating

impact that smallpox could have on society. "

The Centers for Disease Control and Prevention, in Atlanta, has a reserve

of roughly 15 million doses of smallpox vaccine. That vaccine, which is not

available to the public, was manufactured using a method that dates from

the 1700's. The method involves infecting calves with a related virus,

vaccinia; the resulting pus is used in the making of the vaccine.

That process is considered barely acceptable for human vaccine today. So

the government has contracted with a biotechnology company, Acambis, to

make a similar vaccine using modern techniques that involve growing

vaccinia in cells, and to deliver 54 million doses by next summer. Early

next year, Dr. Fauci's institute will begin clinical trials of that

vaccine; in the current climate, he predicted, there will be no shortage of

volunteers.

At the same time, Tommy G. , secretary of health and human

services, says he is negotiating with four drug makers to produce enough

doses to cover every American.

The smallpox virus exists in laboratories that are overseen by the World

Health Organization, although bioterrorism experts believe that clandestine

stocks may exist. In any event, unlike anthrax, which is not transmitted

from person to person, smallpox is highly contagious.

The smallpox vaccine can be used not only to prevent infection but also to

treat people within a few days of exposure to the virus, and thus contain

an epidemic.

An outbreak of smallpox in New York City in 1947 provides insight into how

such a vaccination program would work, said Leonard A. Cole, who teaches

science and public policy at Rutgers University and is the author of a book

on biological warfare.

The outbreak, Mr. Cole said, involved a businessman who had been traveling

in Mexico and arrived in New York on March 10 of that year. He died in a

city hospital after infecting several others, but city health officials did

not detect the outbreak until April 4.

The authorities then made a " crash decision to vaccinate everybody that had

not been vaccinated since childhood, " Mr. Cole said, but, with only 500,000

doses on hand, they soon ran out of vaccine. They turned to the military

for help, and in three weeks 6.3 million New Yorkers had been immunized

against smallpox. In the end, he said, 12 people were infected with the

virus, and two died, including the first patient.

Mr. Cole described this method of responding as " a model that we know

works. " But today's population is far more vulnerable to smallpox: many

Americans have never been vaccinated, and even those who have been now lack

protection because the vaccine is thought to wear off after 15 or 20 years.

So some people say they would rather risk vaccination than the possibility

of a slowly detected outbreak. Others are not so sure. " I'd want to know

more about the side effects and the dangers to my daughter, " said Elaine

Herscher of San Francisco, the mother of a 5-year-old. " The real threat to

her health from the vaccine could be far worse. "

Even if the government does amass 300 million doses, it is unlikely to

offer them without " substantial discussion, " said Dr. V. Inglesby of

the Center for Civilian Biodefense Studies at s Hopkins University.

Among the questions that would need to be answered: Who should be

vaccinated first? Emergency workers? Health professionals? Children? The

elderly?

In the meantime, the government is also paying for research into safer

smallpox treatments. Dr. Mark Buller, a virologist at St. Louis University,

is part of that effort. Because he studies viruses in the pox family, he is

one of the few Americans who have recently been immunized against smallpox.

" I would not even consider having my family vaccinated, " Dr. Buller said.

" I feel I'm more likely to be hit riding my bike to work than to be hit by

a smallpox episode in my own life. "

--------------------------------------------------------

Sheri Nakken, R.N., MA

Vaccination Information & Choice Network, Nevada City CA & UK

530-740-0561 Voicemail in US

http://www.nccn.net/~wwithin/vaccine.htm

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