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3D"Online

PREPARING FOR=20 BIOTERROR

November 14,=20 2002

Susan Dentzer reports on government plans to = respond to a=20 smallpox attack and the controversial possible side effects of smallpox=20 vaccination.

DR. DAN LUCEY: Then you take the needle and = you just,=20 boom, go in and deposit the liquid for the vaccine, and then just = up and=20 down and up and down and up and down 15 times.

SUSAN DENTZER: Recently a group of health and emergency workers = from=20 the Washington, D.C. area got a lesson in giving vaccinations = against=20 smallpox.

The=20 vaccine and its possible side effects

3DDoctors=20 The workers are among a large group = nationwide who=20 may soon receive the smallpox vaccine themselves, that way they'll = be=20 prepared to respond to a bioterrorist attack. Their instructor, = Dr. Dan=20 Lucey, a bioterrorism consultant at a local hospital, was candid = about the=20 vaccine's risks.

DR. DAN LUCEY: This is our least safe vaccine. It has the worst = side=20 effects. So it's quite likely that we will have severe, = life-threatening=20 effects and probably some deaths due to the smallpox = vaccination.

SUSAN DENTZER: Lucey explained that's in large part because the = vaccine=20 designed to fight smallpox is actually made from living version of = another=20 virus, called vaccinia virus. Unlike other vaccines, it is not = injected=20 into the muscle. Instead, it is deposited in the top layers of the = skin.

3DLucey=20 DR. DAN LUCEY: So if you touch it and = get it on your=20 finger and shake hands with somebody or touch somebody's skin or = you touch=20 your eye or you touch any other part of your body, you can = transfer the=20 virus to other parts of your body or to someone else.

SUSAN DENTZER: After the session with Lucey, the workers voiced = a range=20 of reactions about getting the vaccine. William Broadus, commander = of a=20 volunteer rapid response unit in Prince Georges County, Maryland, = was=20 ready to go ahead.

WILLIAM BROADUS: I think it's a good deal. Number one we'll be=20 prepared. And two, we have the resources that can get it out to = everyone=20 to reduce the risk of having an outbreak and not being able to=20 control.

SUSAN DENTZER: But Ouinette Willingham, captain of a = Washington, D.C.=20 volunteer response team, was reluctant.

3DWillingham=20 OUINETTE WILLINGHAM: I know it's for the = greater=20 good. However, this vaccine is extremely different from other = vaccines,=20 due to its high level of the possibility of contamination to = yourself and=20 to others. So I have some reservation about it.

The Bush=20 administration's plan

SUSAN DENTZER: Ever since last year's anthrax attacks, the U.S. = Government as well as state and local officials have been drawing = up plans=20 to respond to future bioterrorist threats.

Near the top of their list of fears is smallpox; the disease = has killed=20 hundreds of millions of people worldwide -- about a third of those = infected -- over the past several thousands years.

3DDoctors=20 Thanks to a global effort at = vaccination, it was=20 eradicated as a naturally occurring disease in 1977. But at the = same time=20 the variola virus that causes smallpox is known to have been = developed=20 into a bioterrorist weapon by the former Soviet Union.

Many bioterrorism experts fear that Iraq and North Korea also = have=20 weaponized smallpox, and that terrorist groups like al-Qaida have = tried to=20 obtain it as well.

The U.S. Government began stockpiling smallpox vaccine last = year and=20 has placed orders for tens of millions more doses.

Dr. Anthony Fauci, who heads the National Institute of Allergic = and=20 Infectious Diseases, says there's already enough on hand to = vaccinate=20 every American.

3DFauci=20 DR. ANTHONY FAUCI: We have enough = material that if=20 we needed to, God forbid, a catastrophe of a massive attack, we = would be=20 able to have a vaccine for every one in the country.

SUSAN DENTZER: Last September, the Federal Centers for Disease = Control=20 and Prevention published a so-called "post-attack" plan; it laid = out=20 details for mass vaccinations of the public in the event of a = smallpox=20 attack.

Now, the Bush administration is debating the specifics of a=20 controversial "pre-attack" vaccination plan. As things stand now, = the=20 proposal would encourage a core group of health care workers and = emergency=20 responders to be vaccinated voluntarily; they could then minister = to the=20 first victims of an attack and help to vaccinate others.

DR. JULIE GERBERDING: We have to have certain people ready to = go. Those=20 people would include public health response teams that would go = out and=20 investigate and evaluate the initial cases of suspected smallpox = in the=20 community, and perhaps help get them to a health care = facility.

SUSAN DENTZER: Dr. Julie Gerberding heads the CDC, which has = played a=20 key role in developing the plan. She says that after half a = million or so=20 of those workers were vaccinated, a broader group might be as = well.

3DGerberding=20 DR. JULIE GERBERDING: We could also = consider going=20 wider with that and including all health care personnel and all = first=20 responders such as police, and firemen, and HAZMAT teams, and so = forth in=20 that response group, and that would be up to about 10 million = people in=20 the United States that fall into those categories.

Some=20 health officials have misgivings

SUSAN DENTZER: Eventually, says Gerberding, the government may = even=20 allow members of the general public to receive the vaccine = voluntarily, to=20 protect themselves against a bioterrorist threat.

3D"Vaccination In deciding just who should be vaccinated = before an=20 attack -- and how to deal with any adverse consequences that could = follow=20 -- officials must weigh a complex set of risks and benefits.

