Re: Would you accept a safe H5N1 pre-pandemic vaccine now?
Yes, I think an informed public will be very important. We have had trouble with trying to institute preventative vaccines of this nature in the past... But if large numbers of people starting dying and therefore the threat was more imminent I'm sure we would see more clamoring for any vaccine that was available with less concern for the side effects of which there are always some....
Here are some interesting excerpts from 'State of Immunity, The Politics of Vaccination in Tweintieth-Century America' , 2006, by James Colgrove..
Smallpox
It was thus against a a backdrop of confusion among the public, sharp disagreements among health professionals, bioterrorism experts, and politicians about risks, benefits, and precautionary action, and the buildup to an increasingly likely war with Iraq that President George W. Bush announced a comprehensive plan to protect the nation from smallpox in mid December 2002. While admitting that his administration had 'no information that a smallpox attack is imminent,' Bush outlined an ambitious three-phase plan. In the first phase, about half a million health care workers and emergency personnel were to be vaccinated within thirty days. Thereupon a broader effort would commence, targeting some 10 million health care workers. Finally, in late spring or early summer, the vaccine would be made available to any adult for whom it was not medically contraindicated.
Former CDC director William Foege was among many who publicly criticized the scope of the plan. Foege's years of experience on the front lines of the global smallpox eradication program in the 1970s gave him special credibility on this issue, which he drew upon when he argued in a Washington Post op-ed column that ring vaccination, not blanketing the general population, was the wisest course of action. Ring vaccination had been effective, he wrote,
even in a place like India, with its high population density, millions on trains at any one time and many people without actual addresses. For anyone not involved in that effort, ring vaccination seemed--and probably still seems-- counterintuitive. But in India we went from the highest incidence of smallpox recorded in decades in May 1974 to zero in May 1975... Compare this with the record of mass vaccination programs, which had been tried in India for more than 150 years without success . The key to fighting smallpox proved to be not background immunity but diligence in finding and vaccinating every possible contact of every patient.
Because of the administration's failure to win the support of frontline health care providers around the country, the program never met the goal laid out in phase one, much less progressed to the second or third stages. Out of the half a million health care workers targeted to receive the vaccine in the first phase, less that ten percent--approximately 40,000 people nationwide--were vaccinated
Anthrax
Another vaccine dispute emerged from the US military. In December 1997, US Defense Secretary William Cohen announced a plan to vaccinate all 2.4 million members of the military against anthrax, a highly lethal bacterial infection. It was the first time that the military had attempted to immunize all active and reserve members against a potential biological weapon, and reflected a growing concern that countries hostile to the United States were developing a variety of agents that could be used for chemical warfare. The vaccine--administered in six injections over the course of eighteen months--was known to cause minor side effects such as pain and swelling at the infection site, headache, and fever, but rumors soon began to circulate among service members that it could cause sterility and paralysis. Many soldiers refused the shots and, in so doing, faced a variety of disciplinary actions, including court-martial,. The resistance was fueled in part by widespread mistrust of the military's past responses to soldiers' health problems, including its failure to be forthcoming about issues such as Agent Orange and Gulf War Syndrome. By eary 2000, some three hundred fifty service members had refused the shots, and an unknown number had left the service rather than be forced to undergo them. The problems with morale and refusal attracted the attention of some members of Congress, who called on the Pentagon to suspend the program in light of concerns about the vaccine's safety and efficacy.
Swine Flu
In 1976, the CDC had to deal with one of the most difficult crises in its history: forestalling a feared epidemic of swine flu.
In January 1976, an army cadet at Fort Dix in New Jersey died of the flu. A culture of the virus revealed that the strain was closely related to the one that had caused the worldwide influenza pandemic in 1918 that had killed at least 20 million people. Alarmed officials at the CDC considered mounting a mass campaign to protect every American from the possible reemergence of the deadly strain. In April, David Sencer, the CDC's director, recommended that a mass vaccination program go forward and President Gerald Ford announced it to the country.
In a survey in New York City in mid November, more than half the respondents said they had not been vaccinated and did not intend to be, citing as reasons that the vaccine was unnecessary, that they were afraid of it, or that their physician had recommended against it.
By mid December more than fifty cases of Guillain-Barre Syndrome had been reported, the majority of cases had received the vaccine within the previous month. On December 16, 1976, the program was suspended, never to resume. Some 40 million people had received the vaccine. Although this was the largest number of people ever vaccinated in a single mass campaign, it was less than one-fifth of the national target population.
