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Wednesday, February 12, 2003"The real problem is that nonvolunteers can also be infected by the vaccine virus and can be crippled or killed."_ This is the reservation that thoughtful public health officials voice most often. As The Post reports, "Physicians said their main concern is for patients and family members who might inadvertently be infected by the live-virus vaccine." The site of the smallpox inoculation on the body can shed vaccinia virus, which, if it infects someone who has a compromised immune system -- say, an HIV or cancer patient -- can kill in a horrible way. In an interview, John Neff, a pediatrician and infectious-disease specialist at the University of Washington School of Medicine, told me, "If I were to go out and get vaccinated for myself, and I inadvertently infect my spouse or someone I didn't even know had an immune problem, and that person died, I've done a terrible thing." Moreover, even one such case in the national headlines could cause a backlash against not only smallpox vaccination but against vaccines generally. It is proper to be concerned about this problem. But it is not proper to be paralyzed by it. Working from data that Neff and three of his colleagues recently published in the Journal of the American Medical Association, I figure the odds of dying from "contact vaccinia," as it's called, at two to four per 10 million inoculations. In 2001, by way of comparison, every 10 million licensed drivers caused the deaths of about 300 pedestrians and other nonriders -- people who had not voluntarily assumed the risk of getting into an automobile. Notice, please, that driving a car is on the order of 100 times more likely to kill a bystander than is getting a smallpox inoculation. Yet we do not prohibit driving. Nor do we even discourage it. Nor do we run a national compensation program for pedestrians injured by automobiles. Rather, we recognize that a sensible society puts up with certain small risks in the pursuit of larger goals. So the people who are foot-dragging on smallpox vaccination are really people who are asking this: "Should Americans be expected to assume a mild inconvenience or a minuscule risk in order to help secure their nation against a fearsome attack?" A country, or a government, that fails to answer that question very clearly in the affirmative is either neurotic about risk or unserious about terrorism. Or both. Our public health system is definitely both. Their statements to the media have managed to make the vaccine seem as dangerous as the disease. When the head of the CDC says that obesity is a bigger threat to our nation than terrorism, when public health officials publicly accuse the smallpox vaccination program of being a political ploy, and when some equate vaccination with supporting war, then you know they aren’t taking the threat of terrorism seriously. And you have to ask, should we be trusting the public health system with our defense? Wait, here’s a voice of reason, from Minnesota: Prof. Michael Osterholm says he's not surprised that some hospitals and health workers are getting cold feet about the smallpox vaccine. But as one of the architects of the national smallpox plan, he thinks the critics are a bit shortsighted -- especially hospitals that want to wait until there's an outbreak to vaccinate their employees. "I can guarantee you that if smallpox were to hit anywhere in the world today, there would be a mad rush for smallpox vaccine," said Osterholm, a University of Minnesota professor who is now a leading bioterrorism adviser to the Bush administration. ..."I don't care if the only smallpox case in the country is in New York City," says Osterholm, the former Minnesota state epidemiologist. "Tens of thousands of people will rush into emergency rooms . . . thinking they have it." If no one there is vaccinated, he warns, hospitals could be overwhelmed. "It will be the perfect storm," he said OK, so he indulges in that overused storm metaphor, but he makes a point that’s being lost on a lot of these people who are opting out - that it isn’t going to be an easy task to vaccinate everyone in the aftermath of an attack: Osterholm says that's easier said than done. "I believe in a situation where you have many people coming in with possible smallpox, there will be people who are literally running from the facility," he said. That will include some unvaccinated employees, he predicts. "That's human nature," he said. During that first 48 hours, he said, every hospital in Minnesota will have its hands full even if the closest case of smallpox is 1,000 miles away. "We're going to need everyone we can who's willing to stay on the front lines," Osterholm said. "Make no mistake, even if we vaccinate all these health care workers . . . we are still going to have a catastrophic event. But it's an event we now can manage [better] than if we had no preparedness at all." Yeah, and if you wait until after an attack to vaccinate everyone, you can’t thoroughly screen out all the people at high risk for complications. This is the one terrorist threat that keeps me awake at night. Sure, it’s only one of many possibilites. They could attack with a dirty bomb, with cyanide, sarin, or VX gas. They could poison us with botulin, or try to infect us with the plague or anthrax. But of all the threats, smallpox not only has the most potential to spread far beyond its initial introduction point and affect us all, it’s also the only one from which we have the means to protect ourselves. It keeps me awake at night to know that my children will go unprotected from this threat because the American Academy of Pediatrics and the CDC deny them the vaccine, despite the fact that it was used in children for generations before us. It keeps me awake at night to know that nurses across the country are opting out of it, not because they’ve weighed the risks for themselves, but because the nurse’s unions are encouraging them not to take it. (I know this to be true, because I’ve seen the letters being circulated by our local nurse’s unions.) It’s hubris, pure and simple, to think that the same organizations who complain that this pro-active vaccine campaign is going forward too fast to be administered safely could adequately vaccinate large numbers of people within the two day window to prevent the dissemination of smallpox. It's cock-eyed optimism to think that everyone exposed to smallpox is going to realize that in time for a post-exposure vaccination to be effective. Unfortunately, since our most vulnerable citizens are also our youngest, it’s a hubris and optimism that very well could cost us our future. posted by Sydney on 2/12/2003 07:02:00 AM 0 comments 0 Comments: |
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