To vaccinate or not? Debate on smallpox likely

Sudden availability of shots increases urgency of discussion

March 29, 2002|By Scott Shane | Scott Shane,SUN STAFF

Later this year, Americans may face an agonizing decision: Should they roll up their sleeves and get vaccinated against smallpox, despite potentially severe side effects and the small risk of a devastating bioterrorist attack?

Prominent health officials are calling for an urgent public debate on the wisdom of offering voluntary smallpox vaccination. Large-scale immunization would be possible soon because research published yesterday shows that the vaccine can be drastically diluted and still be effective, allowing existing supplies to be stretched to cover millions of Americans.

"I think the debate needs to take place over the next few months," said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. "I hope there will never be a smallpox attack. But you certainly need the debate before there's an attack."

The last cases of smallpox occurred in the 1970s, when the disease was wiped out by a global vaccination campaign. But the Sept. 11 attacks, combined with the deadly anthrax mailings last fall, have reignited fears of the return of one of the great scourges of human history, an incurable, highly contagious disease that killed up to a third of people infected.

Articles on the vaccination debate and vaccine dilution were made public by The New England Journal of Medicine yesterday, a week before official publication, because of the pressing nature of the issue. And The Washington Post reported that a huge store of smallpox vaccine - more than five times the previously known supply - has been found at the U.S. headquarters of the French pharmaceutical company Aventis Pasteur.

Scientists are divided on how best to defend against a possible terrorist smallpox attack. Beyond the question of a vaccination campaign, resistance appears to be growing to the Bush administration's decision to preserve the nation's stock of smallpox virus, kept in a high-security lab at the Centers for Disease Control and Prevention in Atlanta.

This week, the deans of more than half the nation's schools of public health called for destruction of the only known stocks of smallpox virus, at CDC and at a Russian research institute. Some experts believe Iraq, North Korea or even terrorist groups might have the virus, though there is no proof.

The deans' statement, drafted by Dr. Alfred Sommer of the Johns Hopkins Bloomberg School of Public Health, rejects the argument of government scientists that more research using the actual smallpox virus is needed.

Destruction of the smallpox stocks "will reduce other nations' concerns that they must acquire and experiment with the virus to maintain parity with the U.S. and Russia," says the statement, signed by deans of 18 of the 31 accredited public health schools.

"We strongly believe that the best defense against one particularly dangerous, potential terrorist agent, smallpox, is a global campaign to eradicate the virus from the face of the earth."

Sommer said he was gratified by the support for his stand, which was prompted by the revelation in January that Army researchers working at CDC had succeeded in fatally infecting monkeys with smallpox for the first time. Their goal was to create an animal model for use in developing new drugs and vaccines.

Fearing the Army research could touch off a biological arms race in which other countries might try to obtain smallpox, Sommer circulated the position statement to other deans.

Their stance runs against recent decisions by the U.S. government and a World Health Organization panel to preserve the virus for research purposes for the time being.

Dr. Peter B. Jahrling, a top Army scientist leading the monkey studies, said yesterday that the deans' goal of virus eradication is not realistic because some of the tons of smallpox virus produced by the Soviet bioweapons program in violation of a treaty probably has made its way to other countries.

"The dream of global eradication was shattered by the Soviet betrayal," Jahrling said. "We can't put the genie back in the bottle."

He and other advocates of more smallpox virus research point to the danger to some people of the existing smallpox vaccine. It can be fatal to people whose immune systems are weakened by the AIDS virus or chemotherapy and can cause severe facial scarring in those with the skin disease eczema.

That vaccine was used for the dilution experiments, in which doctors at the University of Maryland and other research centers vaccinated young adult volunteers with the standard dose, a 5-to-1 dilution or a 10-to-1 dilution, said Dr. Carol O. Tacket of Maryland's Center for Vaccine Development.

More than 97 percent of the volunteers developed the blister that tells doctors a person is effectively immunized.

"I'm absolutely thrilled it was this successful," Tacket said. The freeze-dried vaccine was at least 20 years old, so doctors didn't know whether it would work at full strength, let alone in watered-down form, she said.

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