U.S. may alter smallpox strategy

By STEVE MITCHELL, UPI Medical Correspondent  |  June 11, 2002 at 5:52 PM
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WASHINGTON, June 11 (UPI) -- The U.S. government's impending change of strategy for smallpox vaccination, announced by Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, is already being questioned by citizens groups, representatives told United Press International.

The Centers for Disease Control and Prevention currently is reconsidering its smallpox vaccination strategy, which calls for delaying vaccination until after a biological attack involving the virus has occurred. The vaccine will still protect people up to four days after exposure to smallpox, which is fatal 30 percent of the time.

"It is likely (CDC's new strategy) will be a modification of the present scheme," Fauci told the House Subcommittee on Environment, Technology, and Standards Monday. It would probably include vaccinating first responders such as emergency medical personnel and firefighters, he said.

Twila Brase, president of the St Paul, Minn.-based Citizen's Council on Health Care, an independent non-profit group focused on health policy, claimed such a strategy would be unwise and unfair.

"It's a bit classist that one group gets to be protected because they might come into contact with the affected individual first," Brase told UPI.

She noted the strategy could prove ineffective because first responders might not be the first to encounter a person infected with smallpox. The affected person is likely to come into contact with "many, many more people" before they even realize they are infected and seek medical attention.

The Citizen's Council is pushing for the CDC to make the vaccine available to the general population as long as people are fully informed of the risks of receiving the vaccine.

Fauci told legislators this would probably not be part of the revised strategy. "There is very little indication (the CDC) will make the vaccine" available to the general population, he said. But he left open the possibility the agency may opt to make it available to people who understand the risks.

The smallpox vaccine carries a high rate of side effects, more than other comparable vaccines, and it is contraindicated in people with certain conditions such as HIV infection and eczema. It also can be fatal, and some projections estimate as many as 600 people could die accidentally from the vaccine if the entire population were vaccinated.

"There are risks with the vaccine but there are risks with exposure as well," Brase said. In the event of an attack involving smallpox, there's likely to be mass chaos and hysteria, which will make it difficult to vaccinate people in an orderly fashion, she said.

"What you really need is time and what we have right now is time. We won't have that in the event of an attack," Brase said.

The CDC held a series of public forums on its vaccination strategy with the last one occurring Tuesday in San Antonio, Texas. The CDC's advisory committee on immunization practices will hold a meeting next week to discuss the issue and offer its recommendations to the agency.

The main reason the CDC is reconsidering its vaccination strategy is the recent surplus of vaccine that became available, agency spokesman Curtis Allen told UPI.

The government did not have enough vaccine to vaccinate every U.S. citizen until recently when it was discovered existing supplies could be diluted to make more vaccine and still be effective. In addition, the government has contracted with a vaccine manufacturer to produce millions of additional doses and should have enough to vaccinate everybody by the end of the year.

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