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CNN Saturday Morning News

"Weekend House Call": The Smallpox Threat

Aired January 25, 2003 - 08:32   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


MILES O'BRIEN, CNN CORRESPONDENT: All right, we're not going to forget the morning stories. We never do.
HEIDI COLLINS, CNN ANCHOR: Nope.

O'BRIEN: And if there is news, we'll bring it to you. But, let's take a little break, shall we, and talk about you. Let's talk about you and your health.

COLLINS: All right, this weekend we are going to be talking about smallpox. Is there a real threat that terrorists could actually use it against us? What's being done to protect us and do the benefits of the vaccine outweigh the risks?

Some good questions.

O'BRIEN: To help us wade through all of these issues and take your e-mails and your phone calls, Dr. Sanjay Gupta.

Good morning to you, Dr. Gupta.

DR. SANJAY GUPTA, CNN CORRESPONDENT: Good morning to both of you again.

O'BRIEN: Good to see you.

GUPTA: Because this has become one of the biggest health care issues our nation has probably ever faced. Certainly the virus, the smallpox virus, but also the vaccine, who should get vaccinated and why. The president announced a plan just last month. Take a look at it there. Five hundred thousand members of the military would get vaccinated. President Bush himself would get vaccinated. And subsequently health care workers, our first responders, several hundred thousand of them, as well.

What we've seen since that plan was announced and just over the past few weeks is that while most hospitals are actually opting to go ahead and get the vaccine, there is almost a little quiet revolution going on where several, almost 80 hospitals, I believe, now, are saying that they're not going to go ahead and get the vaccine.

Our Elizabeth Cohen actually went to Connecticut, the first state to actually administer the vaccine and this is what she found.

(BEGIN VIDEOTAPE) ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): A historic doctor, a historic arm, a historic needle. Dr. James Hadler is the first person in 30 years to get a smallpox vaccination in a public vaccination program.

DR. JAMES HADLER, CONNECTICUT DEPARTMENT OF PUBLIC HEALTH: It's important for the country to begin to be more prepared for smallpox than it was before and this has been the first opportunity to do it, and we were ready.

COHEN: Smallpox vaccinations are controversial because statistically, for every million people who get the shot, one will die, 14 will get life threatening illnesses and 48 will become seriously ill. Some say it's worth the risk.

DR. ROBERT FULLER: There's a little bit of risk, a tiny bit of risk to taking this vaccination and the black box is we don't really know what the risk is of smallpox being weaponized.

COHEN: And if Saddam Hussein or anyone else uses smallpox as a bioweapon, the results could be devastating. And these doctors and nurses will have to take care of the victims, to they must take precautions.

CANDACE PETTIGREW, REGISTERED NURSE: It's our duty as a nurse and as a citizen of the United States to get vaccinated.

COHEN: Some health care workers, however, say they don't want to get vaccinated. In fact, many hospitals are choosing not to vaccinate their employees. In fact, the American Nurses Association is urging President Bush to delay the public vaccination program.

DIAN SOSNE, REGISTERED NURSE: Well, I am concerned about the vaccination program right now because there, I do not believe there are enough safeguards in place to protect health care workers who would be, are being asked to volunteer.

COHEN: So what about the general public? Should everyone get vaccinated?

UNIDENTIFIED MALE: We are not advocating for the entire population of our state to volunteer for these.

GEORGE W. BUSH, PRESIDENT OF THE UNITED STATES: Neither my family nor my staff will be receiving the vaccine.

COHEN: Last month, President Bush told Americans that even though as commander-in-chief he's been vaccinated, he doesn't advise it for the general public. But if people absolutely want the shot, the government will try to accommodate them. But right now these shots are for health care workers, for those who choose to get them. Connecticut is the first state. Others are soon to follow.

Elizabeth Cohen, CNN, Farmington, Connecticut.

(END VIDEOTAPE) GUPTA: Yes, so you can see even within the medical community there's a lot of dissent on this issue, certainly a lot of dissent within the general public, as well. And that's why we want to hear from you today. Go ahead and give us a call. There is a phone number on the screen, you can see it, 800-807-2620 or e-mail us as cnn.com/health.

To help answer some of these questions, we have two guests, two guests who are very knowledgeable about this issue, who have been part of developing the president's plan.

First, Dr. Anthony Fauci, who joins us from D.C.

Good morning, Dr. Fauci.

DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTES OF HEALTH: Good morning.

GUPTA: He is the director of the National Institute of Allergy and Infectious Disease at the NIH.

And also in Nashville, Dr. William Schaffner joins us.

He's the chairman of the department of preventive medicine.

Good morning, Dr. Schaffner, to you, as well.

DR. WILLIAM SCHAFFNER, VANDERBILT UNIVERSITY: Hi, Sanjay.

