Anthrax: A Hard Choice
[Sorry, the video for this story has expired, but you can still read the transcript below. ]
SUSAN DENTZER: Howard Williams drives a tractor-trailer for the U.S. Postal Service, hauling mail to and from the Brentwood postal facility in Washington, DC. The building is now closed to all but cleanup workers after having been contaminated by anthrax spores in last fall’s bioterrorist attacks.
HOWARD WILLIAMS, Postal Worker: I would rather be out here in this cold instead of going back in that building. So, that’s the way I feel about it. And basically, we come to work and try to do our job, and the postmaster said that we were the soldiers on the front line.
SUSAN DENTZER: Williams was one of several thousand postal workers who took antibiotics for two months as a preventive measure against anthrax. That was after four Brentwood postal workers developed the inhalational form of the disease in October, and after two of those four workers died. As Williams and other postal workers neared the end of their two-month drug regimen in December, officials of the federal Centers for Disease Control told them they had several options: they could stop taking the antibiotics in the hope that they were out of the danger zone for developing the disease.
They could keep taking the drugs for another 40 days just to be safe; or they could stay on the drugs and undergo an additional measure of precaution by being inoculated with an anti-anthrax vaccine. CDC representatives briefed many of the affected postal workers on these options in person as well as through this video available on the Internet.
JULIE L. GERBERDING, MD, MPH: What I’d like to do now is to give you the facts, the straight facts about what we know and what we don’t know about the risks that you might encounter and what the medical decisions may mean to you and your own personal health.
SUSAN DENTZER: Like many of his fellow postal workers, Williams said he was perplexed at the choices.
HOWARD WILLIAMS: My intentions are to take the remaining of the pills, but as far as the shots are concerned, I don’t know enough information about it. I don’t have any qualms with the CDC as of yet, but until someone comes out and stands behind this new product or this new medicine that they want to give us, I’m leery, just as well as most postal employees are.
SUSAN DENTZER: And in fact, the overwhelming majority of postal workers have elected not to take the vaccine, at least in part because it has long been controversial. Members of the armed forces who’ve received it in the past have claimed it caused a variety of unpleasant or dangerous side effects. So postal workers told us they, too, were reticent.
POSTAL WORKER: I do not trust the government period, none of them.
POSTAL WORKER: If the military didn’t do it why should we take it?
POSTAL WORKER: No, I don’t think so. They haven’t found out any solution for it. I don’t think we should take it.
SUSAN DENTZER: Although the government offered the vaccine to postal workers as well as workers exposed to anthrax spores on Capitol Hill, it never specifically recommended that any of them take it. That decision was itself controversial, and in an editorial, the New York Times decried it as a “medical copout.” But Dr. Anthony Fauci, who heads infectious disease research at the National Institutes of Health and who participated in that decision, defends the move.
DR. ANTHONY FAUCI, National Institutes of Health: This is a case study in the fact that there isn’t definitive information, and as much as the CDC, the Department of Health and Human Services and others would like to add to the comfort level by giving a definitive recommendation, under the circumstances, that just can’t be, because there’s not enough scientific data to do that.
SUSAN DENTZER: Although the vaccine has been proven effective in preventing individuals from becoming ill with anthrax, it has never been proven effective as a treatment for individuals who may already have been exposed to the deadly bacteria. Fauci says the decision to offer it was made on the slimmest of scientific evidence. That came from two studies, dating from 1956 and 1993, that federal officials began poring over in the wake of the anthrax attacks. In those studies, monkeys were given inhalation anthrax, then treated for the disease. Even so, at 75 to 100 days after exposure, some monkeys still had tiny numbers of bacterial spores in their lungs. And even those small amounts of bacteria could still cause harm.
So government officials worried that people exposed in the anthrax attacks would also have those residual spores, even after 60 days on antibiotics. That’s what led to their proposal that people consider taking the drugs for another 40 days, and possibly add in the anthrax vaccine to boost their immunity.
DR. ANTHONY FAUCI: So on the basis of that, that fed into the consideration later on of the theoretical possibility that there may be some residual spores. And if so, could the vaccine then block the emergence of those spores into bacteria that could do harm?
SUSAN DENTZER: But that’s all that government health officials had: a theory, rather than hard science. Meanwhile, physicians overseeing the care of workers exposed to bacteria on Capitol Hill began to press for making a vaccine available. Not long after, the government decided to offer it. And in contrast to the reticence of the postal workers, 65 people exposed to spores on Capitol Hill did take the vaccine. The vaccine is now being offered to all these workers on an experimental basis. People who take it must read and sign this lengthy form that discusses the potential benefits and risks, such as possible allergic reactions. In effect, workers who take it will become enrolled in a clinical trial to test the vaccine’s effectiveness in this new post-exposure use. Fauci says that’s all the more reason it would have been unethical to recommend that people take the vaccine.
DR. ANTHONY FAUCI: When you have a product that you’re going to be making available under those circumstances, in essence, ethically, you can’t really recommend that someone do that. That just goes against all the grain of all the principles that guide the use of drugs or vaccines that have not been proven yet to work.
SUSAN DENTZER: William Burrus is president of the largest postal workers’ union. Although he praises the government’s decision to lay out the options, he says it isn’t making life any easier for the postal workers.
WILLIAM BURRUS, President, American Postal Workers Union: This is a no-win situation for the employee. If the employee does not take the medication, it is a possibility they may contract inhalation anthrax. If they do take the medication, there might be side effects. So this has to be an employee judgment based upon all of the available information. And I applaud CDC for making all of the information available now to the employees of what their options are.
SUSAN DENTZER: Some postal workers we interviewed in recent days said they’d considered all the information and would still forego the vaccine.
ARRIE GRAY, Postal Worker: I don’t see the need for anything else. It’s not like we’re going back into Brentwood, today anyway, I don’t know if we’re going back at all.
SUSAN DENTZER: Postal officials say that 38 workers thought to have been exposed to anthrax bacteria in Washington and New Jersey had taken the vaccine. Any others still considering it have until next Monday to get it.