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medpundit |
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Sunday, June 02, 2002UPDATE REDUX: For a clue to the approach our so-called experts are taking to the smallpox vaccine issue, look at this piece from yesterday's Washington Post. It's by Ruth J. Katz, a member of the National Vaccine Advisory Committee and a dean of the Yale School of Medicine. Some excerpts, which deserve comment: "There is strong public demand for the vaccine but no consensus on whether access should be given to anyone who wants it. Implementing a sound policy is further complicated by misperceptions, with many physicians and lay people believing that smallpox is almost always fatal (it actually kills about 30 percent of its victims) and that the vaccine is as safe as most childhood vaccines (it may be the most dangerous one available)." Thirty percent fatality is very high. Higher than any of the infectious diseases we encounter today. In addition, those who do not die are almost always disfigured by the disease, and they are very seriously ill when they have it. We know the vaccine isn't as safe as other childhood vaccines. Even if we aren't experts in infectious disease. Make the dangers of the vaccine known. Let people make an informed decision. "The multiple dimensions of the issue, and the stakes involved, argue for thoughtful decision-making. The advisory committees studying the smallpox vaccine had expected to complete their expert review in the fall of this year. Between now and then, an ambitious schedule of regional meetings had been established so we could hear from professional medical organizations and groups representing patient populations, health care workers, public health officials, emergency response workers and the public. Now the Bush administration is asking for an abbreviated process leading to recommendations by the middle of this month." Good for the Bush administration. Just what do these experts think they are going to gain by debating and debating the issue for months and months? None of them have ever had to deal with smallpox, so it's doubtful that any of them feel all that comfortable making a decision. They can debate and debate until the cows come home, but that isn't going to increase their degree of comfort with a decision. Nor is it going to increase their knowledge. The fact is, no one has had to deal with smallpox among a non-immune population since the Native Americans of North America succumbed to it two and three hundred years ago. Maybe the Bush administration has reason to believe that Iraq or some other hostile nation has smallpox ready for use as a weapon against us, and wants to protect us from that. If so, the CDC and the Vaccine Advisory Committee should stop this turf protecting behavior of theirs and act for the greater public good. They know the side effects of the vaccine, they know the dangers of smallpox on a non-immune population. But, they are stuck in the experience of the late 1960's and 1970's when the world was widely immune and the contagion could be contained with ring vaccination and quarantine. They need to look further back in history for the example of just how devastating smallpox can be. "The official response to the recent anthrax scare was equally unimpressive. No one seemed in charge, and no one spoke to the public authoritatively about what was and was not known concerning the danger. The result was widespread fear and an erosion of faith that can only weaken future capacity to address the genuine threat of bioterrorism appropriately." Exactly. Which means that their response to a smallpox attack is likely to be just as abyssmal. It would be much better to prepare and take measures to prevent the devastation that smallpox can wreak by immunizing now. If she's worried that we won’t be able to implement a mass preventive vaccine program, how does she think we'll be able to respond if we wait until it's a national emergency? "The Bush administration is now pushing hard on the smallpox vaccine, and it may well have valid reasons for doing so. But public health, not politics or public relations, needs to be the driver here. If the administration is only seeking to show that it is "tough on smallpox" and prepared for anything in the struggle against terrorism, health experts, elected officials and the American public should protest the hijacking of a carefully formulated policymaking process. Planning for a smallpox epidemic is not an event being staged for television." As I said before, I suspect the Bush administration does have valid reasons for pushing for the vaccine. It just may be what's holding them back on Iraq. The "experts" should stop stonewalling. They are not going to gain any more knowledge of our risks by delaying their decision making process. It’s all speculative. We are at war. The debate can not proceed at the slow pace to which academics are accustomed. This is not the same as a routine childhood vaccine. When you consider that the portion of our population at greatest risk are those under forty, those who are at the prime of their lives, and who are the future of our nation, the risks are much too high to wait. The entire tone of this paragraph speaks volumes. It's obvious that the infectious disease experts feel that the government is stepping on their turf, and they don't like it. Doctors never like having their authority questioned, and they are circling the wagons here to try to prevent it. "The eradication of smallpox worldwide ranks as one of the great triumphs of public health. If there is a chance of its return, we need to combat it with the same wisdom and determination used to vanquish it in the first place. But in the absence of a clear and present danger, we can surely take the time to exercise care and to be thoughtful." No, Dr. Katz, we do not have the time. The threat is a clear and present one that can strike at any time, with just as much suddeness as the World Trade Center attack. posted by Sydney on 6/02/2002 07:23:00 AM 0 comments 0 Comments: |
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