Since President Bush helped launch a massive smallpox preparedness program in 2002, local health officials say they have come a long way in developing plans to vaccinate the region's entire population in the event of an outbreak.
But three years after the Sept. 11 attacks and subsequent anthrax scare, medical experts are still struggling with how best to handle a widespread bioterrorism attack. Officials remain concerned about security, shortages of trained staff and the challenge of calming a populace likely to be terrified.
Daniel Lucey, of Washington Hospital Center, said whether the region is sufficiently prepared "depends on the nature of the smallpox outbreak."
(Robert A. Reeder -- The Washington Post)
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"We are better prepared, but are we prepared well enough? To an extent, that depends on the nature of the smallpox outbreak," said Daniel Lucey, director of the Center for Biologic Counterterrorism and Emerging Diseases at Washington Hospital Center.
A worst-case scenario, such as an airborne release of the virus, would be "an extremely difficult public health crisis," he said, and "an extreme challenge, to say the least."
Perhaps the greatest hurdle continues to be a lack of health care workers and first responders willing to become vaccinated. Nationwide, only about 40,000 of them have received the vaccine, way short of the initial target of 500,000, according to the Centers for Disease Control and Prevention.
In a January report derided by Republicans as unfairly partisan, Democratic members of the House Select Committee on Homeland Security concluded that the "civilian vaccination program is stalled and in disarray, threatening the security of millions of Americans."
In the District, only about 100 health professionals have received the vaccine. About 750 have gotten it in Maryland and slightly more than 900 in Virginia.
Officials said people are reluctant to volunteer to be vaccinated because of risks associated with the vaccine, which has been linked to several cases of a potentially fatal heart inflammation. And the risk of an actual outbreak has been seen as increasingly remote, health officials said, further limiting volunteers.
"There was really very little interest on the part of first-responder groups to receive the vaccine," said Lisa Kaplowitz, the Virginia Department of Health's deputy commissioner for emergency preparedness and response. "It wasn't zero, but really very little interest."
Volunteers have been so scarce that the state had to dispose of about 1,700 doses that expired after going unused, said Trina Lee, a department spokeswoman. Even so, the state still has more than 5,000 doses on hand, she said, and could request more from the CDC.
The lack of response from the medical community most likely means that vaccination of the general public would be delayed in the event of an outbreak. Those health officials and emergency workers who previously declined probably would be vaccinated first, costing precious time if panic began to set in, said Julie Casani, director of public health preparedness and response for the Maryland Department of Health and Mental Hygiene.
"We may choose to say it's important to vaccinate police and fire and EMS [emergency medical services] first," she said. "So if we have to say to a parent of four, 'You are going to have to come back tomorrow,' that's going to be hard for them to believe we are doing the right thing."
Casani and other health officials said the region has made significant strides. Counting the number of people who have received the vaccine is not the only way to measure preparedness, they said.
"We feel comfortable that all of the states have the ability to respond as quickly as possible in the event of outbreak or an emergency," said Linda Neff, director of the Office of Preparedness and Emergency Response in the CDC's National Immunization Program. "We are much better prepared than we were two years ago and much better than one year ago."