Public Health Headlines |
Public Health Officials Learn About Smallpox Vaccine Policy
During the symposium, Lynn Goldman, MD, MPH, professor of environmental health sciences and director of the Mid-Atlantic Public Health Training Center, moderated a panel of experts discussing the clinical aspects of smallpox as well as the practical matters of vaccinating the community following a biological attack. Among the first to speak was D.A. Henderson, MD, MPH ’60, perhaps the world’s leading expert on smallpox after having led the World Health Organization’s effort to eradicate the disease in the 1970s. Once the dean of the School and founding director of the Center for Civilian Biodefense Strategies, Dr. Henderson is currently the senior science advisor to the Secretary of Health and Human Services, Tommy Thompson. He described the dangers posed by a smallpox attack and grimly told the crowd, “Smallpox is one of the most deadly diseases known to man.” By his estimates, smallpox killed 300 million people in the twentieth century, which is roughly 200 million more than all of the wars during that same century. Dr. Henderson helped devise the current U.S. strategy, which calls for instituting mass vaccination of the public after the first reported case of smallpox is detected. The CDC guidelines outline a plan for each state to inoculate up to 1 million people within the first 10 days of an outbreak. Health investigators would also track down anyone with smallpox and vaccinate all who came in contact with the sick person. Much of the symposium was devoted to discussing the risks and benefits of vaccinating the public prior to smallpox attack. The CDC’s Smallpox Vaccination Clinic Guide does not address a pre-attack vaccination strategy. The government is considering vaccinating public health and emergency workers who would be the first to respond to an attack; however, offering the vaccine to the general public poses many medical, ethical, and political questions.
As Donald S. Burke, MD, professor of international health and director of the School’s Center for Immunization Research explained, the smallpox vaccine is made from live vaccinia virus, a close relative of the smallpox virus. People with HIV/AIDS, skin disorders, organ transplants, or other immune deficiencies would be at risk for serious complications from the vaccine and from coming into contact with others who have been recently inoculated. Mass voluntary vaccination before an attack may have additional drawbacks. Tara O’Toole, MD, MPH ‘88, director of the Center for Civilian Biodefense Strategies, explained that voluntary pre-attack vaccination would not achieve herd immunity needed to protect the whole population, but it might help protect the vital systems of society and ease the challenges of post-attack vaccination. She noted that the international political implications of a pre-attack vaccination plan must also be considered. Dr. O’Toole added that planning for a biological attack is a public health priority and that effective communication with the public will be critical during an attack. “I believe public health communication and preparedness to deal with the media should be the number one thing on your ‘to do’ list,” she told the group. Ruth Faden, PhD, MPH, the Philip Franklin Wagley Professor of Biomedical Ethics and executive director of the Phoebe R. Berman Bioethics Institute, said many issues must be resolved before allowing the general public to voluntarily take the vaccine in the absence of a direct threat. They include issues of legal liability, should anyone die from the vaccine, and procedures to protect vulnerable populations. Also, she explained that public health officials must clearly explain the risks and benefits of vaccination to preserve the public’s trust in government and help citizens make informed decisions. Move for Health: Benjamin Caballero, MD, PhD, director of the Center for Human Nutrition, chaired the energy panel which formulated the controversial new physical activity recommendation. The new standard of one hour of moderate physical activity each day doubles the Surgeon General’s recommendation from 1996 that Americans get 30 minutes of moderate-intensity physical activity on most days. The report acknowledges that 30 minutes of daily physical activity offers some benefit in reducing chronic disease risk, but insists that it is insufficient to maintain body weight and to maximize disease prevention and mood elevating benefits. Since the report’s release, consumer health groups have expressed concern that the new standard may discourage sedentary individuals from initiating lifestyle changes because they may feel that the physical activity standard, once at arm’s length, is now totally out of reach.
