Purely by the nature of his job, San Diego County paramedic Les Federoff comes face to face daily with the scourges of a modern-day world.
“I come in contact with people suffering from AIDS, meningitis, hepatitis, with all sorts of things,” says the 20-year veteran who loves his work so much he insists, “I'm gonna do this as long as I can walk.”
But volunteering for a smallpox vaccination as part of the Bush Administration's evolving war on bioterrorism? Federoff, for the time being, says no thanks.
“I haven't really seen anything that proves to me that there's really a large threat for me here in San Diego to come in contact with smallpox,” explained the 45-year-old paramedic with American Medical Response Inc., the country's largest private ambulance service and a prime operator in the county. “I really doubt I'm gonna participate in it.
“There's just so many other things, that if I tried to plan and prepare for everything, I'd own a gas mask, have a nuclear shelter and be vaccinated against everything that you could possibly be vaccinated against.”
A certain amount of surreal disbelief rings in the voices of most people when they talk about President Bush's call earlier this month for mandatory smallpox vaccinations for half a million U.S. troops and creation of a voluntary immunization plan for up to 10 million front-line health-care workers throughout the country by spring of next year. The White House all but ruled out inoculations for the general public but suggested that those insisting on it might have access by next summer.
“It has become, you know, the highest priority for a number of us,” said Dr. Nancy Bowen, the county's interim public health officer and de facto spokeswoman for a consortium of public-health and private-hospital interests that are currently coordinating the formation of so-called “health-care smallpox response teams.”
Training to provide information about the risks associated with the smallpox vaccine has begun for prospective volunteers from the nearly two dozen acute-care hospitals that operate in the county. Officials have estimated that 3,100 hospital-staff workers will volunteer for the smallpox vaccination, as well an additional 200 public-health employees, such as physicians, nurses, epidemiologists and disease investigators.
“That's just the first phase,” she explained, adding that this first round of immunizations is set to begin late next month at undisclosed county sites guarded by sheriff's deputies. Although presumed unlikely, a rush by the public for the vaccine apparently prompted the security measures. “That is, I guess, one of the possible scenarios that they want to guard against,” Bowen added.
She also believes a “large percentage” of volunteers will be screened out for a variety of reasons-pregnancy, various skin conditions, people undergoing cancer treatment or those with weakened immune systems. Because the vaccine-made from a live virus similar to smallpox-can be spread from the inoculation site, volunteers with family members suffering the same conditions will also be excluded.
Although vague at this point, a second phase of immunizations is planned for up to 10 million so-called “first responders” nationwide beginning in spring. That would include firefighters, emergency-medical technicians and paramedics like Federoff.
But something drastic would have to happen for Federoff to step up right now for the vaccine, which he has received twice in his life-once as a child and later while enlisted as a medic in the Navy during the '70s.
“It was a long time ago, so I don't think I have a lot of immunity,” Federoff admits, but he remains unconvinced about an imminent threat. Even President Bush has said much the same thing.
“Now if something kicks forward, like they find this big stash somewhere or they find out somebody's making it, I might consider it,” he adds. “But to me, there's so many things out there, like nerve agents, I just don't know how they came up with smallpox over anything else.”
Carmen Durón, a lively 73-year-old public-health nurse with the county since 1984, wonders the same thing. “Chances are, I don't know if I would take it,” she says. “I just think we need to be calm and think about this, you know? What are the assurances, and how is this going to be dealt with if some serious complication occurs?”
Bowen concedes that the liability question over the inoculations has yet to be ironed out. She offers some wording from the Centers for Disease Control (CDC), which is spearheading the counteroffensive against an as-yet-unknown enemy: “The area of liability is dealt with to a fair degree in the Homeland Security Act,” a statement that doesn't exactly calm concerns. Bowen said attorneys at the local and state levels are reviewing the legislation-including liability exemption for vaccine manufacturers-“to make sure all contingencies are covered.”
A nurse who works in the county's Adult Protective Services program investigating elder abuse and neglect, Durón says she's more concerned about the response from the people under her care. “We're trying to think a little ahead,” she said. “Since we work in the community, people are naturally going to ask us, you know, what about it?” Know what your benefits cover, and discuss it with your doctor, are her best pieces of advice.
Current thinking suggests that one in three recipients of the vaccine will suffer minor aches and pains and require a few days off work to recuperate. An estimated 15 out of 1 million inoculated will face life-threatening complications, from which one or two will die, the CDC reports. Because routine smallpox vaccinations in the U.S. were halted in 1972, it is believed nearly half the nation's population carries no immunity to the disease.
Mary Grillo, head of the Service Employees International Union Local 2028, which represents county employees and health-care workers, said last week she's trying to set up a meeting with county officials to talk about uncertainties in the immunization plan.
“We do have concerns,” Grillo said. “We want to confer with the county on the circumstances under which people will be vaccinated, making sure that it's voluntary, making sure that they don't lose any pay or sick leave if they have side effects from the vaccination. We're real concerned about the adverse effects of the vaccine, so we just want to make sure that everything is in writing as to what happens to any worker who chooses to get the vaccination.”
Grillo said the union represents roughly 150 public-health nurses, like the calm-thinking Durón.
She, like many county employees, has relied on their own initiative to read the reams of research on smallpox. The disease, which is thought to date back some 12,000 years, was responsible for deaths of 300 million people worldwide in the 20th century alone. The World Health Organization deemed the disease eradicated from the planet in 1980, but strains remained in the possession of U.S. and Soviet Union laboratories.
Some experts believe when the Soviet Union broke up, some researchers may have sought to sell their know-how to other countries, including Iraq, Libya and other nations. Those claims have yet to be proven, however.
The county's Dr. Bowen, while saying she “respects the judgment” of federal officials on the smallpox threat, does hope all the planning going on is never put to the test. “Hopefully,” she said, “smallpox will never get out of the laboratory.”