DR. ANTHONY FAUCI: What you're doing, in essence, is that = you're=20 potentially exposing people to a defined risk, a risk of serious=20 complications and a risk of possibly death in a very small number = of=20 people, and you're balancing that against the benefit of blocking = or=20 preventing a problem if you get a smallpox attack.

SUSAN DENTZER: What's more, officials can't pinpoint with any = certainty=20 the scope of the risks from vaccination.

Historically, for every one million people vaccinated against = smallpox,=20 about 900 had side effects. Fifteen of those were life = threatening; one or=20 two resulted in death. But the smallpox vaccine has not been = administered=20 routinely in the U.S. for nearly three decades. And in the = interim, lots=20 of things have changed.

DR. JULIE GERBERDING: We predict that people with any kind of=20 suppressed immune system, whether it's from cancer treatment, or = AIDS, or=20 taking drugs that lower your immunity would be at the highest risk = for the=20 vaccine complications.

3DVaccination=20 But we also know from previous experience = that people=20 with eczema or atopic dermatitis, skin conditions that probably = reflect=20 some decrease in the skin's native immunity, these people are also = at high=20 risk for some of the more serious complications from smallpox. =

SUSAN DENTZER: That could place as much as a third of the U.S.=20 population at risk of adverse reactions from the vaccine.

DR. PAUL OFFIT: We need to understand that if we immunize = 500,000=20 people, in fact the risks of this vaccine may outweigh its = benefits.

SUSAN DENTZER: Dr. Paul Offit is a pediatric infectious disease = expert=20 at Children's Hospital in Philadelphia. He also sits on a vaccine = advisory=20 committee to the CDC. That panel recently endorsed the plan to = vaccinate=20 the roughly half million health care workers against smallpox, but = Offit=20 was the sole member of the committee to vote no.

To help explain why, he showed us a pamphlet the CDC has = prepared to=20 inform people about the vaccine's adverse effects.

DR. PAUL OFFIT: Here what you have is you have a child who is=20 vaccinated, who scratched the site where she was vaccinated and = then=20 touched her eye. And you can see that she's got evidence for = vaccinia=20 virus growing around her eye and eyelid.

SUSAN DENTZER: That condition, called "accidental = implantation," can=20 cause blindness, Offit says.

DR. PAUL OFFIT: This is an example of something called = 'generalized=20 vaccinia' which although this picture looks horrific, is generally = a=20 fairly benign disease, but can be associated with mortality, = albeit quite=20 low. This is an example of progressive vaccinia, which although it = looks=20 in this picture as probably one of the least horrific pictures is = often=20 fatal.

SUSAN DENTZER: Offit argues that these risks are so real that = no=20 large-scale vaccination plan should move forward.

3DOffit=20 DR. PAUL OFFIT: We know that smallpox = vaccine can=20 work even after someone is exposed to the disease -- so-called=20 "post-exposure prophylaxis." So I guess I would offer the = following=20 scenario: Let's distribute it to all the hospitals under lock and = key.=20

Let's decide who it is in those hospitals that we want to = vaccinate,=20 and then wait -- wait until there's at least one case of = documented=20 smallpox in any country in this world, before we move forward with = that=20 program.

SUSAN DENTZER: Although other members of the CDC advisory = committee=20 shared many of Offit's concerns, they ultimately voted to approve = plans to=20 offer the voluntary vaccinations to the roughly half-million = person pool=20 of health and emergency workers.

They agreed with CDC Chief Gerberding that steps could be taken = to=20 minimize the risks. Those would include pre-inoculation screening = of=20 workers, and post-inoculation care as well.

DR. JULIE GERBERDING: We also know that you can minimize that = risk by=20 taking proper care of the injection site, and that generally means = keeping=20 it covered with a dry dressing or something that keeps you from = touching=20 it.

For us, patient safety is of paramount concern and we don't = want to=20 jeopardize anyone in the health care facility from coming in = contact with=20 this virus and suffering a life-threatening complication.

SUSAN DENTZER: But there are still other worries about the = impact of=20 pre-attack vaccinations. Hospitals, for example, are already = hearing lots=20 of concern from workers. James Bentley is a top official with the = American=20 Hospital Association.

Healthcare=20 workers' concerns

3DBentley=20 JAMES BENTLEY: The questions people are = asking, that=20 we need more advice on, are during the time a person has the = vaccine,=20 should they go home if they have a child who might be exposed in = adverse=20 circumstances?

What if they care for a parent who has had cancer therapy, what = if they=20 help a neighbor who is perhaps AIDS exposed? What if they think = they might=20 get pregnant?

SUSAN DENTZER: Hospitals also have other concerns that the = soon-to-be=20 released vaccination plan is not likely to allay. On the one hand, = separate legislation in Congress is expected to provide legal = protection=20 for hospitals if they are sued by vaccinated workers who suffer = ill=20 effects.

On the other hand, the Bush Administration will not propose any = money=20 for hospitals if they have to put workers who've been vaccinated = on=20 temporary leave.

3DVaccinations=20 Meanwhile, many health care workers, like = those we=20 spoke with in Washington, remain apprehensive.

WILLINGHAM: Why do we, what seems to be all of a sudden, have a = need to=20 vaccinate against an organism that is supposedly eradicated from = the=20 world?

SUSAN DENTZER: Experts say that's a question that can only be = answered=20 by contemplating the unthinkable -- the deliberate reintroduction = by=20 bioterrorists of one of the deadliest diseases in human history. =