GUPTA: Dr. Fauci, I just want to ask a quick question here. If you could answer this quickly. The president's plan calls for hundreds of thousands of health care workers, the military, President Bush himself, to actually be vaccinated. You're starting to see some dissent now among people.

What do you tell people who are opting not to get this vaccine? How does the plan work if they don't get it?

FAUCI: Well, if no one gets it, then obviously the plan won't work, but that's not happen. You're seeing people who are reluctant to and they're in a minority. And we respect that. That's the reason why the entire program, apart from the military, is totally voluntary.

So if someone comes to me and says I don't want to be vaccinated, I say that's your personal choice, don't get vaccinated. But there are many, many more people who feel that given the situation in which they're in, either as part of a smallpox response team or a first responder or a broader group of health care providers who feel they may be called upon to either respond to take care of people who might be infected with smallpox were there, god forbid, a bioterrorist attack, or who might even be called upon in an emerging situation to vaccinate people, those individuals are getting vaccinated and will be vaccinated.

But there's no real problem with people who, since this is a voluntary program, decide that they do not want to do that. GUPTA: OK. And Dr. Schaffner, there are entire hospital systems that actually are choosing not to get vaccinated. You're actually over at Vanderbilt. You were part of the planning process in determining the whole smallpox vaccination plan.

What are your thoughts on this?

SCHAFFNER: Well, quite similar to Dr. Fauci's. There are a lot of institutions that are now weighing several things. Our own was very concerned that, first of all, the risk of a smallpox bioterrorist event is thought to be very, very low. And then second, that they were very concerned about patient safety first. Even though the risk of transmission of this vaccine virus to a patient is thought to be low, our board, medical board, put that first and decided to vote in favor of patient safety at this juncture.

And then, of course, we're ready to participate at a moment's notice. We were told we could have vaccine here within 12 hours if it's necessary and we have a plan to vaccinate our entire institution in 48 hours, and we're ready to do so.

GUPTA: And that is a little different than what the president has recommended.

Certainly a lot of questions about this from you, the viewers at home. We're going to take your phone calls, take your e-mails. A lot of interest in this topic.

COLLINS: Yes, and I think that's very interesting. We were talking during the break about how long it would take to be vaccinated once there is possibly a case of smallpox.

GUPTA: Right. And can you get vaccinated after you've been exposed. We're going to talk about that, as well.

O'BRIEN: Well, and the vaccination I had when I was an infant, does that still hold?

GUPTA: Right.

COLLINS: How old are you?

O'BRIEN: I'm too old. Forty-three. I don't think it lasts anymore. I think it's, what, about 30 years?

GUPTA: They've actually studied that. They found that while you do have some protection, it's probably not enough.

O'BRIEN: Yes.

GUPTA: But you'll probably tolerate a shot in the future better.

O'BRIEN: Right. Hmmm, interesting.

COLLINS: Interesting. All right. We are going to talk much more about this, so keep it right here. We're going to take your e- mails and your calls coming up in just a little bit later. More on the smallpox issue.

COMMERCIAL

O'BRIEN: You know, no detail is too small for one Heidi Collins.

What's behind the couch right now?

GUPTA: She has a pillow. She was concerned that I clashed.

O'BRIEN: She said that -- hold the pillow in. Hold the pillow in.

COLLINS: It's a little clashy.

O'BRIEN: There is a pillow there. You've got to see it, though.

GUPTA: I appreciate that you gave me this.

O'BRIEN: The folks at home can't see it. Can you pull that pillow in?

GUPTA: Oh, yes. There you go.

O'BRIEN: She says...

COLLINS: Ouch.

O'BRIEN: Now, it's up to you. Does that clash?

GUPTA: I'm trying to avoid what Heidi didn't want me to do.

O'BRIEN: I'm very impressed.

COLLINS: Yes, that's a little off.

O'BRIEN: Anyway, welcome back to the weekend House Call.

We're here with Dr. Sanjay Gupta. Or you're over there. Where are you?

COLLINS: We're right here, Miles.

O'BRIEN: My goodness. There they, there...

COLLINS: Hi, everybody.

You know what? We are going to be taking...

O'BRIEN: Kind of a dodgy crowd here.

COLLINS: We're going to be taking your e-mails and phone calls. In fact, we've already got quite a few right now.

GUPTA: Yes, well, the phones are really ringing a lot already, and not surprising. A lot of concerns about this. You know, there was a poll done, actually, actually polling people to find out who would get the smallpox vaccine, what percentage of people. It's sort of interesting. This was done back in December 11 of last year. Sixty-five percent of the nation at that time polled by the Robert Woods Johnson said they would get the vaccine. Obviously that means 35 percent said they wouldn't and there's a lot of doctors among that 35 percent that said they wouldn't. And a lot of questions about this.

