Smallpox preparedness program needs clarification

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A federal program that is supposed to protect the United States against a smallpox attack has gone awry because of a lack of clear communication about the goals, a panel of experts said on Thursday.

They said the usual scientific authority of the Centers for Disease Control and Prevention was undermined because of the vague messages of the program, and suggested a more forthcoming approach would get people back on board.

Forty thousand civilian healthcare workers and more than 760,000 troops have been vaccinated against the disease under a plan launched in 2002, but Dr. Brian Strom, professor of medicine at the University of Pennsylvania School of Medicine, asked whether hospitals would be prepared to treat smallpox.

“We still do not know the vaccination program’s effect on preparedness. We are unaware of the project’s current status,” Strom said in a telephone briefing. “The focus on the numbers of vaccinees really is misleading people,” he said.

Smallpox was considered to be eradicated in 1979, but the U.S. government and a range of experts believe some governments and groups may have developed the virus for use as a biological weapon.

The government plan was for vaccinating 500,000 troops and an equal number of health and emergency workers to make up the front-line response in case of attack. Eventually, the plan called for as many as 10 million people to be immunized.

The Institute of Medicine, an independent organization that advises the federal government on health matters, was asked to name a committee to monitor the program. The committee, headed by Strom, issued its seventh report on the program on Thursday.

“The committee has found evidence that many key actors had an unfavorable perception of the policy,” the report said.

WHEN POLICY ISN’T SCIENTIFIC

Strom said the vaccine is known to have serious side effects. “The public health rationale for the decisions made were never overtly explained,” he said. “The perception was the CDC was not speaking from its usual...scientific authority.”

CDC Director Dr. Julie Gerberding disputed that in an unusually strongly worded statement. “CDC disagrees with the assertion that in any way its valued scientific voice was constrained in the smallpox program,” she said.

“The Administration policy for the smallpox program was based on the best scientific advice of the CDC and other recognized scientific experts,” Gerberding added.

“So far in response to the policy, each state has a smallpox response plan in place and laboratory capabilities to respond have been greatly enhanced—for example, enhancing the ability of laboratories to distinguish between smallpox and other pox viruses.”

Strom agreed. “It is very clear we are better prepared,” he said. “The question that is not answered is are we prepared enough. That cannot be answered because we don’t have a definition of what prepared is.”

He outlined the questions. “If a case walked into an emergency room tomorrow would people know what to do? Would a physician be available? Would nurses be available?”

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