Low Participation Is Blamed on Confusing Signals From U.S. Health Authorities

Only 152 people of more than 5,100 exposed to deadly anthrax bacteria in the attacks last fall have accepted the federal government’s offer to take an anthrax vaccine on an experimental basis, federal health officials reported yesterday.

As a group, congressional staffers were far more inclined to get vaccinated, while employees of the Brentwood postal station — where two workers died of pulmonary anthrax and two others became ill with the disease — overwhelmingly rejected the offer.

The stark contrast revived criticism that the decision to offer vaccine without providing specific medical recommendations left thousands frustrated and frightened about how best to protect themselves from a disease that has confounded the experts.

“I don’t think they should have offered this if they weren’t going to give a recommendation,” said C.J. Peters, former chief of special pathogens at the federal Centers for Disease Control and Prevention who is now a professor at the University of Texas Medical Branch in Galveston. “If you don’t think a treatment will be useful, you shouldn’t bring it up.”

Although a half million military personnel have received anthrax inoculations as a preventive measure, the vaccine has never been administered as a post-exposure treatment. In addition, the vaccine maker, BioPort Corp., has yet to receive final government approval for its Lansing, Mich., plant.

Two weeks ago, Health and Human Services Secretary Tommy G. Thompson announced that uncertainty about how long anthrax spores can survive in the lungs prompted the decision to offer the vaccine as an additional treatment option. But Thompson and the CDC refused to take a position on the vaccine, and the public heard sharply divergent opinions from some of the nation’s most respected physicians. The numbers suggest those conflicting messages were a factor in whether a person decided to take the vaccine.

On Capitol Hill, where doctors began promoting the vaccine even before Thompson’s announcement, more than 38 percent of the people most likely exposed to anthrax spores opted for it. Most of them were in close proximity to a tainted letter sent to Senate Majority Leader Thomas A. Daschle (D-S.D.). At the Brentwood post office, where local officials and union leaders opposed the vaccine, just 37 of 1,914 people received the first of three shots.

“The absence of a clear recommendation from CDC about who should take vaccine, coupled with the absence of any follow-up care, made it very difficult for the postal workers to say ‘we’ll take it,’ ” said D.C. Health Director Ivan Walks.

Walks and Mayor Anthony Williams recommended against the vaccine, citing the lack of evidence that it worked for this purpose and its possible side effects.

CDC released its tally after running educational programs for two weeks in the District, Florida, New York and New Jersey. A limited number of postal workers in Connecticut may yet be offered the vaccine.

Nationwide, 2 percent of postal workers and members of the media took the vaccine. Many more people — about 1,200 — opted for an extra 40-day supply of antibiotics, calculating that the medication would provide sufficient added insurance.

After studying the numbers and speaking to numerous patients, CDC Director Jeffrey Koplan said he believed people based their decision on their perceived sense of risk. “The folks most likely to go for the vaccine felt they really had a significant exposure that merited this response,” he said.

Several researchers and clinicians, however, said the results revive questions about whether the public has been adequately educated on the possible risks and benefits of such vaccines.

“We’ve not done the proper informational job to acquaint people with its safety and efficacy,” said Philip Brachman, an anthrax expert at Emory University’s Rollins School of Public Health. “That’s a major problem.”

Peters said he was baffled why Thompson and Koplan waited until mid-December to mention the prospect of vaccination.

“The information was available,” he said referring to a handful of animal studies. “People knew this was going to be a problem and they had time to consider this and present it to the people who were involved.”

As experts continued to debate the federal government’s handling of the recent anthrax attacks, the CDC was moving forward with another controversial treatment. Health officials said they are stockpiling protein taken from the blood of vaccinated soldiers in case another attack occurs. Researchers believe the protein, called immune globulin, could neutralize the deadly toxin produced by the anthrax bacterium and have asked for permission to test the theory.

© 2002 The Washington Post Company

Written by Ceci Connolly for the Washington Post, and published on DrKelley.info, January 9, 2002. Embedded links may no longer be active (Ed. 12.30.10)

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