Smallpox Plan No Cure, Panel Says

The Bush administration’s smallpox vaccination plan is too narrowly focused to adequately protect Americans from bioterrorism, and the vaccine itself is too risky to be made widely available to the public, a scientific advisory panel reported Tuesday.

“Smallpox is not the only threat to the nation’s health, and vaccination is not the only tool for preparedness,” said Dr. Brian L. Strom, chairman of the Institute of Medicine committee and a professor at the University of Pennsylvania School of Medicine.

The smallpox vaccination program has “no doubt” improved the nation’s capacity to respond to a bioterror attack as well as to SARS and other natural outbreaks of infectious diseases, Strom said.

But the program has strained the resources of underfunded state and local health departments, leaving them unable to provide some basic public health services and unprepared to respond to other bioterror agents, the committee concluded.

The report calls on the administration to overhaul its bioterrorism preparedness program. Specifically, the government should make its smallpox vaccination plan part of a broader public health program to protect Americans against a variety of threats, the committee said.

The federal Centers for Disease Control and Prevention, which commissioned the report, also should establish a national standard of preparedness and help states develop plans for responding to specific situations, the committee recommended.

“Attaining a high level of preparedness may well be possible without vaccinating” anyone, its report said.

CDC officials have been trying to shift the focus of the smallpox program away from the disappointing number of health-care workers who have volunteered to be vaccinated and work for smallpox response teams. Instead, the CDC has talked about a broader level of preparedness.

But officials have been unable to articulate what would constitute a sufficient level of preparedness and how it could be measured.

CDC officials also agree that preparedness must include plans for responding to attacks involving anthrax, the Ebola virus, botulinum toxin and other bioterror agents.

“Smallpox is not the only agent, the only concern,” Dr. Ray Strikas, director of CDC’s smallpox program, said in a telephone interview from Atlanta.

Strikas said CDC officials were already working to develop measurable preparedness standards -- plans for controlling crowds, isolating and quarantining infected people and alerting doctors and emergency health workers, for example -- that local agencies could train for.

When asked if broad preparedness standards should have been developed before bioterror resources were devoted almost exclusively to the smallpox vaccination program, Strikas noted that he was charged with implementing President Bush’s policy, not with critiquing it.

“We tried to balance the vaccination effort with other things.... But it is not too late” to adopt a more comprehensive approach, he said.

Overall, he added, “we’re much better prepared than we were six, seven, eight months ago, partly because of vaccination.”

The committee’s recommendations come nine months after President Bush announced a plan to vaccinate up to 450,000 health-care workers and as many as 10 million police, fire and emergency medical personnel. As of Aug. 1, just 38,062 volunteers had received the vaccine from state and local health departments.

Strom, in a conference call with reporters, insisted that “the vaccination numbers are not low.” The original recommendation from a CDC advisory committee was for 15,000 vaccinated health workers, he said.

According to CDC statistics, only Texas, Florida, Tennessee, California and Ohio have at least 1,500 vaccinated health-care professionals or first responders. New York City has inoculated 342.

The report from the quasi-governmental Institute of Medicine also comes roughly five months after the CDC began receiving reports of heart attacks -- two of them fatal -- and other cardiac complications suffered by health workers who had been vaccinated.

A key element of Bush’s policy was making the vaccine available to the public after most of the health workers and first responders had been inoculated. But the advisory panel said the vaccine should not be offered to the public unless individuals are monitored for dangerous reactions.

Because the smallpox vaccine contains the live vaccinia virus, it poses health risks not only to those who are inoculated but also to their family members and other people with whom they come in close contact.

A pregnant woman or a cancer patient undergoing chemotherapy could be exposed to the vaccinia virus by touching the vaccine site of a family member or coming into contact with sheets or towels that had touched the site.