We want to cut down to some of the nitty gritty about smallpox and answer your questions.

We'll first go to an e-mail question. This one actually comes from Terri in Massachusetts. This question very simply, "What are the possible side effects of the smallpox vaccine?"

And Dr. Fauci, you know, you're, your background is infectious diseases, but certainly you've been a part of the president's plan. What are you saying to the public about the side effects of this vaccine?

FAUCI: Well, there are various levels of side effects. A substantial proportion of people will get aching in the arm and they might feel constitutionally not very well, a little bit of fever. That usually goes away after several days. But if you look at the big picture, the things you worry about, there are some, out of a million people who would be vaccinated, there are anywhere from, oh, 19 to 50 some odd life threatening serious toxicities and there are maybe between 45 and up to 900 out of a million people will have non-life threatening but serious toxicities. And as you said in the top of the show, one or perhaps two per million historically have actually died from that.

So although the toxicities are rare, they can potentially be serious. But obviously the vast, vast majority out of the millions of people over the decades that have been vaccinated have generally relatively mild side effects, which we've seen in the clinical trials thus far.

GUPTA: That's right. I find that some people just say you know, we're not worried about this at all, and other people are very concerned. Another concern actually comes from Patty in Columbus, Ohio, about the vaccine itself.

Go ahead, Patty.

Thanks for joining us.

PATTY: Good morning.

I was wondering how is the vaccine given today different than the one, say, given in 1954, when I got my vaccine? And is it still effective? And I'm sorry, I have a two part question. I wanted to know how do today's risks compare with the risks from back then?

GUPTA: Dr. Schaffner, why don't you go ahead and take a stab at that.

You know, we didn't hear so much that the vaccine was dangerous 30 years ago. We're hearing a lot about that now. Is it a different vaccine?

SCHAFFNER: It's exactly the same vaccine and it works just as well. The recent studies have shown that. It's inoculated into the upper arm with a little needle through 15 pricks and we're just more aware of side effects and adverse reactions now than we used to be. We are much more attuned to that. We have many more people who are immunocompromised in our population, so we have to be careful to whom to give the vaccine.

I would add to what Tony said before, another side effect that we're worried about is that this vaccine virus, the vaccine virus can be, under certain circumstances, transmitted to others, people who were not vaccinated.

GUPTA: Right.

SCHAFFNER: And that's a concern.

GUPTA: Yes, that is very concerning, no question. Even if you live with somebody who might be at risk, someone who has an immunocompromised system, someone who has eczema, even, you probably shouldn't get the vaccine.

Heidi, Miles, you know, this issue, as I said, is one of the biggest issues we face as a nation because the virus doesn't exist, supposedly, in the world anymore today, yet we're potentially putting ourselves at great risk because of the vaccine.

O'BRIEN: Well, it does exist in two places.

GUPTA: That's right. Right.

O'BRIEN: I mean here in Atlanta on Clifton Road and somewhere in Moscow, right?

GUPTA: Right. And possibly other places, although we don't know for sure. But it's been eradicated as of 22 years ago.

O'BRIEN: And you didn't really get into this, but it's very, it's not an easy thing to weaponize, is it?

GUPTA: That, well, you know, that's a point of controversy. If you give it to someone, could humans actually be the mechanism of weapon delivery?

O'BRIEN: Right.

GUPTA: And that's something else we'll talk about.

O'BRIEN: But it's hard to control something like that, isn't it?

GUPTA: That's right. O'BRIEN: You know, it can come back to haunt you if you unleash it. Anyway, all right...

COLLINS: Obviously a lot more to talk about on this issue.

GUPTA: Yes.

COLLINS: Keep the questions coming, everybody.

O'BRIEN: Well, we'll do that again. Yes, we'll bring General Shepherd in and spice it up that way, what the heck.

COLLINS: We'll walk across the map.

O'BRIEN: All right, good to see you.

COLLINS: We'll be back in just a little while with more on the smallpox vaccine.

COMMERCIAL

GUPTA: Welcome back.

Well, we've been talking a lot about the people who should get the smallpox vaccine as part of the president's plan, but there are a lot of people who shouldn't get it, as well.

Take a look at the list there. This is an abbreviated list. People who have eczema, which is about 30 percent of the nation. People who have either ever had it or have it now or have other skin conditions such as dermatitis, herpes, are pregnant, those are people who should not get the vaccine. Also, if you have a weakened immune system from HIV, being HIV positive, organ transplants or taking steroids, that's certainly a lot of people who shouldn't get this vaccine.

COLLINS: That's right. And also we were talking just a few minutes ago about your current vaccine, if you did get one before they banned it. It's no good for probably anybody who's protected.

