Preparing for Bioterror
[Sorry, the video for this story has expired, but you can still read the transcript below. ]
DR. DAN LUCEY: Then you take the needle and you just, boom, go in and deposit the liquid for the vaccine, and then just up and down and up and down and up and down 15 times.
SUSAN DENTZER: Recently a group of health and emergency workers from the Washington, D.C. area got a lesson in giving vaccinations against smallpox.
The workers are among a large group nationwide who may soon receive the smallpox vaccine themselves, that way they’ll be prepared to respond to a bioterrorist attack. Their instructor, Dr. Dan Lucey, a bioterrorism consultant at a local hospital, was candid about the vaccine’s risks.
DR. DAN LUCEY: This is our least safe vaccine. It has the worst side effects. So it’s quite likely that we will have severe, life-threatening effects and probably some deaths due to the smallpox vaccination.
SUSAN DENTZER: Lucey explained that’s in large part because the vaccine designed to fight smallpox is actually made from living version of another virus, called vaccinia virus. Unlike other vaccines, it is not injected into the muscle. Instead, it is deposited in the top layers of the skin.
DR. DAN LUCEY: So if you touch it and get it on your finger and shake hands with somebody or touch somebody’s skin or you touch your eye or you touch any other part of your body, you can transfer the virus to other parts of your body or to someone else.
SUSAN DENTZER: After the session with Lucey, the workers voiced a range of reactions about getting the vaccine. William Broadus, commander of a volunteer rapid response unit in Prince Georges County, Maryland, was ready to go ahead.
WILLIAM BROADUS: I think it’s a good deal. Number one we’ll be prepared. And two, we have the resources that can get it out to everyone to reduce the risk of having an outbreak and not being able to control.
SUSAN DENTZER: But Ouinette Willingham, captain of a Washington, D.C. volunteer response team, was reluctant.
OUINETTE WILLINGHAM: I know it’s for the greater good. However, this vaccine is extremely different from other vaccines, due to its high level of the possibility of contamination to yourself and to others. So I have some reservation about it.
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 to respond to future bioterrorist threats.
Near the top of their list of fears is smallpox; the disease has killed hundreds of millions of people worldwide — about a third of those infected — over the past several thousands years.
Thanks to a global effort at vaccination, it was eradicated as a naturally occurring disease in 1977. But at the same time the variola virus that causes smallpox is known to have been developed into a bioterrorist weapon by the former Soviet Union.
Many bioterrorism experts fear that Iraq and North Korea also have weaponized smallpox, and that terrorist groups like al-Qaida have tried to obtain it as well.
The U.S. Government began stockpiling smallpox vaccine last year and has placed orders for tens of millions more doses.
Dr. Anthony Fauci, who heads the National Institute of Allergic and Infectious Diseases, says there’s already enough on hand to vaccinate every American.
DR. ANTHONY FAUCI: We have enough material that if we needed to, God forbid, a catastrophe of a massive attack, we would be able to have a vaccine for every one in the country.
SUSAN DENTZER: Last September, the Federal Centers for Disease Control and Prevention published a so-called “post-attack” plan; it laid out details for mass vaccinations of the public in the event of a smallpox attack.
Now, the Bush administration is debating the specifics of a controversial “pre-attack” vaccination plan. As things stand now, the proposal would encourage a core group of health care workers and emergency responders to be vaccinated voluntarily; they could then minister to the first victims of an attack and help to vaccinate others.
DR. JULIE GERBERDING: We have to have certain people ready to go. Those people would include public health response teams that would go out and investigate and evaluate the initial cases of suspected smallpox in the community, and perhaps help get them to a health care facility.
SUSAN DENTZER: Dr. Julie Gerberding heads the CDC, which has played a key role in developing the plan. She says that after half a million or so of those workers were vaccinated, a broader group might be as well.
DR. JULIE GERBERDING: We could also consider going wider with that and including all health care personnel and all first responders such as police, and firemen, and HAZMAT teams, and so forth in that response group, and that would be up to about 10 million people in the United States that fall into those categories.
SUSAN DENTZER: Eventually, says Gerberding, the government may even allow members of the general public to receive the vaccine voluntarily, to protect themselves against a bioterrorist threat.
In deciding just who should be vaccinated before an attack — and how to deal with any adverse consequences that could follow — officials must weigh a complex set of risks and benefits.
DR. ANTHONY FAUCI: What you’re doing, in essence, is that you’re potentially exposing people to a defined risk, a risk of serious complications and a risk of possibly death in a very small number of people, and you’re balancing that against the benefit of blocking or preventing a problem if you get a smallpox attack.
