Vaccine Program Going Well, Military Reports

Injecting the military can-do spirit into a program weighed down by difficulty, an Army colonel said Thursday that the Pentagon has vaccinated “well over” 100,000 troops against smallpox and received only three reports of serious reactions.

“The risks [of the vaccine] are still pretty darn low,” Col. John D. Grabenstein, deputy director for military vaccines, told a scientific panel created to advise the government’s smallpox vaccination program.

“Sick leave is rare and short ... and just about everything is occurring at rates lower than historically predicted,” he added.

Grabenstein’s upbeat report -- coming in the third week of a program characterized by fits and starts, confusion and controversy -- prompted members of the Institute of Medicine committee to ask how the military’s matter-of-fact success can be replicated in the civilian world.

Not easily, appears to be the short answer. The military is spared virtually all the thorny issues that have slowed the vaccination program in state and local health departments.

For about 500,000 military personnel, inoculation against the deadly smallpox virus is an order, not a choice. Their deployment overseas increases the threat of a smallpox attack and, as a result, the incentive to be vaccinated. And they are guaranteed free medical care should they suffer serious side effects.

“It’s all about reason and emotion” and making sure reason wins out, Grabenstein said in an interview.

For federal and state health officials, however, the program is also about logistical challenges, legal complications and constant fine-tuning of the nation’s first large-scale vaccination program in almost 30 years.

In December, President Bush called for inoculations of up to 10.5 million health-care workers and police, fire and emergency personnel so they could safely respond to any terrorist attack that used smallpox as a weapon.

As of Tuesday, 1,043 of these front-line health-care workers, from 18 states and Los Angeles County, had been vaccinated, according to the Centers for Disease Control and Prevention.

Federal health officials are working with Congress to create a compensation fund for anyone injured by the vaccine, and the agency is still developing an electronic reporting system, funding mechanisms and educational materials.

Even the military, with all its built-in efficiencies, has had some problems with its vaccination program. Tens of thousands of military personnel have experienced fever, malaise and swollen lymph nodes after being vaccinated, and “there has been a rash of rashes,” Grabenstein said, about 12 for every 1,000 people inoculated. Almost all are harmless, but as many as seven people have developed what may be generalized vaccinia, a systemic spread of the vaccine’s live vaccinia virus in lesions over the body, he said.

In addition, two soldiers were hospitalized with encephalitis, a serious inflammation of the brain, and an airman developed myocarditis, an inflammation of the heart.

But even these severe cases “have had a full recovery and are not slowing down the military vaccination program,” Grabenstein said.

Almost two-thirds of the military personnel inoculated were getting the smallpox vaccine for the first time. Grabenstein said their low rate of serious side effects shows that the vaccine is safe for people born after the United States stopped routine inoculations of children in 1972.

Public health officials from Georgia and New Jersey told committee members that the demands of the smallpox program have detracted from other bioterrorism efforts, as well as traditional public health activities.

But Dr. Eddy Bresnitz, state epidemiologist of New Jersey, where 98 health-care workers had been vaccinated by Tuesday, said he was pleased with his program’s progress.

“Clearly, we have the capability now of responding” to a smallpox epidemic now, he said.

The Institute of Medicine is part of the National Academies, which were created by Congress to provide advice to the government on scientific matters.

In related action Thursday, Rep. Henry A. Waxman (D-Los Angeles) introduced legislation to establish a no-fault compensation program for anyone injured by the smallpox vaccine. Waxman’s bill would also give states federal grants to help meet costs of the program.