Mock vaccination exercise mimics smallpox response

The trial run, with 500 volunteers, tested the logistical challenges of mass inoculation, but some serious questions remain.

By Susan J. Landers, amednews staff. Feb. 3, 2003.

Washington -- Health officials in Arlington, Va., ended up with a bunch of salty oranges and some valuable lessons on how to run a mass vaccination clinic following a Jan. 11 trial run of the national smallpox clinic guidelines developed by the Centers for Disease Control and Prevention.

"It's important to take the plans off the shelf and put them to the test," said acting Arlington County Police Chief Steve Holl at the start of the four-hour mock clinic.

The test was the first to be sponsored and paid for by the U.S. Dept. of Health and Human Services, although mass vaccination tests have been carried out in other locations in the country. The data gathered at the test will now be analyzed, said a spokesman from the HHS Council on Public Health Preparedness.

The exercise was intended to help the nation's public health system prepare for the logistical challenges of protecting citizens against the possibility that the smallpox virus could be unleashed as a terrorist weapon. The United States ceased smallpox vaccinations in 1972.

Oranges and saline substituted for arms and vaccine.

Still, other questions persist. The Institute of Medicine on Jan. 17 urged the CDC to address all concerns about the program before beginning to vaccinate the 500,000 health care workers who are to act as first responders in the event of an attack. That round of vaccinations was to have begun as early as Jan. 24.

The IOM raised concerns about how people will be compensated for medical expenses and other losses that might be incurred as a result of their vaccination.

The IOM also urged the CDC to be prepared to make midcourse corrections and to adequately evaluate the first round of vaccinations before commencing the second round, which is to include additional health care workers and police and firefighters. The general public would eventually be offered the vaccine.

This is a test, it's only a test

Meanwhile, the Arlington exercise, held at a high school cafeteria, was carefully planned to be as close to the real thing as possible, said County Health Director Susan Allan, MD.

Physicians and other health professionals were present to screen out individuals who, because of immune deficiency conditions such as AIDS or a history of eczema, were advised not to receive the vaccine at that time. The clinic was run as if an outbreak of smallpox had not yet been detected.

Nurses followed the steps necessary for administering the vaccine, even placing a bandage on an individual's arm and providing instructions for caring for the vaccination site.

The steps were necessary, said Dr. Allan, to determine the amount of fatigue experienced by those administering the vaccine and to approximate the length of time it took for each inoculation.

Translators were ready either on site or via the phone companies' services. Paramedics were available in case anyone fainted. The police directed traffic, and county public health personnel made sure the lines flowed as smoothly as possible.

But the test was also quite different from real life.

Volunteers held oranges up to their arms when it was time to receive the 15 scratches with a bifurcated needle. The needle was dipped in saline solution rather than the smallpox vaccine.

There was also none of the apprehension that would likely cloud a real clinic. And missing from this practice run were the very young, the elderly and the infirm who would be present in the event of a real emergency.

About 500 volunteer patients had been recruited from the military, local organizations and the general public. A few state health officials made the two-hour drive from Richmond, Va., to participate.

As the volunteers filed into the cafeteria, their first stop was to view a video presented by CDC Director Julie Gerberding, MD, MPH, on the risks of the vaccine. Then there were health forms to fill out.

The event was also designed to push the model plan to the limit. "We expect the system to fail in part under stress," said Dr. Allan, noting that it is important to try to correct those breakdowns before they occur in a real-life situation.

Dr. Allan said she expects that the experience should prove valuable if Arlington has to mount any mass vaccination to prevent, for example, a flu pandemic.

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