COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

January 15, 2003

BOARD MEETING DATE:

January 28, 2003

 

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director of Health Services

Scott Morrow, MD, MPH, County Health Officer

   

SUBJECT:

Update on Smallpox vaccination planning

Recommendation

Receive the report from the Health Officer.

 

Background

Smallpox was declared eradicated from the world in 1980. However, we are currently preparing smallpox vaccination plans because it is widely believed that the smallpox virus has been made into a weapon and is possibly in unknown hands. The federal government announced a national program for vaccination of healthcare workers and first responders. The goals of this program are: to offer voluntary vaccination to public health and safety teams who may conduct investigations and outbreak control for the initial cases of a smallpox event, and to offer voluntary vaccinations to key healthcare workers who would treat and manage the initial smallpox cases and suspects. San Mateo County is preparing pre-event (before there is a case of smallpox anywhere in the world) and post-event (after there is a case of smallpox) vaccination plans. The implementation of the pre-event plans will allow us to have a mechanism in place to deal with a hopefully very unlikely, but not impossible, post-event situation. This vaccination plan is proposed as a national security issue.

 

President Bush announced the following just before Christmas:

●

500,000 members of the military will be required to be vaccinated. This started on December 13, 2002 and it is continuing.

●

President Bush, as Commander-In-Chief of the armed services, was vaccinated on December 21, 2002.

●

Phase I of the civilian vaccination plan is to be directed at 450,000 health and public health care workers nationwide. This phase will start January 24, 2003, and continue for 30 days. (San Mateo County will vaccinate up to 2,000 local workers in this phase.)

●

Immediately following, Phase II will begin, involving vaccination of 10,000,000 health, public health and first responders. This phase will last until the summer. (This is approximately 25,000 people in San Mateo County).

●

The federal government is not recommending that the general public get vaccinated, but provisions to vaccinate those who insist upon it will be made by state and local health departments.

 

Discussion

We believe, based on the evidence made available to us, that the threat of a smallpox attack is very remote at this point. However, the likelihood of a hoax or a misdiagnosis is quite high. The potential consequences of an intentional release of smallpox are great. We agree with the federal government that San Mateo County needs to be prepared. Therefore, San Mateo County is taking reasonable and responsible action to protect the public from any potential outbreak of this deadly disease. San Mateo County has taken a number of steps in order to prepare our community for the possibility of a smallpox attack.

 

The estimated number of volunteers for vaccination is optimistic and a part of a best-case scenario. We have no way to project the number of volunteers who may come forward. The unresolved issues of liability and compensation for adverse reactions may be elements limiting the pool of volunteers, and resolution of liability issues may increase the number of volunteers.

 

Advisory Committees-We have developed an external working group to advise us on policy decisions related to smallpox vaccinations locally. This committee is comprised of representatives from each local hospital; police and fire departments; the 911 response system; the Office of Emergency Services; Emergency Medical Services; private ambulance companies; infectious disease specialists; emergency room personnel; Public Health, Environmental Health and Mental health personnel; and the San Mateo County Medical Association. This committee has been meeting since late October. A draft of our pre-event vaccination implementation plan was submitted to the state on January, 10th, 2003. We have also developed an internal working group for operational decisions related to the vaccination clinics.

 

Phase I-Our pre-event plan to vaccinate up to 2,000 first responders in San Mateo County is being developed and is expected to be implemented starting in February, 2003. All vaccinations during this phase are voluntary. First responders are people who will be prepared to respond and provide critical services in the event that a case of smallpox is identified locally. Staff from the major hospitals, fire and police departments, as well as Health Services are being asked to volunteer to be vaccinated as part of the preparedness campaign.

 

Trainings-There is very little residual knowledge about smallpox since it's eradication from the earth over twenty years ago. We have felt it was important to provide a number of educational trainings on this topic. We have provided over 30 trainings on smallpox and the vaccine to Health Services staff, medical personnel, private physicians, fire chiefs, police chiefs, union leaders, and city government officials. This has significantly raised the level of knowledge about the disease, the vaccine, and our plans, among these various groups and has improved our ability to respond.

 

Staff communications-Health Services staff are key resources for accomplishing a successful vaccination program. Several communications have been sent to all staff about smallpox including one asking for volunteers for this program. These communications went out to staff in mid-December and mid January.

 

External communications-A mailing went out in early January to about 3,000 doctors in the county. The distributed information advised them of what they need to know about smallpox and the vaccine and how to gain technical assistance from Health Services.

 

The Clinic-A single vaccination clinic will be set up at a central location in the county. We are anticipating that the clinic will be jointly staffed by Health Services, area hospitals, fire, law, and ambulance. From what we know now, it will be open from 8-5 Monday-Friday and may start as early as mid-February. It takes about 30 people each day to run the clinic and we anticipate that we will be asking for up to 150 Health Services staff to work part-time in the clinic during it's course. All aspects of the clinic, including staffing, are prescribed by federal guidelines. The guidelines require on-site screening of each volunteer and careful recording of many data elements before vaccination. In addition to the initial vaccination, every person will be required to report to the clinic each day before work so that the vaccination site may be examined and the dressing checked and changed as necessary.

 

Costs-While we believe we can cover the costs associated with Phase I vaccination within our current resources, this will not be the case if we need to implement Phase II. Under Phase II, the clinic may need to be operational for six to twelve months. We will account for all the salary and supply costs associated with vaccination clinic in a special job org in the County's accounting system. There's no current source of revenue for this program, but we will keep track of the costs in case there ever is a funding source.

 

Issues to be resolved-The effort to put together this very complex plan has required many people from county departments and from our local hospitals, fire, law, OES, our ambulance provider, and EMS. They have all preformed admirably. However, there are many issues which remain. Among them are:

1

The President's goal to prepare by January 24 to vaccinate 2,000 people over the course of the following thirty days will be problematic. If we should have 2,000 volunteers we would propose to begin in mid-February and continue for at least 60 days. Since this program will likely be under a federal emergency declaration, we may not have much leeway on how this is accomplished.

2

There are no new funds to implement the program. As mentioned, enormous effort has gone into this so far. The cost is falling on local agencies. The funding of this should be the responsibility of the federal government.

3

Liability and compensation for adverse events is not completely addressed by current federal legislation. Many organizations feel that Congress needs to pass additional legislation to remedy this situation before we proceed effectively with the vaccination plan. Currently vaccinations are voluntary. The unresolved issues of liability and compensation for adverse reactions may limit the pool of volunteers. Resolution of these issues may increase the number of volunteers.

4

There has been no planning for vaccinating very large numbers of people (Phase II; up to 25,000 people in San Mateo County), and the cost of this would be enormous. San Mateo County could not accomplish this in a pre-event situation without either significant new funding and/or significant impact on existing services.

5

Because of the risks of the smallpox vaccine and the unknown possibility of an intentional release, the vaccine is not being recommended for the general public at this time. It is very unlikely we will be able to set up a system to accommodate general public requests for vaccinations in the near future.

 

Vision Alignment

This report and the work described in it keep the commitment of ensuring basic health and safety for all and goal number 7: Maintain and enhance the public safety of all residents and visitors. They contribute to this commitment and goal by planning to safeguard all residents from a smallpox outbreak.

 

Fiscal Impact

There is no fiscal impact to receiving the report of the Health Officer. If Phase II of the plan is implemented it would have significant impact. In the unlikely event of a post-event vaccination effort, the costs will be very great.