States vary widely on smallpox vaccine plans

WASHINGTON -- In Georgia, health officials sketching plans for smallpox vaccinations are starting small -- fewer than 500 people will be offered the shots at first. But in nearby Louisiana, officials plan to offer it to as many as 20,000.

Weighing the risks of the shot against the risk that the disease will return, states vary widely in their planning for smallpox, an Associated Press survey finds. Yet all of them face the same challenge: educating people about a vaccine not given in this country for three decades.

States, cities and territories were supposed to submit their plans for the first stage of smallpox vaccinations by Monday to the federal government, and 44 of 62 projects met the deadline. Others are expected in coming days.

Variations among the states stem partly from the fact that each state is making its own guess about the chances of smallpox reappearing more than 20 years after it was declared eradicated, said Dr. Rex Archer, director of the Kansas City, Mo., health department.

The vaccination plans were ordered because of concern that hostile nations and possibly terrorist groups have the virus and could unleash it in an act of bioterrorism.

Immunizations will begin soon after a presidential announcement, which could come this week. After that, states have been told they'll have 30 days to deliver the shots.

The first group to be offered the vaccine will include those most likely to encounter a highly contagious smallpox patient: people on special smallpox response teams -- who would investigate suspicious cases -- and emergency room workers.

Nationwide, about a half million people are expected in this group, but the AP survey of states suggests that these shots are not likely to be evenly distributed across the country.

In the Louisiana plan, the vaccine would be offered to one in every 220 to 300 residents. In South Carolina, New Jersey and West Virginia, officials would wind up vaccinating twice that -- about one in every 500 to 600 residents. At the same time, in Georgia, the vaccine would be offered to just one in every 17,000 to 28,000 residents.

"We want to start small and make sure we do it right," said Dr. Paul Blake, the Georgia state epidemiologist. State officials fear that if they move too quickly, they might wind up vaccinating people with compromised immune systems, skin problems or other factors that make the vaccine particularly risky.

People also shouldn't get the vaccine if they live with others who have these conditions because the live virus in the shot can spread to people who come into close contact with the person vaccinated.

Overall, experts estimate that the vaccine will kill one or two out of every million people being vaccinated for the first time, and 15 will suffer life-threatening side effects.

"The more people you immunize, the more chances you are going to have for serious reactions," Blake said.

In Michigan, the state plans to offer the vaccine at only about 30 hospitals, whereas twice that are expected to participate in Montana. "We don't necessarily need it in every corner or at every hospital," said Geralyn Lasher of the Michigan Department of Community Health.

In North Dakota, the state's vastness and lightly populated rural areas make it important that all hospitals are capable of helping a smallpox victim, said Tim Wiedrich, bioterrorism coordinator for the North Dakota Health Department.

"We really believe that it's likely that smallpox patients could present themselves at any of our hospitals," he said.

Federal officials plan to review each plan and make sure it is comprehensive, said Jerry Hauer, the top bioterrorism official at the Department of Health and Human Services. He said he's not concerned by the variation.

"We wanted to give them that flexibility," he said.

Some say the variation among the states is likely to even out after vaccinations begin, with some states asking for more vaccine and others winding up with extra.

Plans being submitted to the Centers for Disease Control and Prevention address a wide range of details about the first phase of smallpox vaccinations. States were asked to explain who would be offered the shots, timelines and locations for delivering them and a plan for ensuring that those at particular risk of severe side effects do not get vaccinated.

Once the vaccinations begin, states will be required to keep detailed track of how many people suffer reactions, with reports due twice a week to the CDC.

The major question being debated within the White House is how fast to proceed in offering the shot to the general public.

There is widespread agreement, though, on the first stage of vaccinations. Federal officials had said that about a half million people were expected in this first group, though they now expect the numbers to be slightly lower. They now estimate that up to a half million will be offered the shots, but that some of them will decline to be vaccinated and others will be screened out because of conditions that make them susceptible to dangerous side effects.

A second stage is likely to cover other health care workers and first responders, totaling as many as 10 million people nationally.

As they begin vaccinating, federal and state authorities will mount an education campaign to help people decide whether to get the shot.

In the end, each person will be forced to consider the same questions Bush and other top federal officials have been struggling with for months, said Dr. Jimmy Guidry, state health officer for Louisiana.

"It boils down to an individual perception," he said. "Is this risk real or not?"