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Bush May Limit Smallpox Inoculations

Top aides to President Bush favor a plan that would offer smallpox vaccinations to millions of Americans, but would stop short of making the bioterror defense universally available, The Washington Post said in its Saturday editions.

While cautioning that Mr. Bush has not given the plan his final sign-off, senior White House officials cited by the newspaper said he is expected to announce his long-anticipated decision in the weeks after Thanksgiving, putting an end to months of anguished debate weighing the catastrophic potential of smallpox against the likelihood of severe side effects from the vaccine.

The president has been weighing the potential menace of smallpox -- which kills as many as a third of those it infects -- against the likelihood that one in a million vaccine recipients would be killed and one in 10,000 suffer severe side effects.

Mr. Bush will most likely put off deciding the most sensitive question of whether the vaccine will be made available to all Americans, the officials said. Bush aides have concluded there is no reason to make such a commitment yet, preferring to use the time while more vaccines are licensed to gauge how to predict and control side effects as the inoculation is given to troops, health care workers and emergency responders, the Post explains.

The policy, if embraced by Mr. Bush as expected, would disappoint those who favor quicker and broader availability. There has been growing sentiment on Capitol Hill and among Bush's ideological allies that the government should not make the vaccination decision for citizens but, rather, let them make it for themselves, the Post points out.

Still, even a limited return to inoculation after a decades-long hiatus is a stark acknowledgment of the concern about smallpox, which was eradicated a generation ago but is still considered a threat because Iraq and North Korea are thought to possess stocks of the virus, and al Qaeda is thought to be pursuing it.

The conclusion essentially follows recommendations from government health and military officials that the government approve a phased-in inoculation, starting with about 500,000 troops and about 500,000 health and hospital workers and, later, for as many as 10 million emergency workers. While "the president is still making his final determinations," a senior official told the Post, "that's the current thinking."

There have been calls from the Pentagon to expedite approval of the military smallpox vaccines, but officials said that approval, too, would likely wait until after Thanksgiving.

In a gesture to those who favor broader distribution, administration officials are discussing a mechanism to make the vaccine available in limited quantity to those who actively seek it, the newspaper says. "There is some discussion of making it available to people who feel they absolutely have to have it," a senior Bush aide said. "The question is, can the government just hold on to a stockpile?" The likeliest mechanism in such cases would be expanded participation in experimental programs.

But the officials said to the Post that they favor using only licensed vaccines, limiting the pace of the inoculations. The government believes it has a sufficient quantity of the vaccine, which was routinely administered until 1972, to protect all Americans in the event of a smallpox outbreak. But only 15 million of the roughly 300 million doses the government has or has ordered are licensed. White House officials said they are reluctant to use unlicensed vaccines in a non-emergency situation.

There is growing pressure on the administration to make the vaccine widely available. Sen. Judd Gregg (R-N.H.), soon to be chairman of the Senate Health, Education, Labor and Pensions Committee, supports giving all Americans the option. "My first hearing as chairman is going to be on this issue," he said in an interview with the Post.

Sen. Arlen Specter (R-Pa.), the incoming chairman of the Appropriations subcommittee overseeing health issues, is also a supporter of optional vaccines and is contemplating hearings of his own. "Ordinarily it's more of an executive function, but it's a big issue and Congress can act on it," he said. Sen. Bill Frist (R-Tenn.), a physician whose health policy views are influential in the White House, also favors a vaccine available to the public.

Speaking yesterday at the Republican Governors Association in Dana Point, Calif., Health and Human Services Secretary Tommy G. Thompson said significant progress had been made in protecting the public from attacks using biological weapons and said the president will decide soon whether to go ahead with proposals to offer smallpox vaccines to all Americans. "If we do go to war in Iraq and there is some kind of a smallpox epidemic, we've got to be prepared," he said.

But retiring South Dakota Gov. William J. Janklow (R), who was just elected to a seat in the House, prodded Thompson to move even faster to make the vaccine available, saying, "The time to give the vaccine is not after we've been attacked."

Even some opponents of broad vaccination see momentum for it, the Post reports. "It looks like more people are going to get vaccinated than we originally suggested," said Myron J. Levin of the federal Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. The group in June recommended vaccinations for some 20,000 people, and in October recommended a plan that would likely reach 500,000.

In the administration, Vice President Cheney has been the most adamant backer of broad vaccination, with D.A. Henderson, a smallpox eradication expert, the most vocal opponent, showing Mr. Bush pictures of victims of vaccine side effects, according to people familiar with the discussions with whom the Post spoke.

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