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With the nation's smallpox vaccination campaign in near hibernation, the Centers for Disease Control and Prevention is trying to get states to identify how many more people need to be immunized --- which experts say could reawaken the controversial effort.
The Atlanta-based CDC said Monday it will issue new criteria this fall for states to measure bioterrorism preparedness, including whether enough medical responders have been inoculated. States must assess their readiness when applying for federal funding.
Since the campaign started in January, about 38,000 health care workers have been vaccinated, far below a Bush administration plan calling for up to 500,000. Many health care workers rejected the shots because of concern about side effects and compensation if they were harmed.
The CDC, as part of a push to establish minimum standards for bioterrorism, now wants states to look at how many more personnel require shots.
"We're pretty confident [38,000 people vaccinated] is not enough," said Joe Henderson, the CDC's associate director for terrorism preparedness and emergency response. "We're going to give more precision on who we feel may be exposed."
The original plan for vaccinating up to 500,000 health care workers and up to 10 million police officers, firefighters and emergency workers came as the country was getting ready for war in Iraq.
"We have learned a huge amount since then, and it's time to step back and rethink what the specific plans should be," said Dr. Brian Strom, chairman of the smallpox vaccination committee of the Institute of Medicine, which advises Congress on health policy.
Some say the CDC's new approach could elicit more cooperation from health care workers.
"It's an attempt to build preparedness from the bottom up this time instead of the top down," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
The CDC will release its new plan at an Institute of Medicine meeting in November, Henderson said. The criteria will be a checklist for bioterrorism preparedness, looking at whether states have identified response teams, vaccinated and trained enough people on those teams, set up communications, run drills and planned mass vaccination clinics.
"It will help us better understand what CDC's priorities are," said Mary Selecky, president of the Association of State and Territorial Health Officials. "It takes much more than just vaccinated individuals."
Smallpox vaccination rates vary greatly among states. Fewer than 50 health care workers have been immunized in Arizona and Nevada, while more than 3,800 have been inoculated in Florida and Texas. In New York, 760 have been immunized.
In Georgia, where 175 health care workers have received the shots, the state has halted its vaccination campaign.
"We believe we have the appropriate number of people vaccinated to respond," said Susan Lance-Parker, an epidemiologist with the state Division of Public Health.
Meanwhile, about 61,000 doses of expired vaccine have been destroyed. Another 192,000 doses have been sent to states, though most have not been opened and are not likely to expire soon, Henderson said.
CDC officials said they couldn't estimate the cost of the destroyed vaccine because the stockpile was purchased many years ago.
Authorities downplayed a recent study by researchers at Oregon Health & Science University saying Americans who received routine childhood immunizations for smallpox before 1972 still have some immunity.
"Because we don't have smallpox anymore, we don't know if those measures of immunity matter anymore," said Strom, with the University of Pennsylvania School of Medicine.
The Institute of Medicine said earlier this month that the vaccine is too dangerous to be offered to the public outside of clinical trials. President Bush said last year that people who wanted the shots could get them beginning this summer, but that effort was put on hold.
Few people seem interested anyway, Henderson said.
Copyright 2003 The Atlanta Journal-Constitution