GUPTA: That's right. And that's probably the biggest question that we get is are we still protected? And the answer to that is probably there's nobody that's really protected unless they've been getting booster shots since the vaccine and since they stopped vaccinating about 30 years ago.

So people who work with smallpox virus for one reason or another, they're probably still getting protected. But most of the country has not received those booster shots, are not protected against this virus.

O'BRIEN: Sanjay, the thing that gets me is all this discussion, it's like a lot of the other things we talk about with security, just talking about those no fly zones earlier. It seems to me that it doesn't really relate to the real risks that are out there. GUPTA: Well, and I think that's the real question, what are the real risks? You know, we're talking to Dr. Fauci and Dr. Schaffner, who are joining us today, about the smallpox vaccine, but that is the question, are we at risk? And I think that almost becomes more of an intelligence question than it becomes a medical question.

Again, you know, the virus, you know, doesn't exist. It's been eradicated from the world.

Let's take a couple of phone calls on this. We've got a phone call from Michael in Tennessee. If we don't vaccinate, are there other ways to protect ourselves?

Go ahead, Michael.

MICHAEL: Hi. How you doing?

GUPTA: Good morning.

MICHAEL: I'm just curious, I'm wondering if one of these countries have upgraded the smallpox virus, OK? Would there be any other precautions a person can take, you know, if they have upgraded the smallpox. Would, you know, people consider gas masks, you know, other precautionaries?

GUPTA: Right. Well, and Dr. Fauci, you know, what he's asking, I think, is about weaponized smallpox or something that's even more virulent than what our vaccine can protect -- than what our vaccination can protect against.

What is the thinking on that, Dr. Fauci?

FAUCI: Well, the comment was made before about it's very difficult to weaponize. It's certainly very difficult for an amateur to weaponize. A graduate student's not going to do that. But the Soviet Union clearly made dozens of tons of weaponized smallpox in the 1970s. And one of the concerns is was that store so well guarded at the dissolution of the Soviet Union that some of it might have gotten into the hands of people who would use it in a nefarious way.

But as you said, we don't really know that. And the question is, there's, it's not a zero risk at all, but we don't know how great the risk is. And that's one of the great dilemmas that we face, that we need to be prepared for that, but we don't know exactly quantitatively what the risk is and you do whatever you can within reason to protect.

It's very, very unlikely that you're going to have a weaponized attack in this country, but not impossible. It's more likely if it occurs it'll occur in cases that are spread throughout, which would hopefully give us time to then vaccinate the entire population were that, god forbid, to happen.

GUPTA: Well, it seems amazingly difficult to make all these plans with so many unknowns out there.

Jerry from Kentucky has another question. Go ahead, sir.

JERRY: Oh, good morning.

How are you guys?

GUPTA: Doing well, thank you.

JERRY: Yes, first, I have a quick comment, then a question. My comment is I do support our president 100 percent in the war against Iraq. And my question is I would like to know, just being an average Joe, so to speak, I'm not a health care worker or anything like that. I don't work in any hospital. How could an average person get this vaccine if he wants to do his part to help and who would I contact or what would I do to try to go ahead and get myself vaccinated?

GUPTA: Right. And Dr. Schaffner, you know, 65 percent of the nation, according to that poll, says they would get the vaccine.

What do you tell somebody? He doesn't fall into the president's plan criteria, but he still wants to get vaccinated. What do you tell them?

SCHAFFNER: Stay tuned because although it's not available for the general public on a voluntary basis right now, it likely will be in the future, according to the president. So when that becomes available, you'll certainly know it and you folks will tell the United States population when that's available.

GUPTA: All right.

Doctors, thank you both very much for joining us.

We could go on and on about this because, like I said, it's such a huge health topic.

Dr. Anthony Fauci in D.C., thank you very much, sir, for joining us.

FAUCI: You're welcome.

GUPTA: Dr. William Schaffner in Nashville, Tennessee.

SCHAFFNER: Good morning.

GUPTA: Lots of questions about this.

Good morning.

Thanks again for joining us.

Lots of questions and, you know, like I said, we could talk forever about this. The plan is under way. It's started now.

O'BRIEN: Yes, I don't feel like we settled much this morning, but at least we're getting people educated about it. COLLINS: Talking about it.

O'BRIEN: Yes.

GUPTA: I think people do have questions about whether or not they should get vaccinated and I think it boils down to an individual choice still. Even amongst you two, differing opinions on this and amongst the medical community differing opinions.

O'BRIEN: Yes.

GUPTA: So not surprising.

COLLINS: All right. We will be back in just a moment.

GUPTA: All right.

COLLINS: Thanks, Dr. Sanjay.