The message that overweight people should take from this, Dr. Caballero suggests, is that “any increase in activity that people can achieve should have a positive effect.” He also emphasizes that one hour of activity need only be “moderate” to achieve benefits, and can be achieved through a combination of active periods throughout the day, including short walks, taking the stairs instead of the elevator and performing household chores. Those who regularly do more vigorous exercise can reach the desirable physical activity level in less time. With conflicting information about the role of carbohydrates, fats and protein in weight loss and health, it’s no wonder that many were looking to the authoritative voice of the Food and Nutrition Board to clarify the situation. They do shed some new light on concerns about fats and carbohydrates. If you avoid saturated and trans fats, you can actually consume more fat as a percentage of the diet than was previously thought and remain in the healthy range. Also, for the first time, the guidelines set a recommended daily minimum intake for carbohydrates at 130 grams (the amount necessary to provide enough glucose for brain functioning). However, those seeking specific advice on what diets to adopt and which to avoid will find this was a misguided hope. For one, the macronutrient ranges outlined in the report are intended for healthy individuals, not those seeking weight loss. Second, the report’s primary audience is the scientific community, not the general public. That’s not to say that the report doesn’t have tremendous public policy implications; it will be used by several government agencies, including the FDA and the USDA, to develop new Dietary Guidelines and revise food labeling standards. In fact, before the complete macronutrient report was released, the panel had already provided evidence to the FDA, which led to a new law requiring food producers to list the amount of trans fat in products on nutrition labels beginning next year. The Institute of Medicine will issue a condensed version of the seven-volume Dietary Reference Intakes next year. Penny Kris Etherton, professor of Nutrition at Pennsylvania State University and a member of the macronutrient panel, said: "Most Americans and Canadians already consume diets within the recommended ranges for fat, protein and carbohydrates (-33 percent fat, -15 percent protein, -52 percent carbohydrates), but we get far too little exercise, consume too much saturated and trans fat and not nearly enough fiber to stave off chronic disease.” Preventing disease and maximizing health requires both individual and collective action. Dr. Caballero and colleagues at the Center for Human Nutrition urge a multi-pronged approach to encourage increased physical activity. Acknowledging the crucial role of environment on health, Caballero urges, “We must work at the community level to create more opportunities for physical activity and to facilitate this in the workplace. To reduce the main killers in America, we will have to find a way to do this.” “To prevent weight gain as well as to accrue additional, weight-independent health benefits of physical activity, 60 minutes of daily moderate intensity physical activity (e.g., walking/jogging at 4 to 5 MPH) is recommended, in addition to the activities required by a sedentary lifestyle.” Minority Summer Internship Program
The students came from across the country and included a Native American student from Montana, two Hispanic Americans, and 26 African Americans. Only three of the students enrolled were males. The undergraduates who participated in the program came from Spelman College in Atlanta, Wellesley College in Massachusetts, Hampton University in Virginia, Montana State University, Johns Hopkins University, Morgan State University, and Goucher College. These students were placed with faculty mentors across the School and assisted in research laboratories and applied public health research. Rochelline Marshall, now a senior at Goucher College, worked with Janice Bowie, PhD, assistant professor of health policy and management, on a project designed to promote cancer prevention in African-American Protestant churches in Baltimore. Marshall says she gained valuable experience in survey design, focus groups, and community outreach. Sasha Nelson, a senior from Johns Hopkins University, was mentored by Laura Caulfield, PhD, associate professor of international health, and looked at iron deficiency in pregnant women living in Baltimore and Peru. “I was very impressed with Sasha and I think she came away with a good experience. We gave her a real flavor of what it was like to do our jobs,” said Dr. Caulfield. All of the college students and one high school student presented their work in a poster session on August 9, 2002, in the student lounge. A formal program was held where the high school students gave oral presentations summarizing their work and experiences. The high school students enrolled in the Minority Summer Internship Program were from across Maryland, but the majority of them came from Dunbar High School in East Baltimore. The Diversity Office worked closely with Mayor Martin O’Malley’s Office for Youth Employment to find positions for everyone. Several students were placed with the School’s new Mid-Atlantic Public Health Training Center. They worked with Lynn Goldman, MD, MPH, the center’s director and professor of environmental health, and with program coordinator Ayanna Fews. The Office of Diversity thanks all the faculty and senior staff who volunteered to mentor these students. Ms. Davis stated that she plans to have many more college students participating in the program for summer 2003. |
Cover | Hopkins Public Health Headlines | In Memoriam
At the School | Smallpox Vaccine Policy | Tech Talk
New Dietary Reference Intakes | Minority Internships
© 2005 by The Johns Hopkins University