NCSL Brief: Vaccines to Protect Against Terrorism

(This is one of a series of briefs written by NCSL, "Protecting Democracy: States Respond to Terrorism.")

Vaccines to Protect Against Terrorism

By Johanna Donlin

The words smallpox and anthrax strike new fears in the hearts of Americans, since the tainted letter incidents this past fall. With bioterrorism in the spotlight, average citizens wonder how they can be protected from biological warfare. At present, the two most publicized vaccines would protect against anthrax and smallpox. Yet the United States has a limited supply of both, and each carries its own controversies.

Anthrax. Anthrax is a bacterium found commonly in soil and livestock, but not so commonly in humans, under normal circumstances. Three human forms of infection are possible--cutaneous, gastrointestinal and inhalation. Direct person-to-person transmission of anthrax is extremely unlikely, if it occurs at all.

Cutaneous, the most common type, usually occurs after skin comes in contact with the bacteria, especially when there is an abrasion or cut in the skin. This type has a reported incubation period from 12 hours to 12 days following exposure. Without treatment, cutaneous anthrax has a 20 percent mortality rate. It is rarely fatal if treated with antibiotics. Gastrointestinal anthrax occurs when a person eats infected meat. It has a suspected incubation period of one to seven days after exposure and an estimated mortality rate of 25 percent to 60 percent, if not treated. Inhalational anthrax is oftentimes fatal unless diagnosed early enough to respond to antibiotics. The inhalation version occurs when a person breathes in a lethal amount of bacteria spores. The incubation period is typically two to three days, but it can last for as long as 43.

An anthrax vaccine, approved by the Food and Drug Administration in 1970, is administered through a six-shot regimen over 18 months. It also requires annual booster shots to remain effective. In 1998, the Department of Defense enforced a mandatory anthrax vaccine program for all military personnel. Currently, the anthrax vaccine is administered only to military personnel who work on special missions in high-risk countries and to staff in anthrax research facilities. The anthrax vaccine may cause irritation around the injection site, but fewer than one in a 100,000 people report a serious allergic reaction.

Smallpox. Smallpox provides a very different kind of threat because it is highly contagious and has a mortality rate of 30 percent. The disease, which cannot be treated with antibiotics, has an incubation period of 12 to 14 days following exposure. Due to an effective vaccine campaign, the last known case of naturally occurring smallpox was in 1977. The World Health Organization declared the world free of smallpox in May 1980. The only known samples of the virus are kept for research at the U.S. Centers for Disease Control and Prevention (CDC) and the Institute for Viral Preparations in Russia. The possibility of undisclosed sources of the smallpox virus heightens the concern about bioterrorism.

In the United States, routine vaccinations against smallpox ended in 1972. The level of immunity, if any, among people who were vaccinated before 1972 is uncertain. Therefore, all people are assumed to be susceptible to the disease. Because the smallpox vaccine contains a live virus and administration can result in severe side effects, routine vaccinations would not be broadly recommended unless a confirmed case of smallpox was reported.

Vaccine Supply. The National Pharmaceutical Stockpile has a limited supply of both the anthrax and smallpox vaccines, as well as antibiotics that can treat anthrax cases. The stockpile is designed to re-supply state and local public health agencies in the event of a biological or chemical terrorism incident anywhere in the United States. The stockpile has two components--push packages and vendor managed inventory packages. The eight push packages are securely stored and can be sent to an affected area within 12 hours of the federal decision to release them. If more assistance is needed, vendor managed inventory packages are distributed with supplies tailored to address the agent used in an attack.

In recent congressional testimony, Secretary of Health and Human Services Tommy Thompson stated that the national stockpile currently has enough antibiotics to treat 2 million people exposed to inhalation anthrax. That supply will soon be increased to serve 12 million people. The stockpile currently holds an estimated 15 million smallpox vaccine doses. In 2000, the CDC awarded a grant to a vaccine manufacturer to increase the smallpox vaccine amount. Recently, President Bush requested $509 million from Congress to accelerate the purchase of 300 million doses of the smallpox vaccine.

State Actions

Few states have addressed emergency vaccine supply and distribution through legislation. After participating in a simulated bioterrorism attack in May 2000, Colorado officials identified numerous gaps in the state's emergency response plans. The legislature created the Governor's Expert Emergency Epidemic Response Committee to come up with a plan for prioritizing, allocating, storing, protecting and distributing vaccines and medicines that may be needed in the event of an emergency epidemic. The committee will advise the governor in an emergency regarding the most "reasonable and appropriate measures to reduce or prevent spread of the disease ..." This may include procuring supplies of medicines and vaccines and quarantining people or property.

A 2001 Oregon law directs the health division to develop and adopt an Oregon Vaccine Education and Prioritization Plan. The plan must include guidelines for health workers and others to identify high-risk groups for protection or treatment in the event of a vaccine shortage. It also includes procedures for mobilizing health crews to assist in vaccine distribution and administration. Although the bill was passed in response to the 2000 flu vaccine delay, it also applies to a bioterrorism attack.

Several national organizations--including the National Conference of State Legislatures, the National Governors Association and the National Association of Attorneys General--are working with the Center for Law and the Public's Health at Johns Hopkins and Georgetown universities to review the Model State Emergency Health Powers Act. This draft model legislation addresses state emergency health procedures and includes authority to ration vaccine supplies and compel people to be vaccinated or treated for an infectious disease during a public health emergency. Citizens who refuse necessary vaccinations and are determined to pose a public health threat could be liable for a misdemeanor charge and may be isolated or quarantined.

Selected References

Centers for Disease Control and Prevention. "Use of Anthrax vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices." Atlanta, Ga.: MMWR 2000; 49 (No. RR-15).

Centers for Disease Control and Prevention. "Vaccinia (Smallpox) Vaccine: Recommendations of the Advisory Committee on Immunization Practices." MMWR 2001; 50 (No. RR-10).

Colo. Rev. Stat. 24-32-2104 (2000)

Or. Re. Stat 433.001 (2001)

U. S. Department of Health and Human Services. Press Release, October 23, 2001

Contacts for More Information

Jo Donlin
NCSL--Denver
(303) 856-1525, ext. 130
jo.donlin@ncsl.org

Centers for Disease Control and Prevention

National Network for Immunization Information

Other NCSL Resources:

Other NCSL Briefs "States Respond to Terrorism"

NCSL's Protecting Democracy Page

NCSL's 2002 Legislative Session Home Page

NCSL's Health Page