O'BRIEN: Stay with us.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com







Aired January 25, 2003 - 08:32   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
MILES O'BRIEN, CNN CORRESPONDENT: All right, we're not going to forget the morning stories. We never do.
HEIDI COLLINS, CNN ANCHOR: Nope.

O'BRIEN: And if there is news, we'll bring it to you. But, let's take a little break, shall we, and talk about you. Let's talk about you and your health.

COLLINS: All right, this weekend we are going to be talking about smallpox. Is there a real threat that terrorists could actually use it against us? What's being done to protect us and do the benefits of the vaccine outweigh the risks?

Some good questions.

O'BRIEN: To help us wade through all of these issues and take your e-mails and your phone calls, Dr. Sanjay Gupta.

Good morning to you, Dr. Gupta.

DR. SANJAY GUPTA, CNN CORRESPONDENT: Good morning to both of you again.

O'BRIEN: Good to see you.

GUPTA: Because this has become one of the biggest health care issues our nation has probably ever faced. Certainly the virus, the smallpox virus, but also the vaccine, who should get vaccinated and why. The president announced a plan just last month. Take a look at it there. Five hundred thousand members of the military would get vaccinated. President Bush himself would get vaccinated. And subsequently health care workers, our first responders, several hundred thousand of them, as well.

What we've seen since that plan was announced and just over the past few weeks is that while most hospitals are actually opting to go ahead and get the vaccine, there is almost a little quiet revolution going on where several, almost 80 hospitals, I believe, now, are saying that they're not going to go ahead and get the vaccine.

Our Elizabeth Cohen actually went to Connecticut, the first state to actually administer the vaccine and this is what she found.

(BEGIN VIDEOTAPE) ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): A historic doctor, a historic arm, a historic needle. Dr. James Hadler is the first person in 30 years to get a smallpox vaccination in a public vaccination program.

DR. JAMES HADLER, CONNECTICUT DEPARTMENT OF PUBLIC HEALTH: It's important for the country to begin to be more prepared for smallpox than it was before and this has been the first opportunity to do it, and we were ready.

COHEN: Smallpox vaccinations are controversial because statistically, for every million people who get the shot, one will die, 14 will get life threatening illnesses and 48 will become seriously ill. Some say it's worth the risk.

DR. ROBERT FULLER: There's a little bit of risk, a tiny bit of risk to taking this vaccination and the black box is we don't really know what the risk is of smallpox being weaponized.

COHEN: And if Saddam Hussein or anyone else uses smallpox as a bioweapon, the results could be devastating. And these doctors and nurses will have to take care of the victims, to they must take precautions.

CANDACE PETTIGREW, REGISTERED NURSE: It's our duty as a nurse and as a citizen of the United States to get vaccinated.

COHEN: Some health care workers, however, say they don't want to get vaccinated. In fact, many hospitals are choosing not to vaccinate their employees. In fact, the American Nurses Association is urging President Bush to delay the public vaccination program.

DIAN SOSNE, REGISTERED NURSE: Well, I am concerned about the vaccination program right now because there, I do not believe there are enough safeguards in place to protect health care workers who would be, are being asked to volunteer.

COHEN: So what about the general public? Should everyone get vaccinated?

UNIDENTIFIED MALE: We are not advocating for the entire population of our state to volunteer for these.

GEORGE W. BUSH, PRESIDENT OF THE UNITED STATES: Neither my family nor my staff will be receiving the vaccine.

COHEN: Last month, President Bush told Americans that even though as commander-in-chief he's been vaccinated, he doesn't advise it for the general public. But if people absolutely want the shot, the government will try to accommodate them. But right now these shots are for health care workers, for those who choose to get them. Connecticut is the first state. Others are soon to follow.

Elizabeth Cohen, CNN, Farmington, Connecticut.

(END VIDEOTAPE) GUPTA: Yes, so you can see even within the medical community there's a lot of dissent on this issue, certainly a lot of dissent within the general public, as well. And that's why we want to hear from you today. Go ahead and give us a call. There is a phone number on the screen, you can see it, 800-807-2620 or e-mail us as cnn.com/health.

To help answer some of these questions, we have two guests, two guests who are very knowledgeable about this issue, who have been part of developing the president's plan.

First, Dr. Anthony Fauci, who joins us from D.C.

Good morning, Dr. Fauci.

DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTES OF HEALTH: Good morning.

GUPTA: He is the director of the National Institute of Allergy and Infectious Disease at the NIH.

And also in Nashville, Dr. William Schaffner joins us.

He's the chairman of the department of preventive medicine.

Good morning, Dr. Schaffner, to you, as well.

DR. WILLIAM SCHAFFNER, VANDERBILT UNIVERSITY: Hi, Sanjay.