SUSAN DENTZER: What’s more, officials can’t pinpoint with any certainty the scope of the risks from vaccination.
Historically, for every one million people vaccinated against smallpox, about 900 had side effects. Fifteen of those were life threatening; one or two resulted in death. But the smallpox vaccine has not been administered routinely in the U.S. for nearly three decades. And in the interim, lots of things have changed.
DR. JULIE GERBERDING: We predict that people with any kind of suppressed immune system, whether it’s from cancer treatment, or AIDS, or taking drugs that lower your immunity would be at the highest risk for the vaccine complications.
But we also know from previous experience that people with eczema or atopic dermatitis, skin conditions that probably reflect some decrease in the skin’s native immunity, these people are also at high risk for some of the more serious complications from smallpox.
SUSAN DENTZER: That could place as much as a third of the U.S. population at risk of adverse reactions from the vaccine.
DR. PAUL OFFIT: We need to understand that if we immunize 500,000 people, in fact the risks of this vaccine may outweigh its benefits.
SUSAN DENTZER: Dr. Paul Offit is a pediatric infectious disease expert at Children’s Hospital in Philadelphia. He also sits on a vaccine advisory committee to the CDC. That panel recently endorsed the plan to vaccinate the roughly half million health care workers against smallpox, but Offit was the sole member of the committee to vote no.
To help explain why, he showed us a pamphlet the CDC has prepared to inform people about the vaccine’s adverse effects.
DR. PAUL OFFIT: Here what you have is you have a child who is vaccinated, who scratched the site where she was vaccinated and then touched her eye. And you can see that she’s got evidence for vaccinia virus growing around her eye and eyelid.
SUSAN DENTZER: That condition, called “accidental implantation,” can cause blindness, Offit says.
DR. PAUL OFFIT: This is an example of something called ‘generalized vaccinia’ which although this picture looks horrific, is generally a fairly benign disease, but can be associated with mortality, albeit quite low. This is an example of progressive vaccinia, which although it looks in this picture as probably one of the least horrific pictures is often fatal.
SUSAN DENTZER: Offit argues that these risks are so real that no large-scale vaccination plan should move forward.
DR. PAUL OFFIT: We know that smallpox vaccine can work even after someone is exposed to the disease — so-called “post-exposure prophylaxis.” So I guess I would offer the following scenario: Let’s distribute it to all the hospitals under lock and key.
Let’s decide who it is in those hospitals that we want to vaccinate, and then wait — wait until there’s at least one case of documented smallpox in any country in this world, before we move forward with that program.
SUSAN DENTZER: Although other members of the CDC advisory committee shared many of Offit’s concerns, they ultimately voted to approve plans to offer the voluntary vaccinations to the roughly half-million person pool of health and emergency workers.
They agreed with CDC Chief Gerberding that steps could be taken to minimize the risks. Those would include pre-inoculation screening of workers, and post-inoculation care as well.
DR. JULIE GERBERDING: We also know that you can minimize that risk by taking proper care of the injection site, and that generally means keeping it covered with a dry dressing or something that keeps you from touching it.
For us, patient safety is of paramount concern and we don’t want to jeopardize anyone in the health care facility from coming in contact with this virus and suffering a life-threatening complication.
SUSAN DENTZER: But there are still other worries about the impact of pre-attack vaccinations. Hospitals, for example, are already hearing lots of concern from workers. James Bentley is a top official with the American Hospital Association.
JAMES BENTLEY: The questions people are asking, that we need more advice on, are during the time a person has the vaccine, should they go home if they have a child who might be exposed in adverse circumstances?
What if they care for a parent who has had cancer therapy, what if they help a neighbor who is perhaps AIDS exposed? What if they think they might get pregnant?
SUSAN DENTZER: Hospitals also have other concerns that the soon-to-be released vaccination plan is not likely to allay. On the one hand, separate legislation in Congress is expected to provide legal protection for hospitals if they are sued by vaccinated workers who suffer ill effects.
On the other hand, the Bush Administration will not propose any money for hospitals if they have to put workers who’ve been vaccinated on temporary leave.
Meanwhile, many health care workers, like those we spoke with in Washington, remain apprehensive.
WILLINGHAM: Why do we, what seems to be all of a sudden, have a need to vaccinate against an organism that is supposedly eradicated from the world?
SUSAN DENTZER: Experts say that’s a question that can only be answered by contemplating the unthinkable — the deliberate reintroduction by bioterrorists of one of the deadliest diseases in human history.