By Dorsey Griffith, The Sacramento Bee, Calif. Knight Ridder/Tribune Business News
Sep. 9--With the devastation of Sept. 11, 2001, still fresh in her mind, Elizabeth Pataki was eager to do what she could to help respond to future terrorist threats.
For Pataki, a registered nurse at Mercy General Hospital in Sacramento, that meant rolling up her sleeve for a vaccination against smallpox, a disease that killed an estimated 500 million people in the 20th century before it was eradicated and that the Bush administration feared could be unleashed again by terrorists.
'It was a gut response,' Pataki said. 'I was a public health nurse for many years. I thought OK, this is a patriotic thing to do.'
But as reports of people dying from the vaccine trickled out, Pataki -- and thousands of other civilian health care workers -- had second thoughts.
'There was too much risk both to our patients and to our families that we felt it was unacceptable,' Pataki said.
Since the vaccination program began in the spring, only 1,840 people in California have been inoculated against smallpox, representing less than 10 percent of the 19,000 doses of vaccine the state requested from the federal government late last year. As a result of the dismal response, the state has or will have to destroy 35 percent of its initial vaccine supplies.
The vaccination numbers include those for Los Angeles County, which produced a separate smallpox vaccination plan from that of the rest of the state. Los Angeles requested 9,000 doses of the vaccine and has so far vaccinated 243 people, according to the state Department of Health Services.
The story is the same across the country: While the federal government initially estimated that nearly 450,000 health workers would be vaccinated within a month of the federal order, just over 38,000 -- roughly 8.5 percent -- have received the vaccination so far.
In Sacramento County, 36 people received the vaccine, including just five hospital workers. Other counties fared worse. State health records show that there are no health care workers vaccinated against smallpox in 12 California counties, most of which are rural.
'The current program is dead in the water as far as I am concerned,' said Dr. Steven Black, co-director of Kaiser Permanente's Vaccine Study Center in Oakland and a member of the Centers for Disease Control and Prevention's National Vaccine Advisory Committee. 'The number of people volunteering is quite small, and it is not really any meaningful program compared to what was contemplated.'
Federal and state health officials maintain that the program continues to move forward, and that the paltry response among health workers does not mean the public health system is ill-equipped to handle an initial smallpox outbreak.
'It is not the full number of persons necessary to respond to a big outbreak,' said Kevin Reilly, deputy director of prevention services at the state health department. 'But it is enough to be able to do some things immediately, to vaccinate other health care workers.'
The current smallpox vaccination program was born in the aftermath of the terrorist attacks on the Pentagon and World Trade Center, and because of the Bush administration's strong belief that Iraq harbored weapons of mass destruction, possibly including vials of smallpox.
Dr. Karen Tait, Sacramento County's deputy health officer in charge of bioterrorism preparedness, said the federal mandate required hasty action.
'We had very little information and very little preparation with hospitals and a short timeline over the Thanksgiving Day weekend,' she said. 'Everything was being worked out on the fly.'
As a result, she said, the county overestimated the amount of vaccine it would need, struggled to quickly train staffers to give the inoculations and faced mounting concerns from health workers about potentially dangerous side effects from the live vaccine.
Pataki, for example, wondered who would be responsible if one of her patients became infected with vaccinia -- the live virus used in the vaccine, from the lesion left by the inoculation.
Still, Tait said she believes the number vaccinated up to this point in Sacramento County is adequate, considering the threat level and risks of the vaccine.
'There is a real ethical issue we have to consider: We are vaccinating against a disease that as far as we know does not exist on the face of the Earth,' she said. 'You have to consider the ethics of subjecting people to side effects, including death, for what is more of a defense strategy than a health care issue.'
In response to the lukewarm reception to vaccination, the federal government has asked states and local jurisdictions to shift their focus from 'pre-event' vaccination programs to more thorough preparation, including education and training of first responders, in the event of an actual smallpox outbreak.
Dr. Howard Backer, acting chief of the state's immunization branch who is in charge of smallpox planning, said the state is updating its vaccination plan, in part to reflect the lower numbers of vaccinated health workers than had been anticipated.
That plan was the subject of a public records request made by The Sacramento Bee in July 2002 and finally fulfilled on July 30 of this year.
The pre-event document obtained by The Bee indicates that the state, excluding Los Angeles County, Long Beach and Pasadena, would need about 6,000 people to make up its smallpox response teams, all of whom would be previously vaccinated.
Backer said the plan will be updated in the coming months to include provisions for immediate vaccination of health care providers who will make up those teams.
'What we will have to do is call them, vaccinate them in a priority manner and give them protective gear,' he said. 'They will have to start working without the added confidence that they are immune.' It takes about 10 days for the vaccine to fully protect someone from the disease.
Health officials say they have no doubt that if there is a case of smallpox, health care providers will step up and get vaccinated.
'It wasn't that they weren't willing to respond if something happened,' said Backer. 'They just felt the risk-benefit equation wasn't strong enough.'
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(c) 2003, The Sacramento Bee, Calif. Distributed by Knight Ridder/Tribune Business News.
