WASHINGTON -- President Bush said Friday he will take the smallpox vaccine along with U.S. military forces, but he is not recommending the risky inoculation for most Americans.
Vaccinations for a few dozen military personnel began Friday, and by late January states are expected to begin inoculating health care response teams and others who would respond to a smallpox attack. The government will make the vaccine available to the general public beginning in late spring or early summer, though Bush emphasized that it is not recommended for most people. He said his family and staff -- including Vice President Dick Cheney and the Cabinet -- would not be vaccinated.
With war in Iraq a growing possibility, Bush said the vaccine will be mandated for about a half-million U.S. troops in "high-risk parts of the world."
Bush noted that the disease was eradicated in 1980, but said, "In the aftermath of September the 11th, we are evaluating old threats in a new light."
Rare side effects
The shot that carries rare but serious side effects. One or two out of every 1 million vaccinated will be killed by the vaccine, and 15 will face life-threatening complications.
"As commander in chief, I do not believe I can ask others to accept this risk unless I am willing to do the same," Bush said. "Therefore, I will receive the vaccine along with our military."
It was unclear how troops would respond to this directive. Some in the military balked at mandatory anthrax vaccinations, which are considerably safer than smallpox vaccinations.
About 20,000 people working in U.S. embassies in the Middle East will also be offered the vaccine, the State Department said.
Available to civilians
Civilian vaccinations will begin with about 450,000 people most likely to encounter a highly contagious smallpox patient. That includes people who work in hospital emergency rooms and those on special smallpox response teams. States have already identified these people and are preparing to set up clinics. Once these programs begin, it's expected to take about 30 days to vaccinate this group.
Next up will be emergency responders, such as police officers, firefighters and other health care workers. The government is recommending the vaccine for an estimated 10 million in this group, and health officials predicted Friday that about half would say yes. It was unclear when these shots would begin or how long it would take for this group.
For months, the administration has been debating vaccinations for the general public.
Top health advisers preferred to wait until the vaccine, just recently manufactured, is licensed by the Food and Drug Administration before offering it to people who face no particular threat. That's not likely until early 2004.
Some states are balking at the prospect of delivering vaccinations to so many people so quickly. But Bush decided that the administration could not offer a vaccine to some without making it available to all.
"Some individuals feel so strongly they want to be vaccinated right now that we wanted to make it available," Health and Human Services Secretary Tommy Thompson said.
Adults who want the vaccine can sign up for clinical trials now under way. HHS also will create a special program for people who want to sign up -- expected in late spring or early summer, health officials said.
Or, people could wait until 2004, after the vaccine is licensed, although it will still not be recommended.
Bush and his top health aides emphasized that there is enough vaccine for all 280 million people in this country, and that plans are in place for mass vaccinations should an attack with the virus occur.
Once among the most feared diseases on Earth, smallpox killed hundreds of millions of people in past centuries, but it hasn't been seen in this country since 1949. Its eradication was one of public health's greatest victories.
But because no one has been vaccinated in decades, the population is highly vulnerable. While all stocks of the virus beyond two official labs were supposed to be destroyed, experts fear that hostile nations or terrorist groups may have smallpox and could use it in an attack.
An education campaign will explain the vaccine's risks in detail.
The most serious complications include encephalitis, which can cause paralysis or permanent neurological damage, and progressive vaccinia, where the vaccination site does not heal and the virus spreads, eating away at flesh, bone and gut.
The vaccine poses significant risks for certain people, including cancer patients, organ transplant recipients, people with HIV, pregnant women and people with a history of eczema. People who live with others who have these conditions should not be vaccinated, because the live virus used in the vaccine can sometimes escape the inoculation site and infect others.
Health workers delivering the shots will have to ask questions that will screen these people out. Federal officials are recommending that states make pregnancy and HIV tests available to people considering the vaccination.
Health officials said they have enough vaccinia immune globulin, or VIG, which is used to treat side effects of the vaccine, to care for those being offered the vaccine in the coming months.
On the Net: Government smallpox information: http://www.smallpox.gov
Who will be offered the vaccine? First up will be about a half million military troops, and for civilians, those people most likely to encounter a highly contagious smallpox patient. In a second stage, the shot would be offered to all other health care workers plus emergency responders such as police, fire and emergency medical technicians. Eventually the vaccine will be available to all Americans, though the government will probably not encourage them to get it.
How long does it last?
The Centers for Disease Control Web site says the first dose of smallpox vaccine offers protection from smallpox for three to five years, with decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts longer.
Is it mandatory? For the military, yes. For civilians, no.
Wasn't smallpox wiped out? In 1980, the disease was declared eradicated worldwide, and all samples of the virus were to have been destroyed except those held by special labs in Atlanta and Moscow. Experts fear some of the Russian sample could have escaped to hostile nations.
Does Iraq have the virus? U.S. officials believe Iraq has a small amount of smallpox left over from the last outbreak in the 1970s, though United Nations inspectors have not singled out smallpox as a threat in their reports.
Why not just vaccinate everyone right now? The vaccine itself, made with a live virus called vaccinia, carries rare but serious risks. Based on studies from the 1960s, experts estimate that 15 out of every million people vaccinated for the first time will face life-threatening complications, and one or two will die. If a smallpox attack never comes, that would be a heavy toll to pay. Reactions are less common for those revaccinated. For the approximately 130 million Americans never vaccinated, experts would expect nearly 2,000 to face life-threatening complications and 125-250 of them to die. For about 158 million people being revaccinated, experts expect nearly 800 life-threatening complications and about 40 deaths.
What sort of reactions and complications? Typical reactions include sore arms, fever and swollen glands. The most common serious reaction comes when vaccinia escapes from the inoculation site, often because people touch the site and then themselves or someone else. For instance, the virus transferred to the eye can cause blindness. More deadly is encephalitis, which can cause paralysis or permanent neurologic damage. Also fatal though very rare: progressive vaccinia, where the vaccination site does not heal and the virus spreads, eating away at flesh, bone and gut.
Who's at greatest risk of complications? People with weak immune systems -- those with HIV, cancer and transplanted organs -- face much greater risk, as do pregnant women. People with eczema risk a serious, permanent rash. Officials administering the vaccine will ask detailed questions to try to screen out such people.