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US Smallpox Vaccination Plan Delayed by Fears of Side Effects
Shelley Schlender
Boulder, Colorado
05 Jul 2003, 19:04 UTC

After vaccinating nearly half-a-million American servicemen and women for smallpox, the Pentagon announced last week it has found the vaccine to be safe. Concerns about the vaccine's side effects had stymied the Bush administration's plan to prepare for a possible bio-terror attack by inoculating 500,000 health care workers and emergency medical teams. But only about 10 percent of these so-called first-line responders have signed up to be vaccinated, and some experts worry that this will prevent America from reacting quickly, if a smallpox outbreak ever occurs. In Colorado, some communities are getting prepared with practice drills that don't include vaccinations.

The University of Colorado Events Center is usually filled with cheering crowds, who flock there in the thousands for basketball games and graduations.

But on this sunny summer morning, the arena has been reserved for just 50 people. These public health officials, private emergency crews, police and church volunteers, are all focused on a safety drill. The church volunteers wear fluorescent orange safety vests to make them easy to spot, in the event that someday they must deal with large crowds of frightened citizens, and they're prepared for my somewhat unusual question.

"Does anyone here have smallpox?" I asked.

"I don't," answered a volunteer, laughing. "No one here has smallpox."

That's hardly surprising. Thanks to worldwide efforts, the last known case of smallpox occurred over 20 years ago. In the United States, the risk has been so minimal, doctors stopped vaccinating against the disease in 1972. But there's always a chance that terrorists might release the deadly virus. This is the reason for today's smallpox drill, as volunteer Terry Owen points out.

"We are training today so that we can train others, so we can get more volunteers and we'll have lots of personnel if this actually did happen and they'll be well trained," she explains.

Volunteer training today begins with a video, produced by the government's Centers for Disease Control, about smallpox vaccinations.

As one group pays close attention to the video, another gets ready to simulate a mass inoculation program. Boulder County Immunization Program Coordinator, Pat Hood, explains to the volunteers playing health workers how to advise other volunteers who are playing the role of citizens who want to be vaccinated.

"If they're concerned that they might be pregnant or they might be HIV positive, then we can do testing here," she says. "If none of those issues apply then they're just directed right on here to the vaccination site."

At that vaccination site, the first volunteer rolls up his sleeve, to time how long getting a shot might take. Ms. Hood says that he will not be vaccinated. "What we're doing is everything except actually poking people," she explains.

Inoculating these volunteers today would make them immune to smallpox. But as participants at this mock drill are learning, many national experts believe the risk from being vaccinated is greater than the risk of contracting smallpox.

"When there is no disease against which to protect ourselves, just the potential for disease, then we ought to be very careful about how we vaccinate," says William Schaeffer, the chair of Preventative Medicine at Vanderbilt University and an outspoken skeptic of mass vaccination campaigns for smallpox.

"When you can make some people ill, and some seriously ill, then you have to proceed with care, and unfortunately, we have only this very imperfect vaccine to use at this time," he says.

Dr. Schaeffer stresses that America's long-standing policy of vaccinating for measles, diphtheria and tetanus, during a child's regular pediatric exam, makes sense. Those are common diseases with vaccines that are considered safe. In contrast, smallpox has been eradicated around the world, and the risk of getting sick from the smallpox vaccine is relatively high.

The Centers for Disease Control in Atlanta estimates that the vaccine causes serious side effects in one out of every 1,000 recipients and is fatal in one out of every million. That's why the CDC recommends that the smallpox vaccine should not be administered to pregnant women, anyone with a weakened immune system or the skin rash eczema, and people at risk for heart attack, such as smokers or those with high blood pressure, diabetes or high cholesterol.

And a mass inoculation campaign is not necessarily the best strategy. According to Colorado's chief medical officer, Ned Colange, it's possible to contain an infectious disease without vaccinating everyone.

"What many people don't realize is that mass vaccination is not what got rid of smallpox," he says. "What eliminated smallpox from the population was ring vaccination and usual epidemiology techniques."

Ring vaccination is a focused form of emergency inoculation, in which health officials identify the ring of contacts for a person with a serious contagion. Those contacts are vaccinated, then the search widens for the ring of their contacts. This method has successfully contained many disease outbreaks, for instance, in a community or school where people have been exposed to Hepatitis A. Even when a vaccine is not available, the technique can still be effective. For instance, "ring quarantines" have been a key to containing the spread of SARS.

Dr. Colange says that if an outbreak of smallpox ever did occur, health officials might use a combination approach, conducting a mass vaccination in a huge ring within the community where smallpox has occurred, then staying alert in regions where no one has yet come down with disease. But as Boulder County's Public Information Officer, Jim Burrus, points out, it always helps to test things before you actually have to do them.

"I think everybody learns from practice, and instead of just thinking what if, actually going through a plan and making it real," he says.

Thanks to today's drill at the CU Events Center, Mr. Burrus says he's confident that all 300,000 residents of Boulder County could be vaccinated for smallpox in three to five days. What's more, he says, this exercise has improved the area's ability to respond to many other emergencies, including hazardous spills, floods, forest fires, or the outbreak of a different deadly disease.

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