Mass Inoculations Pose Complexities

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Mass Inoculations Pose Complexities

Date: 12/13/02; Publication: The Washington Post; Author: Guy Gugliotta

Washington Post Staff Writer

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<http://ask.elibrary.com/images/shim.gif> The Washington Post

<http://ask.elibrary.com/pubminis/The_Washington_Post.gif> Mass Inoculations

Pose Complexities Byline: Guy Gugliotta Washington Post Staff Writer

Edition: FINAL Section: A Section

Middle-aged Americans probably remember it as little more than a ho-hum trip

to the family doctor, but the resumption of large-scale smallpox

vaccinations after a 30-year hiatus promises to be anything but simple.

The Bush administration is expected today to set in motion plans to

inoculate 500,000 military personnel and as many as 500,000 health care

workers nationwide -- the front-line defenders in any biological warfare

attack against the United States.

As more vaccine becomes available, federal health officials say the " Phase

I " program will soon expand into a " Phase II " to include 10 million to12

million additional Americans -- virtually the nation's entire contingent of

police, firefighters and other first responders. The vaccine would probably

be offered to the general population by 2004.

Sixty-two states, cities and territories have been getting ready for Phase I

for months, calling for volunteers, educating them on the vaccine' s dangers

and preparing to monitor its effects. Wyoming conducted drills to determine

how long it took to vaccinate 100 people.

" We are extremely pleased and quite impressed with the plans that have been

submitted so far, " Health and Human Services Secretary Tommy G.

said yesterday. " It is obvious the state and local health departments and

hospitals have stepped up to the plate under an extremely tight timetable. "

The military plan, unlike the civilian version, is mandatory, according to a

key member of Congress, but in other respects will largely mimic civilian

procedures -- vaccinating first-line medical personnel before immunizing

soldiers in high-risk areas such as Iraq and the Middle East. The Pentagon

did not respond to requests for information on its plan.

Despite administration enthusiasm for the vaccinations, many questions

remain unresolved.

" This is not something that anyone can take lightly, " said Diane Sosne, a

registered nurse and leader of the 16,000 health care workers in the

Washington state branch of the Service Employees International Union. " We

want to make sure this doesn't pose more risks than it is supposed to

address. "

The smallpox vaccine, used throughout the United States until 1972 and in

the U.S. armed forces until the 1980s, can have extreme side effects. For

every million people vaccinated, as many as 52 will suffer serious illness,

including prolonged fever, and one or two will die.

At the least, people who receive the vaccine -- usually in a series of

pinpricks on the upper arm -- can expect swelling, redness, itching and a

large, lingering scab. A few days of fever or malaise is common.

Such adverse reactions were deemed more than acceptable when smallpox was a

world scourge, but there has not been a reported case anywhere in the world

since 1977.

Doctors warn that the vaccine poses unacceptable risks for babies, people

with a variety of skin conditions and anyone with a weakened immune system.

" In the old days, we didn't have a lot of the medications we have today, so

those patients would die, " said e Mascola, who is in charge of the

vaccine program for Los Angeles County, Calif. " Today there are many more

cancer patients living, more people on steroids, and more people living with

HIV. "

The Service Employees International Union, the nation's largest health care

workers union with 1.5 million members, criticized the administration

earlier this month for failing to provide compensation for volunteers who

may miss work, become ill or even die from taking the vaccine.

" This is an economic decision as well as a health care decision, " said SEIU

President L. Stern. " Suppose I'm a per diem nurse, and I'm out for a

couple of days or I go to the hospital. That has to come out of my pocket.

This should be a no-fault situation. "

On Capitol Hill, Rep. Shays (R-Conn.) questioned whether the

armed forces will adequately screen personnel likely to suffer adverse

reactions:

" It's mandatory, so people will take this vaccine against their will, " said

Shays, a longtime critic of Pentagon vaccine policy. " Since they will have

to comply, it's important to determine who should get it. "

Shays said medical workers in the military must not cede control of the

vaccination process to field commanders with little expertise: " The record

of the military in following private-sector procedures is basically

nonexistent, " Shays said.

Despite these misgivings, the public climate for the vaccination program

appears to be markedly positive. A Wood Foundation poll

released Wednesday found 65 percent of respondents are willing to get a

vaccination.

" I thought we'd be having a lot of our people saying this is a bad idea, "

said Wyoming state epidemiologist Karl Musgrave, in charge of vaccinations

in the least populous state. " But more questions came from people who wanted

to do it and were asking for a waiver -- one nurse was on chemo, another was

taking steroids and another had diabetes. No matter what, they want to take

it. "

In Wisconsin, Herb Bostrom, the director of the Bureau of Communicable

Diseases, found the same enthusiasm, " even though significant questions

remain " about compensation and medical care. " People in hospitals and public

health recognize they are supposed to do this, and they will, " Bostrom said.

The U.S. Centers for Disease Control and Prevention gave states and local

governments until Dec. 9 to submit plans for conducting vaccinations both

before and after a smallpox outbreak. The CDC said yesterday that plans it

has examined so far envision inoculating almost 450,000 people.

Musgrave said Wyoming's plan calls for " about 1,000 people " to receive the

vaccine in Phase I, a task he said could probably be completed in a few

hours. He said eight communities practiced vaccinating 100 people this

summer and managed the job " in a couple of hours. "

Elsewhere, authorities appeared less inclined to move that quickly: " We'll

start slowly, do one site first and see what happens, " said s C.

, former land secretary of health and mental hygiene, who said

his state expects to vaccinate between 6,000 and 8,000 people during the

initial phase. ( resigned Sunday to take another position.) He said

land could complete the vaccinations " within a week, " but is in no

hurry: " There is no emergency. We're going to look at the experience, and

see if our criteria are too rigid or too loose. There's a learning curve. "

In Los Angeles County, Mascola will vaccinate as many as 12,000 people but

is " not interested in doing it until January, " when the worst of the flu

season is over.

Staff writer Ceci Connolly contributed to this report.

Keywords: SCI

Guy Gugliotta Washington Post Staff Writer, Mass Inoculations Pose

Complexities. , The Washington Post, 12-13-2002, pp A20.