Senate Appropriations Subcommittee on Labor, Health and Human Services and Education Holds Hearing on Smallpox Vaccination

FDCH TRANSCRIPTS
Congressional Hearings
Jan. 29, 2003

Senate Appropriations Subcommittee on Labor, Health and Human Services and Education Holds Hearing on Smallpox Vaccination Plan

MURRAY:

Well, thank you, Mr. Chairman.

I think everyone here, particularly in this Capitol building, are certainly aware of bioterrorist attacks after the anthrax situation that occurred a year ago. And we understand prevention is important. And we understand the impact of any kind of bioterrorist attack.

As I go out into my communities across Washington state, many people are expressing real deep concern to me about the risks of vaccinating a population in hopes—and I know that we are just looking at first responders at this point and health care people who may be exposed early on. But there is a huge question in the minds of many of what kind of risks we are taking and what the real risk of a smallpox infection could be.

We all understand it is a horrible disease. We do not want to see it—any kind of attack occur that would harm our populations. But the question I get all the time is twofold. Is—what is the risk of this happening? And secondly, how are we going to pay for its implementation.

There is serious concern in all of my communities—small, rural, suburban, urban—how they are ever going to be able to pay the—pay for this without funding from us.

So let me start with the risks. I think we all really want to know what are the real risks of a smallpox attack? Is this something that can potentially end up in the hands of terrorists? Can it be recognized? Are there more sources than we know? I know there is two known sources—one in Atlanta and one in Moscow. Are there more than that?

Can either one of you give me a solid answer of what is the real risk of a smallpox attack in this country?

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MURRAY:

OK. So you can definitely say there are risks in not moving forward in some kind of vaccination?

FAUCI:

Yes.

MURRAY:

But you can also definitely say that there are risks in populate—in vaccinating our population at the present time? And even on your own Web site...

FAUCI:

Yes, ma'am.

MURRAY:

... you say who should not be...

FAUCI:

Right.

MURRAY:

... vaccinated. I think Senator Harkin said children, those under 18, pregnant women...

FAUCI:

Right.

MURRAY:

... nursing women—that the risks associated with vaccination are clear, as well.

Some of the concerns I'm hearing is it's not just the person who's vaccinated, but if they go home and could infect someone they live with. Is that a real possibility?

FAUCI:

Yes. That's called contact Vaccinia—where someone gets vaccinated—that almost exclusively, though not exclusively, but almost always happens in a situation where someone would go home in a household contact of a child who's vaccinated who passes it on to a sibling in the house. Or someone who's vaccinated and might pass it on to someone who they have close contact—like...

MURRAY:

A spouse to a pregnant...

FAUCI:

...—yes.

But that is an unusual situation, but it is not impossible. We have to realize that there is a risk, though it usually is when you vaccinate children—not exclusively. That's something that we do recognize when we engage in these programs.

MURRAY:

Knowing what that risk, then, is, what are we doing to educate those who are now responsible in thousands of communities across the country, who are being told not to vaccinate? How do we educate them—educate the people who are receiving vaccinations to make sure that we eliminate, or as closely as possible reduce the risks associated with vaccinations?

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MURRAY:

Mr. Chairman, I know my time is up. I would just say that it's a long ways from Washington D.C. to counties out in my state and rural communities and a lot of steps along the way. And it's incredibly important that we spend the time to make sure people get the information so that they can make their decisions about themselves. That has to be a part of that.

I wasn't able to ask about cost, but that is an associated cost, as well, that we need to understand.

Thank you, Mr. Chairman.

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MURRAY:

Thank you, Mr. Chairman.

And thank you, really, to all of our witnesses today. I think that all of us are hearing a lot of concerns from our communities about what their responsibility is going to be and how they're going to pay for this, weighed against the risks that clearly have been outlined, but, you know, how real there are.

And Mr. Libbey, I'm glad you responded because I did want to ask you—Dr. Gerberding is speaking from a national perspective and putting a model together. And certainly in the issue—in the case of where smallpox actually occurred, I think we all know that's different than what we're looking at right now, which is prevention. And you started—you responded shortly to that, but I'd like to ask you specifically, do you see that model being in place?

You talked in your testimony about diverting from other resources and other public health care crises. Does this model help you or does it take it away from other things that health care—or health—public health officials are trying to do?

LIBBEY:

It has helped in some regards, in terms of the public health community making better and stronger connections with the medical care community—other parts of the emergency management systems of their community. In that regard it has been helpful, but that would be the case of overall bioterrorism preparedness. What we have heard in a survey, about 715 respondents, two-thirds said it has detracted from their ability to provide other public health services, as well as from other—bioterrorism more broadly, those—that general preparedness...

MURRAY:

Because of the singular focus...

LIBBEY:

Because of the singular focus to the—to the issue.

There will likely be, I wouldn't disagree, some level of residual value to preparedness, but to suggest that it is—it is an equivalent transfer, suitable for other agents or other issues, we would—we would question.

MURRAY:

You, in your testimony, said that in metropolitan areas it would cost between $142 and $222 a person to inoculate. Odds are, especially out in Mason County, which is not far from where you used to be—a very small rural community who were very concerned about the costs—rural communities—would the price be higher because you don't have as many people as you're doing so it's...

LIBBEY:

I think the difference expressed by Iowa is a very good example of that—the time travel distance and the fewer numbers.

COLACECCHI:

We have larger per capita numbers because we've taken a rather conservative approach in the number of people that we're inoculating, but we do have increased cost due to the rural nature of our state in terms of travel and the ability to train people on the—on the state level.

MURRAY:

I think that's what we're hearing from a lot of our communities is how, with all the other burdens that they're in right now, they're going to pay for this risk and whether the risk is worth it—certainly difficult questions for all of us.

Dr. Gerberding, I wanted to go back to you again because I listened carefully to Dr. Bell in his testimony and thinking through the process in his hospital of—and deciding not to inoculate their health care officials. I know I'm hearing from several of the hospitals in my state that have gone through the same process and come to the same conclusion—not children's hospitals, other hospitals because patients in hospitals today are much sicker than they were 30 or 40 years ago and could possibly be at much higher risk. And weighing those risks is a very difficult decision for any hospital administrator.

How do you respond back to Dr. Bell or to the hospitals in my state and argue to them a case that's different—a conclusion that they—than they've come to?

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MURRAY:

And are you concerned that in many communities they don't have the resources, so given this concern now they are diverting resources from other public health issues that they may have?

GERBERDING:

I really look forward to working with NATO (ph) and ESTA (ph) and the other organizations that are assessing that. We received progress reports from the jurisdictions in November to assess where they were in terms of their implementation of the expectations from the appropriation that went out in June. Our feedback from that progress report was that people had taken excellent steps toward achieving the expected capacities. But if there has been a change in that, we will need to look at it again as we go out for the next round of evaluations.

So we'll take that concern very seriously.

MURRAY:

I know my time is running out, but Dr. Fauci, I wanted to ask you one other question. We know there's risks to children, pregnant women. What research is taking place at the institutes that will help us better evaluate the long-term impacts on early childhood development or pregnant women—pregnant women or fetal development? Is there any research going on? And what do we know today?

FAUCI:

To my knowledge, no—I would have to get back to you on that. That would be through the National Institute of Child Health and Human Development, so that wouldn't be in our institute, but I can get that back to you, Senator Murray.

MURRAY:

OK. I would really like to know that. Thank you.

Thank you, Mr. Chairman.