GUPTA: Dr. Fauci, I just want to ask a quick question here. If you could answer this quickly. The president's plan calls for hundreds of thousands of health care workers, the military, President Bush himself, to actually be vaccinated. You're starting to see some dissent now among people.

What do you tell people who are opting not to get this vaccine? How does the plan work if they don't get it?

FAUCI: Well, if no one gets it, then obviously the plan won't work, but that's not happen. You're seeing people who are reluctant to and they're in a minority. And we respect that. That's the reason why the entire program, apart from the military, is totally voluntary.

So if someone comes to me and says I don't want to be vaccinated, I say that's your personal choice, don't get vaccinated. But there are many, many more people who feel that given the situation in which they're in, either as part of a smallpox response team or a first responder or a broader group of health care providers who feel they may be called upon to either respond to take care of people who might be infected with smallpox were there, god forbid, a bioterrorist attack, or who might even be called upon in an emerging situation to vaccinate people, those individuals are getting vaccinated and will be vaccinated.

But there's no real problem with people who, since this is a voluntary program, decide that they do not want to do that. GUPTA: OK. And Dr. Schaffner, there are entire hospital systems that actually are choosing not to get vaccinated. You're actually over at Vanderbilt. You were part of the planning process in determining the whole smallpox vaccination plan.

What are your thoughts on this?

SCHAFFNER: Well, quite similar to Dr. Fauci's. There are a lot of institutions that are now weighing several things. Our own was very concerned that, first of all, the risk of a smallpox bioterrorist event is thought to be very, very low. And then second, that they were very concerned about patient safety first. Even though the risk of transmission of this vaccine virus to a patient is thought to be low, our board, medical board, put that first and decided to vote in favor of patient safety at this juncture.

And then, of course, we're ready to participate at a moment's notice. We were told we could have vaccine here within 12 hours if it's necessary and we have a plan to vaccinate our entire institution in 48 hours, and we're ready to do so.

GUPTA: And that is a little different than what the president has recommended.

Certainly a lot of questions about this from you, the viewers at home. We're going to take your phone calls, take your e-mails. A lot of interest in this topic.

COLLINS: Yes, and I think that's very interesting. We were talking during the break about how long it would take to be vaccinated once there is possibly a case of smallpox.

GUPTA: Right. And can you get vaccinated after you've been exposed. We're going to talk about that, as well.

O'BRIEN: Well, and the vaccination I had when I was an infant, does that still hold?

GUPTA: Right.

COLLINS: How old are you?

O'BRIEN: I'm too old. Forty-three. I don't think it lasts anymore. I think it's, what, about 30 years?

GUPTA: They've actually studied that. They found that while you do have some protection, it's probably not enough.

O'BRIEN: Yes.

GUPTA: But you'll probably tolerate a shot in the future better.

O'BRIEN: Right. Hmmm, interesting.

COLLINS: Interesting. All right. We are going to talk much more about this, so keep it right here. We're going to take your e- mails and your calls coming up in just a little bit later. More on the smallpox issue.

COMMERCIAL

O'BRIEN: You know, no detail is too small for one Heidi Collins.

What's behind the couch right now?

GUPTA: She has a pillow. She was concerned that I clashed.

O'BRIEN: She said that -- hold the pillow in. Hold the pillow in.

COLLINS: It's a little clashy.

O'BRIEN: There is a pillow there. You've got to see it, though.

GUPTA: I appreciate that you gave me this.

O'BRIEN: The folks at home can't see it. Can you pull that pillow in?

GUPTA: Oh, yes. There you go.

O'BRIEN: She says...

COLLINS: Ouch.

O'BRIEN: Now, it's up to you. Does that clash?

GUPTA: I'm trying to avoid what Heidi didn't want me to do.

O'BRIEN: I'm very impressed.

COLLINS: Yes, that's a little off.

O'BRIEN: Anyway, welcome back to the weekend House Call.

We're here with Dr. Sanjay Gupta. Or you're over there. Where are you?

COLLINS: We're right here, Miles.

O'BRIEN: My goodness. There they, there...

COLLINS: Hi, everybody.

You know what? We are going to be taking...

O'BRIEN: Kind of a dodgy crowd here.

COLLINS: We're going to be taking your e-mails and phone calls. In fact, we've already got quite a few right now.

GUPTA: Yes, well, the phones are really ringing a lot already, and not surprising. A lot of concerns about this. You know, there was a poll done, actually, actually polling people to find out who would get the smallpox vaccine, what percentage of people. It's sort of interesting. This was done back in December 11 of last year. Sixty-five percent of the nation at that time polled by the Robert Woods Johnson said they would get the vaccine. Obviously that means 35 percent said they wouldn't and there's a lot of doctors among that 35 percent that said they wouldn't. And a lot of questions about this.

