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Getting Ready: Smallpox

The U.S. government takes steps to prepare for a mass vaccination in the event of a smallpox outbreak.

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  • GWEN IFILL:

    Now the government and smallpox. The Centers for Disease Control today outlined steps for potential mass vaccination in the event of a smallpox outbreak. The new guidelines spell out for the first time how complicated it could be to guard against biological terror attack. For details of the report, we're joined by the Director of the Centers for Disease Control, Dr. Julie Gerberding. Welcome.

  • DR. JULIE GERBERDING:

    Thank you.

  • GWEN IFILL:

    So why is it that we are preparing for a smallpox attack at all?

  • DR. JULIE GERBERDING:

    Well, you know, we know that the United States and the Soviet Union had the smallpox virus, but we're worried that some other nations may have it as well. And since we've been working on it for the last two years the preparedness for bioterrorism attacks, we've got to take this one seriously too.

  • GWEN IFILL:

    We started paying attention to all this of course after the anthrax outbreaks last year. But now that we are at this point where we're beginning to make proposals for how one copes with the unthinkable, how did mass vaccination get on the table, I guess?

  • DR. JULIE GERBERDING:

    The most important thing we need to do if there's a smallpox exposure is to find the infected people, immunize the contacts of those people as well as the contacts of the contacts.

    Once we've gotten that done, we also need to look and see whether or not there's evidence of a broader exposure risk to the community. And if there is, we need to be prepared to scale up and do a whole community level immunization. And that's what we really mean by mass vaccination, that scaling- up process if a particular exposure situation indicates that's necessary.

  • GWEN IFILL:

    And so who does this? Who gets to carry out this what sounds like would be a pretty massive task?

  • DR. JULIE GERBERDING:

    Well, you know, the local health agencies including local and state health… public health officials and so forth, have a tradition of doing immunization programs for a whole variety of infectious diseases so they're going to be our first army to handle this at the local level.

  • GWEN IFILL:

    It's coordinated from the top to the bottom or do they alert you? How does that work?

  • DR. JULIE GERBERDING:

    Well, in general if there was a suspicious exposure, a suspicious case in a particular, let's say, community, the local health officials there would be notified. They would work with the state and then if it looked like there was a serious problem, they'd contact CDC right away.

  • GWEN IFILL:

    Every day I read about the red ink in state and local governments. Can they afford to do? And how does the federal government help them?

  • DR. JULIE GERBERDING:

    Well, this planning process is something that we supported through the investments that HHS made this year in preparedness planning. So the $1.1 billion that went out already is to help support this planning process.

    But should we actually have to implement an immunization program at that level of course additional resources would probably be required. I'm sure in that kind of an emergency situation, we would be able to find the support that's necessary to get the job done.

  • GWEN IFILL:

    If an attack crossed jurisdictional lines, it was more than one state, more than one city involved would the federal government, would the President or the Secretary of Health and Human Services? How high would it go before a decision was made that all 288 million citizens of the United States should get a smallpox vaccination?

  • DR. JULIE GERBERDING:

    What you're really describing is the whole spectrum of things that might happen. If this was a small localized event, then it would be the local and state health officials that have jurisdiction. If it is something that is multi-jurisdictional then of course Secretary Thompson and the CDC, I as the CDC Director would be working together to determine what kind of resources need to be deployed. Then the secretary would be communicating with the White House and making sure.

    If we were actually dealing with a disaster or a national emergency, the President could declare a state of emergency and then that would activate the whole federal emergency response plan, HHS has the role there for dealing with the health consequences in that situation.

  • GWEN IFILL:

    Since smallpox as a disease has been basically eradicated for decades, what would it take to trigger an action, whether it's the just inoculating people in the ring, that is to say, the medical professionals, the first responders or the wider mass inoculations that you're talking about today?

  • DR. JULIE GERBERDING:

    Well, we're kind of talking about two things here. One is what we might want to do to ensure that we could make a response, and that's where our advisory committee has suggested that we immunize a team of initial responders in a community. These would be the people who would go out and investigate any suspect cases.

    But when we talk about ring vaccination, we're actually talking about something different. That's a situation where we have a case and then we identify their close household contacts or the people that they would most likely have spread virus to in the stage of infection, and then immunize those contacts, but to be extra sure we also then immunize the contacts of the contacts. So we've got kind of a double ring around the infectious case.

