Smallpox vaccination policy: Part II--preparedness begins. (Health Policy Update).To begin preparing the nation for a smallpox bioterrorist attack, President George W. Bush announced his plan to begin revaccinating the American people An American people may be:
The civilian component of the plan as proposed has three phases.
1. Phase one consists of two categories of emergency teams: public health response and hospital response.
2. Phase two will include all health care and other emergency response workers.
3. Phase three will cover all Americans.
The president proposed that phase one, which started in January, is to be followed shortly by phase two. He did not recommend the initiation of phase three at this time although there is a provision to allow access to vaccine for citizens who demand receiving the vaccine under certain conditions. The military component of the phase one plan began immediately.
Phase one will include as many as 500,000 people and will use a fully licensed vaccine. The public health response teams are to be trained and prepared to respond 24/7 and would be available to go to the site where a suspected case of smallpox is located and make a definitive diagnosis.
The team would also be able to begin the disease containment process (vaccination and isolation) as well as the epidemiological investigation. These teams will include physicians, nurses, epidemiologists, laboratory personnel and support staff to include public safety and legal staff.
Hospital response teams would include up to 200 people and be composed of those whom the hospital felt it needed to provide initial diagnostic, clinical and health service support (e.g. dietary and laundry) pending prophylactic vaccination of the exposed and expanded staff.
This first phase also includes another 500,000 military members scheduled for deployment to the Persian Gulf Persian Gulf, arm of the Arabian Sea, 90,000 sq mi (233,100 sq km), between the Arabian peninsula and Iran, extending c.600 mi (970 km) from the Shatt al Arab delta to the Strait of Hormuz, which links it with the Gulf of Oman. .
While the administration is. not recommending vaccine be made available to the general public, they will allow individuals without clinical contraindications to receive the vaccine if they insist. The plans on how best to do this are unclear but one way for individuals to accomplish this is by participating in any of the vaccine research protocols currently underway.
The second phase includes up to 10 million health care workers and emergency responders. The purpose of vaccinating these workers is based on the prior experience that when secondary spread occurred, it was to other health care workers usually in hospitals. (1)
Phase three will include all Americans and is not recommended as a pre-attack strategy at this time. Decisions on whether to vaccinate vac·ci·nate
To inoculate with a vaccine in order to produce immunity to an infectious disease such as diphtheria or typhus.
vac all Americans as a pre-attack strategy requires: adequate stores of licensed vaccine (available in 2004), demonstrated acceptance of the risks of the vaccine by the public after phases one and two and/or a clear risk assessment that the return of smallpox is imminent.
National public health officials stress that there is enough vaccine available today should we need to vaccinate all Americans as an emergency measure.
Should a case of smallpox occur, the plan is to utilize ring vaccination Noun 1. ring vaccination - administering vaccine only to people in close contact with an isolated infected patient; prevents the spread of a highly infectious disease by surrounding the patient with a ring of immunization and other containment techniques as initial strategy followed by broader vaccination as necessary. This was effective during the smallpox eradication program and is generally viewed as an effective way to contain an outbreak.
Whether there will be a general demand for vaccination after an outbreak is unclear although state and local public health professionals are planning for mass vaccination clinics in order to be prepared to meet the demand.
A recent poll funded by the Robert Wood Johnson Foundation Robert Wood Johnson Foundation, charitable organization devoted exclusively to health care issues. It was established in 1936 by Robert Wood Johnson (1893–1968), board chairman of the Johnson & Johnson medical products company. showed that 65 percent of the public was willing to be vaccinated against smallpox despite the risks. In addition, 58 percent were somewhat worried or worried that terrorist would attack the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. using smallpox. (2)
Despite this apparent strong degree of support, the proposal leaves several unanswered questions that may alter public participation. Ensuring that the individuals that give the vaccine have adequate protection against potential legal action is an important requirement because of the incidence of complications associated with vaccinia vac·cin·i·a
1. See cowpox.
2. An infection induced in humans by inoculation with the vaccinia virus in order to confer resistance to smallpox; it is usually limited to the site of inoculation. vaccine. It is believed that as many as 15 out of every million individuals who receive the vaccine may have a serious complication and 1-2 of them may die.
In an attempt to address this concern, Congress added Section 304 to the recently passed legislation creating the new department of homeland security Noun 1. Department of Homeland Security - the federal department that administers all matters relating to homeland security
executive department - a federal department in the executive branch of the government of the United States . This legislation allows a "covered person covered person,
n an individual who is eligible for benefits under a dental benefits program.
covered person Health insurance An insured person who is eligible for medical benefits or other services covered by a health policy " to be considered an employee of the public health service if they administer a smallpox countermeasure.
A declaration from the secretary of the U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS defines the period of protection and the covered countermeasure. This declaration triggers this liability protection for both manufactures and vaccinators. There are some concerns that this provision does not cover all potential situations and efforts are underway to find a legislative solution to these perceived loopholes.
About 41 million Americans have no health insurance and many more are underinsured un·der·in·sure
tr.v. un·der·in·sured, un·der·in·sur·ing, un·der·in·sures
To insure under a policy that provides inadequate benefits: Be certain that you are not underinsured against catastrophic illness. . Many advocacy organizations are voicing concern over how both of these groups will receive care should the nation go to universal vaccination. This is probably a minor issue during phase one but will become an increasing concern during phase two and three.
Workman's compensation insurance will cover some workers who suffer injury from the vaccine and may mitigate the health insurance concern to some degree, but there are concerns that some insurers will not honor the coverage since the vaccination' program is voluntary. Public heath planners initiating such programs will need to get a firm decision on this aspect of worker protections as they implement this program.
Who pays the costs?
