Officials Up to the Task of a Vaccine Campaign?
The government’s last mass vaccination campaign against an infectious disease, the swine flu in 1976, was a disaster. And the last time the government tried to inform and reassure the public about a bioterrorism threat -- anthrax -- its record was mixed, at best.
So on Thursday, the eve of President Bush’s announcement that the smallpox vaccine soon will be made available to all Americans, the government’s top public health officials were holed up, working to ensure they get it right this time.
In fact, administration officials have been working ever since Sept. 11, 2001, to prepare the nation for a bioterrorism attack, something they have repeatedly characterized as all but inevitable.
The government has bought and stockpiled supplies of the vaccine, improved public health communication systems and begun training health-care workers -- all while debating a mass vaccination policy.
States and a few cities, including Los Angeles, have filed emergency vaccination plans and identified the hospitals, clinics and number of health-care workers who would participate.
Now comes the hard part: Not only explaining to the American people why a potentially risky vaccine is being made available, but doing so without alarming them that they cannot make an informed decision about whether to be vaccinated.
Already, the challenges are clear.
“A lot of people may still have questions about why we’re talking about all this,” said David Ropeik, director of risk communications at the Harvard School of Public Health. “It’s expectable that people would have an ‘Oh, my God, why are we doing this?’ reaction.”
Dr. Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention, understands the importance of getting out a clear message.
“The highest priority initially is to communicate the plan,” she said Thursday, adding that the CDC has been developing a public education campaign, targeting key audiences, getting training in risk communications and putting “tons of information” on its Web site (https://www.bt.cdc. gov/agent/smallpox/index.asp).
“People are hungry for information that will give them a sense of security,” Ropeik said. But to properly convey that, he added, the Bush administration will have to act a little bit less like the government. “I think the real challenge in doing this well is giving up a little bit of control” and simply giving people the information they need to make their own decisions, he said.
A new public opinion poll commissioned by the Robert Wood Johnson Foundation supports Ropeik’s view that the communication challenges facing the administration are considerable.
Conducted in late October, the poll found that while almost 60% of Americans are worried about a possible smallpox attack, three-quarters believe the country is only “somewhat prepared” or “not too prepared” for a biological or chemical attack.
In addition, the poll indicated a strong preference for medical professionals as the messengers of information on how to prepare for and protect against a bioterrorist attack. While half of those surveyed said they most trusted their personal physician to correctly convey such information, only 24% expressed confidence in the secretary of Health and Human Services, and just 19% preferred to hear from the secretary of the new Homeland Security Department.
The head of the CDC and local and state health officials also ranked high on the trust scale, while the media ranked last, garnering the trust of only 13% of those surveyed.
Public health officials said they were troubled by indications that Americans would primarily rely on their family doctors during a smallpox outbreak.
“Protecting a community from smallpox cannot be handled on a person-by-person, case-by-case basis,” said Patrick Lenihan, deputy commissioner of the Chicago Department of Public Health and president of the National Assn. of County and City Health Officials. “It requires a system.”
The results offered a mirror image of the administration’s management of last year’s anthrax crisis. The head of the CDC and the surgeon general, both of whom have since left office, were largely kept out of the loop, while HHS Secretary Tommy G. Thompson and Homeland Security Director Tom Ridge struggled to communicate rapidly changing information.
The poll’s findings raised questions about the administration’s smallpox communication strategy, which until now has focused on educating reporters.
President Bush has to be involved in explaining the smallpox vaccination policy, Ropeik said, because “people look to him in a kind of parental way.”
Beyond that, he said, the administration should enlist the nation’s major doctors organizations, as well as state and local public health officials.
“Everyone agrees this is a deadly vaccine we’re dealing with,” said Andrew L. Stern, president of Service Employees International Union, which includes 755,000 health-care workers. “This is not your normal childhood vaccine here. Yet [the administration] hasn’t done nearly enough to protect the health” of the nurses, doctors and others who would respond to a smallpox attack, he said.
Stern met this week with Jerome M. Hauer, head of the HHS Office of Public Health Emergency Preparedness, to discuss his union’s concerns.
While the vaccination of health-care workers is voluntary, for example, many emergency room workers report they have been pressured to get the vaccination.
And there is nothing in the administration’s plan to guarantee that non-vaccinated workers will not suffer retribution, Stern said.
“We took care of the pharmaceutical companies,” Stern said, referring to a liability provision in the law setting up the Homeland Security Department, “but we haven’t taken care of the health workers yet.”
