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Extended Interview: Dr. Julie Gerberding

Dr. Julie Gerberding, the Director for the Centers for Disease Control and Prevention, discusses the risks and benefits of the smallpox vaccine.

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    Who are we talking about in terms of what roles they [the 500,000 workers who may get immunized] play within the hospitals

    DR. JULIE GERBERDING Well, one way of thinking about this would be if a patient was brought to the emergency room with a severe case of the smallpox and had to be put in the isolation room in the Intensive Care Unit, who are all the people that would come in contact with that patient in the first couple of days until the vaccine program could be initiated in that facility, and that would include the people in the Emergency Room, it would include the specialists in the Intensive Care Unit, the nurses, the clinicians, it would include the housekeepers who took care of cleaning that room, the people who delivered food to that room.

    So it would involve a team of people from a lot of different disciplines within the health care facility that would all be involved in the care of that patient.


    How is the voluntary nature of this pre-attack vaccination going to be handled in the health care system?

    DR. JULIE GERBERDING Well, I think if we're looking at a voluntary program, the individuals would need to be apprised of the advantages of immunization and certainly the risks of immunization, both to themselves or to any potential members of their household that could have a special risk from exposure to the vaccine, and then they would make their decision based on their job circumstances, the likelihood that they would be called upon to assist in an emergency situation, and their personal preference.


    So workers would be screened to see whether it was appropriate to vaccinate them at a particular time?

    DR. JULIE GERBERDING Part of the screening would include discussion about family members or household contacts who might be at special risk for exposure to vaccine, and we would discourage use of the vaccine in situations where there was a risk on the part of someone else in the household.


    The hope is to use licensed vaccine for this vaccination effort. How close are we to having sufficient supplies of licensed vaccine to carry this out?

    DR. JULIE GERBERDING If we had an emergency in the United States, we have enough vaccine to protect our country today for emergency use. But for licensed vaccine, meaning that it's gone through the whole gamut of FDA [Food and Drug Administration] approval and inspection for safety and so forth, we expect to be able to have about a million doses of one of our vaccine supplies available by November, and then additional lots of a million doses will be coming online in the months to come after that. So over the next year we could make several million doses available.

    We also, of course, have a new vaccine that's in production. That will take some time to license because it has to be studied in people before the data are available to assure that it is safe and effective, and we don't expect that new vaccine to be licensed until the end of 2003 or possibly in 2004.


    What is the applicability of what we're discussing now — this narrow question of vaccinating health care workers for smallpox — to addressing the long list of other potential agents?

    DR. JULIE GERBERDING Well, one of the ways of thinking about all of this discussion of smallpox is that even this thought process helps us shape better plans for any of the threats of terrorism, or even any emerging infectious disease problem that was naturally acquired.

    For example, what you need to be effective in the threat situation is you need a plan, you need people who are trained and know what their roles and responsibilities are, you need the product such as vaccine or antibiotics that are countermeasures against whatever health threat is present, and you need practice so that you know what to do, and you've exercised the whole strategy.

    Now, if we're able to create a program that is successful in initiating a smallpox vaccine, whether it's a mass vaccine program or a pre-event program, if we can do that, we'll be using exactly the same mechanisms for any other kind of threat that occurs.

    So it has advantages that extend far beyond smallpox per se.


    What is CDC planning in terms of additional communication as a decision is ultimately made and the implementation of a vaccination program takes place? What other avenues are going to be used to continue to educate people about the risks of the vaccine, the precautions they need to take, and so on?


    Well, CDC will be working, of course, with all of our partners at Health and Human Services, and we already have an evolution, a communications plan around smallpox, but in addition we are lucky because we can take advantage of the people in the state and local communities that are professional health communicators, and engage them in the process of crafting messages and helping get the word out at a local level.

    Now, people really look toward the most credible spokesperson, especially when there is a lot of uncertainty on an issue, and that's going to be very important and helpful to us to have people at the local level that are trusted and credible come out and be able to educate people about this. We're really counting on that.


    So what kinds of things might we envision?

    DR. JULIE GERBERDING Nothing has been ruled out. Now, I think the first step process, then, to get as accurate an information portfolio available so that when we do disseminate the information, we're all saying the same thing, and we're not inadvertently creating confusion by using different numbers, or framing things in a different way.

    Now, of course, we can't be too specific right now because we don't have a decision about the policy and so it's difficult to craft information materials until we really know what it is that we're going to be recommending people do. But every medium is included in the planning.

    The Internet is very important, working with clinicians in the health care delivery system is essential, getting the local public health personnel, the governor's office, all avenues will likely be involved.

    And as you know, we live in an era where there is no void on the media in terms of people talking about a hot topic, so we'll definitely want to be engaging the television media as well.


    You mentioned earlier that as best as can be discerned, there's no scientific basis for recommending a furlough of a worker who has been vaccinated. What, if anything, led anybody to think that that might be a necessity, and what is it that has dispelled the belief that that is going to be necessary?

    DR. JULIE GERBERDING A furlough is the situation where someone has an infection and you ask them not to come into work so they don't present a risk to other people, and we are concerned about a risk that a vaccinated health care worker could pose to a highly immuno-suppressed patient. But we also know that that risk can be minimized by using some common sense hygienic practices which are supposed to be normative in hospitals in the first place.

    We have experience with this with the vaccine that's used for chicken pox, where some health care workers get that vaccine, and if they don't have a complicated vaccine, or they don't disseminate the virus as a complication of their immunization, they can safely take care of most patients.

    We want to err on the side of protecting patients, but there is no indication right now, at least, from our reading of the literature that every health care worker who gets vaccinated would have to be away from work for a long period of time. We're relying on our experts to really scrutinize all of the data and come up with the best possible infection control recommendation that will address this.