A larger concern is how to pay for the program beyond phase one. Vaccination costs for other vaccine programs costs about $10-$12 dollars per shot to actually deliver the vaccine. Total societal costs to include lost workdays, complications and other health care developments add additional costs to the proposal.
State and local governments received $1 billion dollars for public health preparedness. These dollars are appropriated to improve the public health infrastructure to ensure the capacity to respond to bioterrorist events for all hazards. Some of these dollars are being diverted to fund the smallpox vaccination program, but many feel this will make the nation vulnerable to attack with other agents. (3)
Other costs are both functional and financial. The national nursing and other staff shortages will require significant juggling of work schedules and other measures to avoid the exposure of high-risk patients.
The blood supply will also be affected as people who are vaccinated are prohibited from donating until the scab falls off which is between three and four weeks after vaccination. Health planners will have to address issues such as these as the program expands.
The U.S. Center for Disease Control and Prevention Noun 1. Center for Disease Control and Prevention - a federal agency in the Department of Health and Human Services; located in Atlanta; investigates and diagnoses and tries to control or prevent diseases (especially new and unusual diseases)
CDC (CDC See Control Data, century date change and Back Orifice.
CDC - Control Data Corporation ) has set up mechanisms to track adverse reactions adverse reactions,
n.pl unfavorable reactions resulting from administration of a local anesthetic; responsible factors include the drug used, concentration, and route of administration. and is working with state and local public health agencies to ensure the availability of expert consultation to help patients and providers sort through the various types of vaccine reactions.
The Institute of Medicine has also been asked by the CDC to review and make recommendations concerning outstanding clinical issues relating to relating to relate prep → concernant
relating to relate prep → bezüglich +gen, mit Bezug auf +acc the plans. These issues include: (4)
* Current guidelines and tools used to identify people at high risk of vaccine adverse events and complications
* Measures to ensure appropriate diagnosis and treatment of people with adverse events
* The adequacy of data collection plans
* The adequacy of the informed consent process
* Training and educational materials for professional
* Public and professional communication plans
* State smallpox implementation plans
* Achievement of the overall program goals
This process should provide an additional level of expert advice since many individuals believe the national experience will be quite different from the 1940s.
(1.) Benjamin, G., "Smallpox Vaccine smallpox vaccine
A vaccine containing vaccinia virus suspensions that is inoculated subcutaneously to immunize against smallpox. Policy: The National Debate." The Physician Executive, American college of Physician Executives. Vol. 28, No 5, 2002.
(2.) Lake Snell Perry & Associates, Inc., Americans Speak Out On Bioterrorism and US. Preparedness to Address Risk. Robert Wood Johnson Robert Wood Johnson was the name shared by members of the family that descended from the President of Johnson & Johnson:
(3.) Hardy, G., Testimony by Association of State and Territorial Health officials to the Institute of Medicine committee on Smallpox Vaccination Program Implementation December 19, 2002.
(4.) Institute of Medicine, National Academy of Sciences, Statement of Tasks committee on Smallpox Vaccination Program Implementation December 2002.
RELATED ARTICLE: Benjamin Takes Reins At APHA
ACPE ACPE Accreditation Council for Pharmacy Education
ACPE American Council on Pharmaceutical Education
ACPE American College of Physician Executives
ACPE Association for Clinical Pastoral Education, Inc. congratulates College member and longtime columnist Georges Benjamin on his new role as executive director of the 130-year-old American Public Health Association The American Public Health Association (APHA) is Washington, D.C.-based professional organization for public health professionals in the United States. Founded in 1872 by Dr. Stephen Smith, APHA has more than 30,000 members worldwide. based in Washington, D.C.
Benjamin was chosen by the APHA board to be executive director for a three-year term following a nationwide search. He replaced Mohammad N. Akhter, MD, MPH, who stepped down after six years at the helm.
"APHA has found itself an outstanding new leader," Akhter said. "He has both the vision and experience to help the association succeed in its mission to promote and protect the health of the public."
Benjamin, a nationally known leader in public health, left his post as secretary of the Maryland Department of Health and Mental Hygiene mental hygiene, the science of promoting mental health and preventing mental illness through the application of psychiatry and psychology. A more commonly used term today is mental health. at the end of 2002. In that job, he helped lead the public health preparedness efforts of the state while managing the core public health responsibilities of one of the state's largest agencies.
"In today's world, the public health community must be prepared for all hazards -from disease outbreaks to bioterrorism. Dr. Benjamin played a key role developing Maryland's bioterrorism plan," says said Sen. Barbara Mikulski (D-Md.). Benjamin has worked on issues such as emergency preparedness, West Nile virus West Nile virus, microorganism and the infection resulting from it, which typically produces no symptoms or a flulike condition. The virus is a flavivirus and is related to a number of viruses that cause encephalitis. and mental health care.
Benjamin is a graduate of the Illinois Institute of Technology Illinois Institute of Technology, in Chicago; coeducational; founded 1940 by a merger of Armour Institute of Technology (founded 1892) and Lewis Institute (1896). and the University of Illinois College of Medicine The University of Illinois College of Medicine, part of the University of Illinois system, is the largest medical school in the United States, with over 2,600 students and trainees. The college provides scientific and clinical training. . He is board-certified in internal medicine and is a fellow of the American College of Physicians The American College of Physicians (ACP) is a national organization of doctors of internal medicine (internists), physicians who specialize in the prevention, detection and treatment of illnesses in adults. .
APHA is the oldest and largest organization of public health professionals and represents more than 50,000 members from over 50 public health occupations.
Georges C. Benjamin, MD, FACP FACP Fellow of the American College of Physicians.
1. Fellow of the American College of Physicians
2. Fellow of the American College of Prosthodontists , is executive director of the American Public Health Association in Washington D.C. He can be reached by phone at (202) 777-2430 or by email to firstname.lastname@example.org