Federal Advisory Panel Makes Final Recommendation on Smallpox Vaccination Policy

The Advisory Committee on Immunization Practices yesterday recommended offering the smallpox vaccine to 510,000 emergency room and other hospital employees, a shift from its June recommendation to vaccinate between 10,000 and 20,000 health care workers, the New York Times reports. The Times notes the committee did not recommend inoculating some 10 million other workers, such as law enforcement officers, fire fighters and paramedics, who also might be first responders in a bioterrorist attack (Altman, New York Times, 10/17). Under the recommendation, every hospital with a "respiratory isolation" room, which prevents air from inside the room from circulating to other parts of the hospital, would designate a "smallpox care team" made up of 15 emergency room doctors and nurses; 15 intensive unit care nurses; several medical specialists, such as dermatologists and lung disease experts; and other staff, including respiratory therapists and X-ray technicians. About half of U.S. hospitals would be affected initially, although eventually nearly all would be expected to assign smallpox responders, according to Committee Chair John Modlin of Dartmouth Medical School (Brown, Washington Post, 10/17).

In the event of an attack, staff members who volunteered to be immunized would be required to work in shifts to care for people infected with smallpox for the entire first week of an outbreak. The first wave of health care workers expected to be vaccinated would be those who already received the vaccine prior to 1972, when the federal government halted the smallpox vaccination program. According to the panel's recommendation, workers should be asked if they are pregnant, have HIV/AIDS or if their immune system is compromised in any way. However, the advisers did not recommend requiring HIV or pregnancy tests before administering the vaccine (New York Times, 10/17). The Philadelphia Inquirer reports that the panel altered its initial recommendation to vaccinate between 10,000 and 20,000 health care workers "because of more study and feedback" (McCullough, Philadelphia Inquirer, 10/17).

According to the Times, the government typically follows ACIP recommendations, but in the case of smallpox, President Bush has received several different vaccination proposals (New York Times, 10/17). On June 20, ACIP 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 to address "any suspected smallpox cases" (California Healthline, 6/21). HHS Secretary Tommy Thompson on Sept. 3 sent Bush a proposal for a "multiphase smallpox vaccination program" under which as many as 500,000 public health workers would receive the vaccine in preparation for a bioterrorist attack (Washington Post, 9/4). In addition, CDC, HHS and NIH officials earlier this month said they support a multi-phase vaccination strategy, beginning with 500,000 people at "greatest risk" and eventually making the smallpox vaccine available to everyone in the United States (California Healthline, 10/7). D.A. Henderson, an adviser to the HHS and Thompson, said he expects Bush to make a final announcement on a smallpox vaccination policy "in coming weeks," the Wall Street Journal reports. In the meantime, Henderson said that preparations to vaccinate selected health care workers can proceed, and vaccinations could begin as soon as early 2003 (Terhune, Wall Street Journal, 10/7).

NPR's "All Things Considered" on Wednesday reported on the debate among public health officials about the risks of smallpox vaccinations. The segment includes comments from University of Washington Professor Dr. John Neff and Public Health Policy Advisory Board Vice Chair Dr. Don Millar, who worked together on eradicating smallpox in the 1970s but now take "different view[s]" of the risks of vaccination (Knox, "All Things Considered," NPR, 10/16). The full segment is available in RealPlayer online.