Carnegie Reporter, Vol. 1, No. 4 | Preventing “Dark Winter”— The Public Health System’s Role in Strengthening National Security, page 6 (low bandwidth)

What if there is a significant bioterrorism attack? Is the U.S. prepared to treat all those who might become sick? Who would be given protective antibiotics or vaccines? People exposed to the infection? Healthcare workers? Police, firefighters and emergency personnel? All of these groups, or only some? And what if supplies are not sufficient?

There is enough "old" smallpox vaccine in U.S. stockpiles to protect about 15 million people, but that's hardly enough to cover the entire population. (An additional 85 million doses were recently rediscovered in a pharmaceutical plant freezer.) Analysis is underway to determine whether these doses can be diluted to vaccinate larger numbers of people, but even so, massive doses of new vaccine are needed. In the last major smallpox outbreak, which took place in Yugoslavia in 1972, 18 million doses of vaccine were needed to contain the epidemic. In 1947, a single case of smallpox in a man who had traveled from Mexico led to vaccination of more than six million people in New York City-500,000 of them in a single day.

Infectious disease experts are cautious about using the old smallpox vaccine, which was produced from cowpox infection of live calves-much like the vaccine that the English physician Edward Jenner used in 1796. This vaccine caused serious, even fatal, illness in a small number of people: the very young, pregnant women and those with compromised immune systems were more likely to have reactions. Many more people are now in those risk categories: immunosuppressed because of organ transplants, chemotherapy for cancer and infection with HIV/AIDS (of which they may be unaware). In November 2001, Secretary of Health and Human Services Tommy Thompson awarded production of a new smallpox vaccine to a firm working on the development of a "cleaner" vaccine that is less likely to cause reactions.

Dr. Akhter expects that the U.S. will have adequate vaccine to protect the entire U.S. population against smallpox by next year-and then, he believes, every American should be vaccinated because everyone is vulnerable.

Another response to the previously underplayed possibility of having to treat vast numbers of patients in a very short time was the creation of the National Pharmaceutical Stockpile. Established by CDC in 1999, it maintains reserves of antibiotics, chemical antidotes and medical supplies at several secret sites around the nation. In the event of a terrorist attack, CDC says the supplies can be delivered to the attack site within twelve hours. Vastly increased funds, about $644 million, have been spent this year to increase the stockpile and to replace antibiotics used in the anthrax scare. Its first use was on September 11th, 2001, when supplies were sent to New York City to help treat victims of the World Trade Center attack.

In January 2002, CDC officials told the Atlanta Journal-Constitution that 12 of the ready-to-go shipments of drugs and medical supplies, called "push packs," are stored in 10 cities around the nation. Contents of the packages, the warehouses and the cities where they are stored are a closely guarded secret.

In October 2001, American pharmaceutical companies established a task force to assist the government in emergency preparedness, meeting with federal agencies and members of Congress. Leaders of major pharmaceutical firms said they would offer free antibiotics to treat people infected by or exposed to anthrax, offered to develop and manufacture a smallpox vaccine, promised to increase production of certain medicines as needed, and promoted interchanges between government and company scientists, including allowing government scientists access to company labs and making company scientists available for work in government facilities.

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