We want to cut down to some of the nitty gritty about smallpox and answer your questions.

We'll first go to an e-mail question. This one actually comes from Terri in Massachusetts. This question very simply, "What are the possible side effects of the smallpox vaccine?"

And Dr. Fauci, you know, you're, your background is infectious diseases, but certainly you've been a part of the president's plan. What are you saying to the public about the side effects of this vaccine?

FAUCI: Well, there are various levels of side effects. A substantial proportion of people will get aching in the arm and they might feel constitutionally not very well, a little bit of fever. That usually goes away after several days. But if you look at the big picture, the things you worry about, there are some, out of a million people who would be vaccinated, there are anywhere from, oh, 19 to 50 some odd life threatening serious toxicities and there are maybe between 45 and up to 900 out of a million people will have non-life threatening but serious toxicities. And as you said in the top of the show, one or perhaps two per million historically have actually died from that.

So although the toxicities are rare, they can potentially be serious. But obviously the vast, vast majority out of the millions of people over the decades that have been vaccinated have generally relatively mild side effects, which we've seen in the clinical trials thus far.

GUPTA: That's right. I find that some people just say you know, we're not worried about this at all, and other people are very concerned. Another concern actually comes from Patty in Columbus, Ohio, about the vaccine itself.

Go ahead, Patty.

Thanks for joining us.

PATTY: Good morning.

I was wondering how is the vaccine given today different than the one, say, given in 1954, when I got my vaccine? And is it still effective? And I'm sorry, I have a two part question. I wanted to know how do today's risks compare with the risks from back then?

GUPTA: Dr. Schaffner, why don't you go ahead and take a stab at that.

You know, we didn't hear so much that the vaccine was dangerous 30 years ago. We're hearing a lot about that now. Is it a different vaccine?

SCHAFFNER: It's exactly the same vaccine and it works just as well. The recent studies have shown that. It's inoculated into the upper arm with a little needle through 15 pricks and we're just more aware of side effects and adverse reactions now than we used to be. We are much more attuned to that. We have many more people who are immunocompromised in our population, so we have to be careful to whom to give the vaccine.

I would add to what Tony said before, another side effect that we're worried about is that this vaccine virus, the vaccine virus can be, under certain circumstances, transmitted to others, people who were not vaccinated.

GUPTA: Right.

SCHAFFNER: And that's a concern.

GUPTA: Yes, that is very concerning, no question. Even if you live with somebody who might be at risk, someone who has an immunocompromised system, someone who has eczema, even, you probably shouldn't get the vaccine.

Heidi, Miles, you know, this issue, as I said, is one of the biggest issues we face as a nation because the virus doesn't exist, supposedly, in the world anymore today, yet we're potentially putting ourselves at great risk because of the vaccine.

O'BRIEN: Well, it does exist in two places.

GUPTA: That's right. Right.

O'BRIEN: I mean here in Atlanta on Clifton Road and somewhere in Moscow, right?

GUPTA: Right. And possibly other places, although we don't know for sure. But it's been eradicated as of 22 years ago.

O'BRIEN: And you didn't really get into this, but it's very, it's not an easy thing to weaponize, is it?

GUPTA: That, well, you know, that's a point of controversy. If you give it to someone, could humans actually be the mechanism of weapon delivery?

O'BRIEN: Right.

GUPTA: And that's something else we'll talk about.

O'BRIEN: But it's hard to control something like that, isn't it?

GUPTA: That's right. O'BRIEN: You know, it can come back to haunt you if you unleash it. Anyway, all right...

COLLINS: Obviously a lot more to talk about on this issue.

GUPTA: Yes.

COLLINS: Keep the questions coming, everybody.

O'BRIEN: Well, we'll do that again. Yes, we'll bring General Shepherd in and spice it up that way, what the heck.

COLLINS: We'll walk across the map.

O'BRIEN: All right, good to see you.

COLLINS: We'll be back in just a little while with more on the smallpox vaccine.

COMMERCIAL

GUPTA: Welcome back.

Well, we've been talking a lot about the people who should get the smallpox vaccine as part of the president's plan, but there are a lot of people who shouldn't get it, as well.

Take a look at the list there. This is an abbreviated list. People who have eczema, which is about 30 percent of the nation. People who have either ever had it or have it now or have other skin conditions such as dermatitis, herpes, are pregnant, those are people who should not get the vaccine. Also, if you have a weakened immune system from HIV, being HIV positive, organ transplants or taking steroids, that's certainly a lot of people who shouldn't get this vaccine.

COLLINS: That's right. And also we were talking just a few minutes ago about your current vaccine, if you did get one before they banned it. It's no good for probably anybody who's protected.

