Advisory Panel Recommends Limited Provision of Smallpox Vaccine to Health Workers

A committee of public health experts that advises the federal government on U.S. vaccination policy yesterday recommended that a small number of health care workers in each state should receive the smallpox vaccine to protect them in the event of a bioterrorist attack, the Washington Post reports (Brown, Washington Post, 6/21). In a unanimous vote, the Advisory Committee on Immunization Practices recommended that the government offer the vaccine on a voluntary basis to the estimated 10,000 to 20,000 individuals who "would be the first to respond to a deadly bioterrorist attack" and address "any suspected smallpox cases" (Garvey, Los Angeles Times, 6/21). The recommendation that ACIP approved yesterday would expand the use of the smallpox vaccine for the first time in about 30 years but represents the "most limited" of several proposals that the committee considered. Under the recommendation, each state would establish at least one smallpox response team that includes physicians, epidemiologists, investigators, laboratory technicians and nurses. In addition, each state would select at least one hospital as a "referral center for possible cases of smallpox," where a "pre-designated group of caregivers" who have received the smallpox vaccine would attend to the patients. The decision "affirms" support for the "ring vaccination" policy that the CDC recommended last November. Under the policy, local health officials would locate smallpox victims, isolate those exposed to the disease and vaccinate victims and those in contact with victims in the event of an attack (Washington Post, 6/21).

Reaction

ACIP will send the recommendation to the CDC and HHS Secretary Tommy Thompson for approval (Altman, New York Times, 6/21). The White House also may "weigh in" on the decision, HHS officials said (Stroh, Baltimore Sun, 6/21). Thompson said that he plans to review the recommendation with public health experts "as the administration works toward a policy on the smallpox vaccine" (New York Times, 6/21). "We plan to move as expeditiously as possible so that we have a policy in place" later this year, Thompson said (HHS release, 6/20). "It is uncertain how long that will take," although HHS "typically agrees with the decisions" of ACIP (Carrns/Lueck, Wall Street Journal, 6/21). The committee made the recommendation based on the "belief that the risk of attack employing smallpox virus is too small to justify the complications that would arise from widespread vaccination." Large-scale smallpox vaccination would "probably cause at least one death per million people vaccinated," and a larger number of individuals would become "seriously" ill, the Post reports (Washington Post, 6/21). However, supporters of wider use of the smallpox vaccine said that the "risks are overpowered by the chance that a smallpox outbreak could get out of control" in the event of a bioterrorist attack. "I think ring containment in a terrorist situation has been thoroughly discredited," William Bicknell, a physician at the Boston University School of Public Health, said (Washington Post, 6/21). Charles Pena, a defense policy analyst at the Cato Institute, added, "That's the government deciding who gets to live. They're willing to allow some number of the public to be exposed to the virus if it's used as a bioterror weapon" (McClam, AP/Arizona Republic, 6/21).

Media Coverage

NPR's "All Things Considered" yesterday reported on the smallpox vaccination recommendations. The full segment is available in RealPlayer Audio online (Knox, "All Things Considered," NPR, 6/20).
CNN's "Wolf Blitzer Reports" yesterday included an interview with Dr. Sue Bailey, former assistant defense secretary for health affairs. A transcript of the program is available online (Blitzer, "Wolf Blitzer Reports," CNN, 6/20).
NPR's "Morning Edition" today included an interview with Dr. Julie Gerberding from the CDC. The full segment will be available in RealPlayer Audio online after noon ET (Knox, "Morning Edition," NPR, 6/21).
NPR's "Talk of the Nation/Science Friday" today will feature Bruce Clements, associate director of the Center for the Study of Bioterrorism at the St. Louis University School of Public Health. The full segment will be available in RealPlayer Audio online after 6 p.m. ET (Flatow, "Talk of the Nation/Science Friday," NPR, 6/21).

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