  • GWEN IFILL:

    And just a single case would be enough to trigger this?

  • DR. JULIE GERBERDING:

    We do the ring vaccination for a single case. Now if we saw that there were many cases in a community or that many communities were connected with a single exposure or multiple exposures, that's the situation where we might have to scale up and do a community level vaccination program or even what people are calling now kind of mass vaccination.

  • GWEN IFILL:

    If smallpox is such a dread disease, why not vaccinate people before they have a chance to… it seems almost backwards. Why wouldn't you vaccinate someone against the disease instead of after the disease has been discovered?

  • DR. JULIE GERBERDING:

    Well, the problem with this particular vaccine, the one we have right now, is that it has some real serious side effects. And there are some people who are at very high risk for the most serious problems including people with eczema or skin conditions, people have to immuno suppressive disorders and little children. When we use a vaccine like this for what is a theoretical risk we've really got to be aware that there's going to be some very bad complications for some part of the population. So it's that balance that we're struggling with.

  • DR. JULIE GERBERDING:

    Well, the problem with this particular vaccine, the one we have right now, is that it has some real serious side effects. And there are some people who are at very high risk for the most serious problems including people with eczema or skin conditions, people have to immuno suppressive disorders and little children. When we use a vaccine like this for what is a theoretical risk we've really got to be aware that there's going to be some very bad complications for some part of the population. So it's that balance that we're struggling with.

  • GWEN IFILL:

    If this trigger happens would these vaccinations be mandatory? We would just order people to go out and get them or would they be voluntary, it's up to you to figure it out.

  • DR. JULIE GERBERDING:

    Our vaccination program is designed to be voluntary. If we were dealing with an exposure situation, people would still have the choice of whether they wanted to take the vaccine or not. But if they were exposed or could pose a risk to others by not being vaccinated, then we might have to isolate them so that they couldn't transmit to other people.

  • GWEN IFILL:

    Are you counting on people to just want to do this?

  • DR. JULIE GERBERDING:

    Well, our experience with public health emergencies in the past has been that with — people are given the right information and we communicate with them honestly and openly trusted people are necessary to that, of course, that people will really do the right thing because they can understand and respond to that sort of information.

  • GWEN IFILL:

    Based on what you said a moment allege about the potential risks of giving this vaccine in advance, have you had to factor into the possibility that the risks may outweigh the benefits?

  • DR. JULIE GERBERDING:

    Well, in the pre-event situation, I mean, before we actually have a case of anthrax that's exactly what we're struggling with. We know the vaccine will carry some risk. We can do a lot of things to minimize it but we want to have enough protection in our population so that if we needed to go forward with the full court press, that we would have the doctors and the clinicians and the front line responders protected enough to be able to do that. And at the same time we don't want to expose those people to unnecessary risks either.

  • GWEN IFILL:

    This is the best balance you could come up with for now?

  • DR. JULIE GERBERDING:

    We still are working on the pre-event policy. That's something that is still under active discussion. But this post exposure policy that went out today is sort of the "just in case we really have an emergency" we want to make sure that the state and local personnel are ready to go.

  • GWEN IFILL:

    If an emergency happens, how long does it take to ramp up… to make this vaccine available to the maximum number of people?

  • DR. JULIE GERBERDING:

    I think the time it would take depends on how much practice we have and how prepared we really are. That's kind of why we're pushing it out saying we hear you, we know you need help with this, you need some specificity around the suggestion that you be available to immunize say a million people in ten days.

    Here's the first round of help that we can provide in terms of technical support. But now let's work with it. Let's find out what's going well and then when we get a reasonable plan together, we need to practice it.

  • GWEN IFILL:

    Do we have enough vaccine in stock now to provide vaccinations if this attack were to happen tomorrow?

  • DR. JULIE GERBERDING:

    If we had an emergency, we have enough vaccine that we could protect every American today. We do have the vaccine. That's not the rate limiting step here. What we don't have the plan and the practice to make sure that we could get that vaccine to every single person quickly. And our goal now is to ensure that every American, whatever jurisdiction they live in, can have access to this vaccine if an emergency arose.

  • GWEN IFILL:

    Dr. Julie Gerberding, thank you very much for joining us.

  • DR. JULIE GERBERDING:

    You're very welcome.

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