ublic-health officials criticized a new federal plan to fight a potential smallpox attack, saying the government is asking cities and states to shoulder the burden without giving them enough money to do the job.
mimc_bigad3
The plan, issued as a draft yesterday by the Centers for Disease Control, says that if there were a smallpox outbreak, infected people should be quarantined and a vaccine administered to anyone who had contact with them. It does not call for mass vaccinations. The plan relies on local officials to spot and track the disease, much as they are relied on to spot anthrax. It also gives states broad powers to isolate victims and even quarantine entire cities by closing roads and airports.
But local health officials say their budgets are far too meager to handle the responsibilities.
''There is a strong contradiction between saying you have to be ready and providing no resources,'' said John Auerbach, executive director of the Boston Public Health Commission. ''You need local resources for the monitoring, the quick assessment and diagnosis and public-health outreach to ensure people get the immunization that they need.''
The CDC plan provides a framework for responding to an outbreak, but no additional money. Any extra federal funds would have to come out of the antiterrorism bill currently before Congress.
Auerbach's agency is moving forward despite the lack of money. It has hired a doctor to design a citywide preparedness plan that, with salary and supplies, will cost $125,000 to draw up this year. The document will spell out how emergency workers will track down infected patients and even which hospitals need to have special isolation units.
Health officials also criticized another aspect of the new plan: It would not provide vaccine for the front-line local health workers who would have to investigate an outbreak. The CDC, meanwhile, has vaccinated more than 80 members of its staff against the lethal disease.
''The CDC should consider vaccination of state teams that will be the first to see these diseases,'' said Claire Hannan, senior director for immunization policy for the Association of State and Territorial Health Officials. ''We are concerned.''
CDC officials yesterday said they would not recommend vaccination of any state or local workers because the risk of illness or death from the vaccinations is greater than the probability of getting smallpox.
''If we vaccinate all first responders, where would we start? The fire department? the EMTs?'' asked Curtis Allen, a spokesman for the CDC. ''We will not vaccinate willy-nilly.''
He said the same group of CDC officials would travel around the country to document first cases and they will be at the greatest risk for contracting and spreading the disease.
Since the terrorist attacks of Sept. 11, CDC officials have feared that terrorists might have the smallpox virus, a highly infectious disease that kills one in three and leaves disfiguring scars on survivors. The last known smallpox case in the United States was in 1949, and the country discontinued vaccinations in 1971. Only the United States and a Russian lab officially have samples of the virus, but federal officials fear other countries might have private caches of smallpox.
Allen said the draft plan is seen only as a framework - and money to help local public-health authorities will be provided through proposals now in Congress. A $1.6 billion bioterrorism proposal includes $175 million for state and local efforts.
State public-health officials said they too need more money, but expect comments on the draft to change its final structure.
''We would agree there needs to be more resources,'' said state Department of Public Health deputy commissioner Paul Jacobsen. ''But it's a draft, and people will weigh in.''
