- The Washington Times - Tuesday, December 17, 2002

President Bush may be willing to roll up his sleeves to be among the first Americans to be vaccinated against smallpox, but you won't find me fighting to be first in that "live" shot line.
Neither will Dr. Michael S.A. Richardson, senior deputy director of medical affairs of the D.C. Department of Public Health. It's not because this prudent physician, with medical credentials as long as he is tall, doesn't believe vaccinating the public against the potential threat of a biochemical attack is necessarily a bad idea either.
No, the District's public point guard against bioterrorism whose duties include the task of informing the public about the risks and the benefits of such preventive vaccinations should not take the "live" vaccine himself because of his predisposition to eczema. Like yours truly.
This skin condition is just one of the medical reasons some people should not be vaccinated against smallpox, a disease that no longer exists anywhere in the world, as Dr. Richardson notes.
And, there's a large part of the rub: Lots of folks don't understand the value of taking a vaccine against a disease that doesn't exist, except in laboratories.
"This is a brand new concept," Dr. Richardson acknowledged, especially for public health administrators. However, his job is to provide balanced, honest information and provide "a way in which the public can have a discussion so persons can make choices in an informed and comfortable way."
Critics of the Bush administration's initial plans to inoculate the entire American population against smallpox because of terrorists' threats contend the risk to some, including death, outweighs the benefits. They rightly point out that no one, not even drug manufacturers, can be held liable if something goes wrong with the inoculations. Further, critics argue, it does not make sense to spend so much money on the smallpox vaccine when the disease has been eradicated worldwide, the potential threat is unknown, and the funds might be better spent on other pressing social and medical issues.
Besides, can we protect everyone against every potential threat? No.
The wisely revised plan, offered by Secretary of Health and Human Services Tommy G. Thompson, with whom Dr. Richardson agrees, is to vaccinate Americans in phases. Those who have the most potential for coming in contact with the dormant disease are to be inoculated first.
That sector includes the military and some medical and frontline hospital personnel like Dr. Richardson.
It will be at least another year before the vaccine will be available to those who want to voluntarily take it, but it's not too early to talk about it, he said. By then, the hope is that a safer form of the "live virus" vaccine will be available. In addition, medical advances in technology and treatment, which can now increase survival rates, have been developed since the smallpox vaccine was first administered in the 1800s, he said.
In the beginning of this latest controversy surrounding the smallpox vaccination, Dr. Richardson concedes, "there were more questions than answers and that added to the confusion." However, Dr. Richardson defended the Bush administration's initiative, in part, because he understands from a political and military standpoint "the imperative of war" and the need to protect the public against potential terrorist attacks especially since the September 11 attacks.
"The public would not be happy if [the government] didn't protect them" if a bioterrorism attack occurred similar to the anthrax scare late last year.
Still, even public-health officials such as Dr. Richardson long to see some of the government's billion-dollar investment expended to prevent or battle bioterrorism attacks used to prevent or treat current major health issues such as influenza, pneumonia, tuberculosis and HIV/AIDS. "There are diseases and conditions that are killing far more people," he said.
"There are things we find money for when we think it is important but there are other things we don't want to lose sight of," he said. The meticulous and cautious Jamaican-born physician, who was a partner in a private D.C. practice specializing in pulmonary disease before he joined the D.C. Health Department two years ago, added, "We are trying to get the balance right."
What worries Dr. Richardson most is that his main constituents, who are already vulnerable to a variety of poor health conditions, are the least likely to obtain the best information about the inoculations.
More worrisome is that blacks, in particular, are the most likely to be skeptical of the government's motives for providing smallpox vaccinations, Dr. Richardson acknowledged. Many blacks have been distrustful of the government's vaccination practices and medical trials since the infamous Tuskegee experiment, or even as recently as with the contamination of the Brentwood post office, where two black workers died.
"We need to make everyone understand what the benefits would be to come into the mainstream," said this physician, who looks the picture of health. "There is a psychological as well as physical benefit" of vaccination because you can relax with the peace of mind that this is one issue you don't have to worry about.
From Dr. Richardson's prescription pad, "any preventive medicine is good medicine."

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