Lost Vaccines Offer Expensive Lesson
In Defending Against Smallpox Threat
By MARILYN CHASE
Staff Reporter of THE WALL STREET JOURNAL
November 30, 2001
In 1991, the World Health Organization had a white elephant on its hands: 200 million doses of smallpox vaccine. That year, it incinerated more than 99% of the stockpile -- for lack of about $25,000 a year to store it.
On Wednesday, as part of its effort to defend against future acts of bioterrorism, the U.S. said it will pay $428 million to two companies -- Acambis PLC and Baxter International Inc. -- to produce 155 million doses of smallpox vaccine. That contract, plus others, will boost the U.S. stockpile to slightly more than 280 million doses, at a total cost of $850 million -- a price tag many times higher than the 10-year storage bill for WHO's destroyed vaccine, and one many critics view as an example of the risks of pennywise decision-making in the public-health field.
The last naturally occurring case of smallpox appeared in 1979, and the deadly disease was declared eradicated in 1980. More than a decade later, WHO made the difficult decision to discard almost all of its smallpox vaccine, keeping only 500,000 doses in Geneva, after WHO member-nations refused to help store the stockpile. At present, a total of just 60 million doses are thought to exist world-wide, including 15 million in the U.S. Until new supplies are made, the world could be vulnerable to a smallpox attack.
"What happened 10 years ago was terrifically short-sighted," says Nils Daulaire, president and chief executive officer of the Global Health Council, a nonprofit organization based in White River Junction, Vt., that lobbies for WHO funding. The decision, he says, reflected a mindset that unless something is a crisis, we don't need to worry about it. "We need to take a 20-year view," he adds. "Eternal vigilance is the price of health."
Of course, the world has turned into a different place in the past three months, not to mention 10 years. With the clarity of hindsight, sacrificing the stockpile to save modest sums seems foolish. In good times, many countries trim long-term investments and contributions to organizations such as WHO, letting the world's public-health infrastructure decline until a crisis occurs. The U.S., for example, is now running about $33 million behind in its share of WHO funding.
More money might have saved the smallpox vaccine stockpile. But David Heymann, WHO's executive director of communicable diseases, isn't pointing fingers. "In public health, you go with known risks. It was the right decision at the time," he says.
Some veterans of the fight against smallpox are less guarded in indicting delinquent donor countries. Larry Brilliant, a former member of WHO's smallpox team in India, learned about the destruction of the doses only this year, after attending a post-Sept. 11 refresher course in smallpox procedures at the Centers for Disease Control and Prevention. "It is appalling," he says, that such a public health safety net was destroyed "for want of a few thousand dollars to pay the electricity bills."
With its limited budget, WHO is obliged to devote resources to the biggest threats to life and health, Dr. Heymann says. By the mid-1980s, a WHO advisory committee had deemed the return of smallpox so unlikely that it made no sense to expend scarce resources on vaccine storage.
Other illnesses -- tuberculosis, malaria, HIV, respiratory diseases and childhood diarrhea -- were killing almost 14 million people a year. WHO put such immediate threats ahead of smallpox's hypothetical risks. Moreover. in 1990, says Dr. Heymann, "there was great optimism that we had freed the world of [smallpox]. The take-home lesson is that public health always has surprises."
WHO offered to let member nations take a share of the smallpox vaccine and store it themselves. But countries refused for fear that the vaccine -- then made from calf skin -- carried a risk of transmitting foot-and-mouth disease to cattle. Today, that risk seems remote.
In Europe, countries are assessing their own stocks of smallpox vaccine. France has asked Aventis SA, a French-German drug maker, to produce three million doses of vaccine to augment the five million doses the country already has. Citing national security, officials in England decline to state the size of its stockpile.
Some health experts argue that Europe really needs a centralized vaccine pool, not country-by-country caches. "In an emergency, every country would be involved. So we have to think globally," says Robert Sebbag, an infectious-diseases expert and an Aventis spokesman.
WHO's discarded stockpile would have served as just such a centralized pool, available to any member country in need. The annual cost of maintaining the pool was $21,000, plus $3,000 for regular testing to ensure potency, according to a 1988 WHO report. Dr. Heymann this week said those figures seem too low. But even an updated estimate of several hundred thousand dollars pales beside the current cost to the U.S. of amassing a new war chest.
For much of the past two decades, the U.S. has lagged in paying its assessed share of WHO's expenses. WHO operates on a two-year budget of $842 million, or $421 million a year, of which the U.S. is assessed about one-quarter each year, according to WHO. One reason for the U.S. lag is structural: The Oct. 1 start of the federal fiscal year is out of sync with WHO's biennial budget period based on the calendar year. But the lag also is a product of wavering political support. Recent efforts by Congress to catch up in its support of international organizations have resulted in two payments, with a third payment pending.
In Washington, a spokeswoman for the Senate Foreign Relations Committee says planned payments of back obligations to United Nations-affiliated organizations, such as WHO, "accelerated [after Sept. 11] because everybody recognized the importance" of supporting such global bodies. The third installment will include roughly $30 million earmarked for WHO.
As scientists march toward eradication of other infectious diseases, such as polio, the cost of replacing the smallpox-vaccine stockpile is something they shouldn't forget, experts say. "We need to be vigilant," says Mohammad Akhter, executive director of the American Public Health Association. "We also need to be patient, and think twice before we dismantle an infrastructure," he says.
-- Jill Carroll and Gautam Naik contributed to this article.
Write to Marilyn Chase at marilyn.chase@wsj.com2
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