GUPTA: That's right. And that's probably the biggest question that we get is are we still protected? And the answer to that is probably there's nobody that's really protected unless they've been getting booster shots since the vaccine and since they stopped vaccinating about 30 years ago.

So people who work with smallpox virus for one reason or another, they're probably still getting protected. But most of the country has not received those booster shots, are not protected against this virus.

O'BRIEN: Sanjay, the thing that gets me is all this discussion, it's like a lot of the other things we talk about with security, just talking about those no fly zones earlier. It seems to me that it doesn't really relate to the real risks that are out there. GUPTA: Well, and I think that's the real question, what are the real risks? You know, we're talking to Dr. Fauci and Dr. Schaffner, who are joining us today, about the smallpox vaccine, but that is the question, are we at risk? And I think that almost becomes more of an intelligence question than it becomes a medical question.

Again, you know, the virus, you know, doesn't exist. It's been eradicated from the world.

Let's take a couple of phone calls on this. We've got a phone call from Michael in Tennessee. If we don't vaccinate, are there other ways to protect ourselves?

Go ahead, Michael.

MICHAEL: Hi. How you doing?

GUPTA: Good morning.

MICHAEL: I'm just curious, I'm wondering if one of these countries have upgraded the smallpox virus, OK? Would there be any other precautions a person can take, you know, if they have upgraded the smallpox. Would, you know, people consider gas masks, you know, other precautionaries?

GUPTA: Right. Well, and Dr. Fauci, you know, what he's asking, I think, is about weaponized smallpox or something that's even more virulent than what our vaccine can protect -- than what our vaccination can protect against.

What is the thinking on that, Dr. Fauci?

FAUCI: Well, the comment was made before about it's very difficult to weaponize. It's certainly very difficult for an amateur to weaponize. A graduate student's not going to do that. But the Soviet Union clearly made dozens of tons of weaponized smallpox in the 1970s. And one of the concerns is was that store so well guarded at the dissolution of the Soviet Union that some of it might have gotten into the hands of people who would use it in a nefarious way.

But as you said, we don't really know that. And the question is, there's, it's not a zero risk at all, but we don't know how great the risk is. And that's one of the great dilemmas that we face, that we need to be prepared for that, but we don't know exactly quantitatively what the risk is and you do whatever you can within reason to protect.

It's very, very unlikely that you're going to have a weaponized attack in this country, but not impossible. It's more likely if it occurs it'll occur in cases that are spread throughout, which would hopefully give us time to then vaccinate the entire population were that, god forbid, to happen.

GUPTA: Well, it seems amazingly difficult to make all these plans with so many unknowns out there.

Jerry from Kentucky has another question. Go ahead, sir.

JERRY: Oh, good morning.

How are you guys?

GUPTA: Doing well, thank you.

JERRY: Yes, first, I have a quick comment, then a question. My comment is I do support our president 100 percent in the war against Iraq. And my question is I would like to know, just being an average Joe, so to speak, I'm not a health care worker or anything like that. I don't work in any hospital. How could an average person get this vaccine if he wants to do his part to help and who would I contact or what would I do to try to go ahead and get myself vaccinated?

GUPTA: Right. And Dr. Schaffner, you know, 65 percent of the nation, according to that poll, says they would get the vaccine.

What do you tell somebody? He doesn't fall into the president's plan criteria, but he still wants to get vaccinated. What do you tell them?

SCHAFFNER: Stay tuned because although it's not available for the general public on a voluntary basis right now, it likely will be in the future, according to the president. So when that becomes available, you'll certainly know it and you folks will tell the United States population when that's available.

GUPTA: All right.

Doctors, thank you both very much for joining us.

We could go on and on about this because, like I said, it's such a huge health topic.

Dr. Anthony Fauci in D.C., thank you very much, sir, for joining us.

FAUCI: You're welcome.

GUPTA: Dr. William Schaffner in Nashville, Tennessee.

SCHAFFNER: Good morning.

GUPTA: Lots of questions about this.

Good morning.

Thanks again for joining us.

Lots of questions and, you know, like I said, we could talk forever about this. The plan is under way. It's started now.

O'BRIEN: Yes, I don't feel like we settled much this morning, but at least we're getting people educated about it. COLLINS: Talking about it.

O'BRIEN: Yes.

GUPTA: I think people do have questions about whether or not they should get vaccinated and I think it boils down to an individual choice still. Even amongst you two, differing opinions on this and amongst the medical community differing opinions.

O'BRIEN: Yes.

GUPTA: So not surprising.

COLLINS: All right. We will be back in just a moment.

GUPTA: All right.

COLLINS: Thanks, Dr. Sanjay.

O'BRIEN: Stay with us.

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