Risk-benefit ratio steers public health action

Weighing the factors in whether to recommend the anthrax vaccine highlights the challenges facing the public health community.

By Stephanie Stapleton, AMNews staff. Jan. 14, 2002.

Public Health: Renewed Attention
A six-part series exploring the role of the public health system in the context of our nation's newfound state of alert.

1. From the front lines
2. Recent history
3. Greater expectations
4. The risk-benefit ratio
5. New promises
6. Homeland security

Washington -- Last month, when Health and Human Services Secretary Tommy Thompson issued a set of additional treatment options for people exposed to anthrax, his action underscored how the public health system is struggling to meet the challenge of protecting citizens against a range of biological threats.

The new treatment options Thompson outlined were generated by the unusual set of circumstances with which public health and medical experts now must contend. The approach demonstrates how interventions are being developed based on an evolving body of experience and knowledge.

Meanwhile, the issues involved are complex. They touch on how public health agencies plan emergency responses, provide vaccines and other treatments, and hold the public's trust. A central variable is how experts communicate to the public the risks at stake -- from exposure and illness as well as from vaccines and treatments. At the heart of the debate, then, is a discussion that touches on questions that play into immunization in general, and now, specific vaccinations against threats such as anthrax and smallpox.

"The whole subject of protection has clearly been in the public arena," said Michael J. Scotti, MD, AMA senior vice president for professional standards and a retired general from the Army Medical Corps.

On Dec. 18, 2001, Thompson outlined two supplemental preventive treatments for people -- mainly postal workers -- exposed to anthrax spores. Since October 2001, when two anthrax-contaminated letters were identified, about 10,000 people have been on preventive 60-day antibiotics regimens. [...]