Posted: July 12, 2002
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Article SummaryI think this is my wife and colleague Jody Lanard’s first risk communication publication, a newspaper op-ed urging that people who want to be vaccinated against smallpox get sent to “vaccination camp.”

Vaccination Camp

The Trenton Times, July 12, 2002

On June 20, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices offered many bad reasons and one good reason why I shouldn’t be allowed to get vaccinated against smallpox. To address the good reason, I propose “vaccination camp.”

The good reason to prohibit voluntary vaccination is the danger posed when a newly vaccinated person transfers the vaccinia virus to unvaccinated people during the 14–21 days that the new vaccination is still scabbing over. This phenomenon, called hetero-inoculation, can cause some immunosuppressed and other people to become quite ill, without their consent. Nothing voluntary about it.

So how about wave after wave of three-week vaccination camps – a voluntary quarantine program staffed by previous waves of vaccinated and trained “first responders.” President Bush asked us last fall to be Sept. 11 volunteers; here’s one way we can do it.

At vaccination camp, you get vaccinated (after medical screening and informed consent – including, perhaps, informed consent by next-of-kin who might otherwise sue). And then while you’re shedding virus and scabbing over, you get trained. CPR. EMT training. Radio dispatching. Intro to volunteer firefighting. How to help screen for smallpox and other threats. How to network with local health agencies. (Maybe throw in some camp songs, games, and physical fitness?)

Officials think it would alarm us if they allowed voluntary vaccination now. The CDC Web site says, “in the event of an outbreak, the CDC has clear guidelines to swiftly provide vaccine to people exposed to this disease.”

State and local health agencies and hospitals aren’t as reassuring: “When you see what you really need to do in case of attack, it’s so dramatic … The average hospital in this country is totally ill-equipped,” according to the president of The Medical Center at Princeton (as quoted in the Princeton Packet, May 24). And my town is adjacent to “anthrax ground zero.”

Imagine trying to quickly quarantine a mobile, freedom-loving population, perhaps even before the diagnosis is confirmed, since doing so afterward might be too late. Will the government even try? How about the second time, after the first false alarm? Oh, I almost forgot: There have been several false alarms already, with no quarantine and no ring vaccinations. If one had proved real, would the cat have been out of the bag? The government’s paternalistic reassurance scares me more than the vaccination’s side effects.

Risk communication expert Peter Sandman, Ph.D., says: “The question of ‘how safe is safe enough’ is not a technical or medical question. It is a values question, answered for society as a whole by the political process and for the individual by that individual.” The risk of a terrorist smallpox attack is unknown; there are no experts. The Advisory Committee’s conclusion that the risk of vaccine side effects outweighs the risk of a smallpox attack is based on a precarious risk assessment. The magnitude of a smallpox attack might or might not be enormous; the probability is extraordinarily uncertain; and estimating this probability requires expertise the “experts” don’t have.

With this much uncertainty, coercive reassurance won’t work. “We recommend; you decide” is a more reassuring approach, because it transfers some control to us.

Oh, by the way, one of the bad reasons the government doesn’t want to let me get voluntarily vaccinated is because of the approximately 1 in a million chance of fatal complications, and some other rather horrendous nonfatal side effects. But many legal voluntary activities are far more dangerous, and far less pro-social, than getting vaccinated:

  • The National Safety Council reported 25 swimming deaths out of every million participants in 2000.
  • The National Highway Transportation Safety Association reported 590 motorcycle fatalities for every million registered motorcycles in 1999.
  • Supreme Court Justice Steven Breyer quotes a statistic that 10 out of every million high school football players died each year between 1970 and 1980. Some of them were below the age of informed consent.

I won’t bother you with scuba, hang gliding, and parachuting numbers – one in a million starts to look good.

So I really want to go to vaccination camp. The civic benefits would reach way beyond just mitigating or reducing the risk of a smallpox attack. Quarantine me until I scab over, teach me some new skills, and then I’ll pass them on. I want to be a Sept. 11 volunteer.

Jody Lanard is a physician in Princeton and contributed to the risk communication training her husband, Peter Sandman, did for the Centers for Disease Control during the anthrax attacks.

Copyright © 2002 by the The Trenton Times

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