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medpundit |
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Monday, May 20, 2002"I have several concerns about both a "mass vaccination" strategy, as well as the informed consent/"give the people what they want" strategy as you propose. First, you present your argument as if a smallpox attack is a given. While I appreciate the gravity of the situation -- 119 million or so unvaccinated individuals in the U.S., unknown protections for those vaccinated 30+ years ago, high contagion rate, 30% mortality & high levels of debilitating morbidity for the infected, the difficulty, if not impossibility, of giving potentially hundreds of millions of people 15 scratches each in a very short period of time -- it is still a largely theoretical threat. In my opinion, "educating the people on the risk of the vaccine and the disease" would have to include some information about the risk of attack. Otherwise, we're asking the government to put themselves in the position of creating a public health panic based on little evidence in order to get people to subject themselves to the shots. Second concerns the herd immunity argument you raise to protect the immunosuppressed/unimmunized. As I'm sure you know, a voluntary immunization program likely won't cut it for "herd immunity" purposes, unless we are able to scare the bejeezus out of the American public and frighten everyone to get vaccinated (and downplay the very real and very serious side effect threats of getting vaccinated). It will take 80-85% vaccination coverage to achieve herd immunity for smallpox, according to the CDC. Furthermore, a voluntary vaccination program likely will increase the chances of the immunosuppressed/unvaccinated of being infected by those choosing to get vaccinated (unless, of course, we can assume that every person getting a new vaccination will be able to completely avoid the immunosuppressed while they're still contagious). Furthermore, in many states, there is a religious and philosophical exemption to vaccination available, and some states, like Wisconsin, have even added a philosophical exemption to their proposed Model State Emergency Health Powers Acts, so that, even if we were to vaccinate everyone, there would still be a good percentage of people with non-medical reasons who would "opt out" of the vaccination. Finally, there is the ability of the health care community/government to minimize the side effects of vaccination. In order to minimize severe side effects, we need to have on hand a sufficient supply of Vaccinia Immune Globulin (VIG). These supplies, like the smallpox vaccine, are also controlled by the CDC; however, unlike smallpox vaccine production, VIG can only be produced from people recently vaccinated against smallpox. Therefore, our supplies of VIG are likely insufficient to adequately address the likely number of side effects we will face should we embark on a mass vaccination campaign. Except for a few stray CDC cites and the DA Henderson et al article in 1999 JAMA titled "Smallpox as a Biological Weapon," very few pieces on smallpox vaccination have addressed this issue." I have more faith in the ability of the general public to act for the greater good in the face of a crisis. I am also less sanguine about the risk of an attack. While I don't think that we should force anyone to have the vaccine who doesn't want it, I do think that if the public is given the straight facts about the lethality of smallpox and the risks of the vaccine the majority would choose to be vaccinated, and we would see rates approaching the 80-85% needed for herd immunity. After all, smallpox is much deadlier than any of the other diseases we ask people to be immunized against, and so, much more worth the risk. As for the immunocompromised, yes, they will be put at some risk from their vaccinated fellow citizens, but that risk pales in comparision to what they would face in an epidemic among an unimmunized public. No one can guess or predict what the chances are that a smallpox attack will occur. In times like this we have to assume the worst. Failure to do so would result in more of an outcry (and justly so) than we are seeing now over the intelligence community failures and 9/11. In the case of a smallpox attack, as it stands now, we would have imagined the worst and failed to act to prevent it. posted by Sydney on 5/20/2002 09:52:00 PM 0 comments 0 Comments: |
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