IOM: CDC never made a case for smallpox vaccine
IOM: CDC never made a case for smallpox vaccine
We still need info on preparedness, panel says
In 2003, an urgent concern about bioterrorism drove the health care community to mobilize and deliver smallpox vaccine to health care workers across the country. The Department of Health and Human Services called for vaccination of 500,000 health care workers nationwide. Yet vaccination efforts waned as reports arose about adverse cardiac events. Within six months, the program was all but over. About 40,000 health care workers had been vaccinated.
How much was accomplished? That’s not clear — because the Centers for Disease Control and Prevention (CDC) still needs to define smallpox preparedness and set goals "that reflect the best available scientific and public health reasoning," an Institute of Medicine (IOM) panel said in a recent report on the smallpox vaccination program.1
The IOM panel also criticized the CDC for failing to present a compelling case for smallpox vaccination, saying, "The public health reasoning behind the smallpox vaccination policy and program was never fully explained. Skepticism among key constituencies was followed by a lack of buy-in."
While hospitals and health care workers struggled to decide how to balance the known risks of the vaccine with the unknown risk of a smallpox attack, the CDC was constrained from speaking freely, the IOM panel asserted.
"The two key points here are that CDC must be allowed to speak from science," said Brian Strom, MD, MPH, chair of the panel and associate vice dean of the School of Medicine at the University of Pennsylvania in Philadelphia. "If it isn’t, then it loses trust and the health care and public health communities will respond accordingly. The second key point is we still don’t know if we’re prepared, and we need to [know]."
Julie L. Gerberding, CDC director, said, "CDC disagrees with the assertion that in any way its valued scientific voice was constrained in the smallpox program. The administration policy for the smallpox program was based on the best scientific advice of the CDC and other recognized scientific experts."
Strom said he doesn’t dispute the scientific basis of the program or CDC’s voice within the administration. "We questioned whether the CDC spoke to the public, the hospital community, and the public health community from science," he added.
Gerberding also said the smallpox efforts helped the nation’s overall bioterrorism preparedness. "The policy was successful in preparing the nation to respond not only to a potential smallpox event, but also preparing the nation in response to other public health emergencies," she said in a statement. "Let me reinforce that terrorism preparedness is more than a vaccination program."
But without specific goals and an evaluation based on them, it’s impossible to measure our level of preparedness, Strom noted.
"Knowing that we are prepared is critical because, if there were an attack, one of the key issues would be one of public panic," he said. "The public has to have confidence that we are prepared in order to prevent that. We as a committee don’t know if we are prepared. How can the public be assured we are prepared?"
Disaster scenarios guide planning
A CDC working group already is considering some of the issues raised by Strom, says Charles Schable, MS, director of CDC’s Coordinating Office of Terrorism Preparedness and Emergency Response.
The Department of Homeland Security developed National Planning Scenarios, with examples of catastrophic incidents that could occur.
According to a report in The New York Times, that included the spread of pneumonic plague in the bathrooms of an airport, sports arena, and train station, killing 2,500 and sickening 8,000 worldwide; an anthrax attack aerosolized and dispersed by terrorists driving a truck through five cities over two weeks, killing 13,200 and exposing 350,000; and pandemic influenza. (Smallpox was not included as one of the scenarios.)
"We’re going to put some of this [information from] scenario planning into our cooperative agreement [with state health departments]," Schable notes.
For example, state health departments will need to have an emergency preparedness phone line that is monitored 24/7, he says. They will need to conduct live drills, not just tabletop exercises, to ensure preparedness.
Schable notes that the Bush administration has given "close to a billion dollars" to state health departments for preparedness activities.
The working group discussed the status of smallpox vaccination and decided that a push to increase the numbers of health care workers vaccinated isn’t necessary at this time. "With smallpox, most people believe that even though we only vaccinated 40,000 people, that’s probably enough to respond to an event," he says.
"Most people believe in the ring vaccination theory. You do have several days to respond to an attack," Schable says.
However, hospitals should review their vaccination records, he says, as some employees may have left or retired, and the hospital may need to vaccinate additional employees.
"I think we need to get it back on the radar screen. It’s something they need to think about for overall preparedness," he adds.
Meanwhile, further research on a safer smallpox vaccine could lead to the ultimate preparedness. "If we had a very safe vaccine, you could say, Vaccinate everybody,’ and take that threat completely off the table," Schable explains.
Reference
1. Baciu A, Anason AP, Stratton K, Strom B, eds. The Smallpox Vaccination Program: Public Health in an Age of Terrorism. Washington, DC: National Academies Press; 2005.
In 2003, an urgent concern about bioterrorism drove the health care community to mobilize and deliver smallpox vaccine to health care workers across the country. The Department of Health and Human Services called for vaccination of 500,000 health care workers nationwide. Yet vaccination efforts waned as reports arose about adverse cardiac events. Within six months, the program was all but over. About 40,000 health care workers had been vaccinated.Subscribe Now for Access
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