January 25, 2002

Bolstering the Public's Trust Begins with Offering SmallPox Vaccinations

Doctors at Front Line Need Training, Can't Heal What They Can't Diagnose

By Dr. Elen Rios

WASHINGTON - Just when Americans adjusted their lives to the threat of anthrax, smallpox - a deadlier and more contagious bioterrorism horror - looms heavily over the nation.

This threat has not been unleashed - and we hope it never will be - but its psychological terror has already sprouted and is decaying the public's fragile sense of security. Now more than ever, we need to put the public's mind at ease by offering smallpox vaccinations to anyone who wants and demands it.

This is no easy step - and these are no easy times. The supply of smallpox vaccine is limited, and we must safeguard enough in case this threat becomes a reality so authorities can treat those who most need it. Because of these limitations, the public must realize that the vaccine is not to be taken on a whim. We all must be responsible and prudent, keeping in mind our own health and also that of our nation.

The leaders and doctors of the National Hispanic Medical Association (NHMA) stand ready to help national and local authorities administer these vaccinations and diminish smallpox as a terrorist weapon - both in the public's perception and as a bioterrorism reality.

We applaud Health and Human Services Secretary Tommy G. Thompson, who has called on minority doctors, including our Hispanic members, churches and medical organizations to help in the fight against bioterrorism. Thompson has already launched a process for rapid new production of the smallpox vaccine and research to diagnose and treat smallpox.

Federal health officials recently signed a $428 million contract to buy 155 million doses of the smallpox vaccine, bringing the government's supply to 286 million doses by the end of this year. Thompson said the supply is large enough to vaccinate every American.

We at the National Hispanic Medical Association take Thompson's call to arms seriously and are eager to do our part, both as Americans and as trained physicians. Our doctors have access to a huge community of Hispanic Americans - the fastest-growing segment of the population. NHMA has trained 60 physicians around the country to serve as leaders through its Leadership Fellowship program, in partnership with the Robert F. Wagner Graduate School of Public Service at New York University. These doctors and professional leaders are eager to serve their country as spokespeople who can help our communities in this time of need.

These doctors also can bridge the language barrier that otherwise might keep people from seeking treatment - thus endangering the health of whole communities. As our nation becomes more diverse and multilingual, language continues to be a barrier to health care. That's one barrier we cannot afford when combating anthrax, smallpox and other bioterror agents. To win this war on all fronts, we must have interpreters and health information in Spanish and other languages to reach every American.

This pernicious plague presents an urgent call for more doctors to be trained in diagnosing and fighting these deadly pathogens. Without advanced training on the most advanced diagnostic techniques and treatments, their hands will be tied against this formidable enemy.

The Centers for Disease Control and Prevention is ready on one of many fronts, including providing doctors with smallpox vaccinations and developing a response plan and guidelines. If the smallpox threat became a reality, CDC authorities could impose such far-reaching measures as shutting down public events and regional transportation - and could even place cities under quarantine.

These measures aren't considered drastic in light of the damage bioterrorism could cause our nation, its people and our health-care system. The statistics are grim. One person carrying this highly contagious disease could infect an entire community. As many as 30 percent of people infected with smallpox could die from it. Many more would suffer in pain and torment.

HHS and the CDC have been tenacious leaders during these trying times, educating the public and putting to rest unsubstantiated fears. It's not easy to ease the public's mind when there's so much misinformation around.

Here are the facts: It takes about 12 days before an infected person shows symptoms of smallpox, such as high fever, vomiting, pustular eruptions, fatigue and head and back aches. A characteristic rash - most prominent in the face, arms and legs - follows in two to three days. The rash starts with red, flat lesions that evolve at the same rate. People with smallpox are most infectious during the first week of illness.

Although smallpox is an old menace, it is new to today's medical professionals. Smallpox was eradicated in 1977, long before many of today's professionals began their careers. We cannot fight this scourge if we cannot identify it.

The responsibility for responding to a bioterrorism crisis falls first and heaviest on doctors at the local level. We cannot enhance our readiness for and response to a bioter-rorism attack without improving surveillance of infectious diseases, and that means expanding training for doctors and health professionals. Without doctors at their best and most prepared, our nation will be vulnerable to unimaginable evil.

Dr. Elena Rios is president of the National Hispanic Medical Association, representing Hispanic physicians around the country. NHMA's mission is to improve health care for Hispanics and the underserved in the U.S. Dr. Rios is from Los Angeles. Readers may write Dr. Rios at NHMA, 1411 K St. NW, Suite 200, Washington, D.C., 20005.

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