Smallpox effort needs more than vaccine

WASHINGTON, Nov. 2 (UPI) -- Even if 300 million doses of updated smallpox vaccine arrive as promised by the end of 2002, local public health agencies need federal help to use that vaccine effectively, a Boston health official told a Senate committee Friday.

The Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies held a hearing to discuss the best way for the country to prepare or prevent a bioterrorism attack using smallpox. Sen. Tom Harkin, D-Iowa., the subcommittee chairman, said efforts to date have been inadequate.

"In the past couple of weeks we have seen the havoc that can be created by just a few grams of anthrax spores," Harkin said. "So I find it less than comforting when I'm told that the greatest risk is not from anthrax but from smallpox."

Harkin said the subcommittee has developed a $2.3 billion plan to address the threat of bioterrorism.

In 1977, public health officials worldwide declared smallpox eradicated in the wild, and vaccination efforts ended shortly thereafter. The virus still exists in U.S. and Russian laboratories, and perhaps elsewhere, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. It therefore remains a potent threat to a largely vulnerable population, he told the committee.

Fauci said NIAID is developing short-, medium- and long-term solutions to this problem. The existing 15 million doses of smallpox vaccine can apparently be diluted yet remain effective enough to provide 75 million vaccinations in the short term, he said. In the medium-term, the institute is accelerating efforts to create a modern, safer vaccine; the program should produce 300 million doses by the end of next year, Fauci said.

Such a development program normally takes several years, said Dr. Michael Friedman, the Pharmaceutical Research and Manufacturers of America's chief medical officer for biomedical preparedness. Despite the fast-track nature of the plan, Friedman backed up Fauci's prediction, testifying the drug industry is ready to meet the government's needs.

Creating the stockpile is only part of the solution, however, testified Dr. Anita Barry, director of communicable disease control for the Boston Public Health Commission. She spoke on behalf of the National Association of County and City Health Officials.

"All the vaccine in the world isn't going to do any good without the capacity to distribute and administer it locally," Barry said. "The current levels of staffing, planning and preparedness at the local level are not enough, even in cities that have initiated bioterrorism preparedness."

For example, Barry's organization has one infectious disease physician and a few nurses to cope with a city population exceeding 1 million on workdays. Barry said at least $835 million of planned emergency bioterrorism funding should go directly to local and state health departments. The federal government should help improve communication systems between local, state and national health agencies, she said, as well as include local health officials in national planning.

Such actions are already underway, testified Dr. James LeDuc, a staff member of the National Center for Infectious Diseases, part of the Centers for Disease Control and Prevention. The CDC will host a live satellite broadcast Dec. 13 on smallpox-related topics for doctors, nurses and other medical personnel, he said. The centers are also expanding a nationwide program for communication between health agencies, he said, as well as creating a secure Web-based system for sharing vital information between health officials at all levels.

The National Institutes of Health are also taking steps beyond the vaccine program, Fauci said. The NIH has investigated a number of anti-viral drugs originally developed to help fight AIDS, he said. One of those medications, cidofovir, is promising enough that the NIH is developing rules for using it against smallpox in emergency situations, Fauci said.