Federal Government Should Suspend Smallpox Vaccinations,
Learn From Failure Of First Phase, Health Affairs Article Says

Expansion Of Effort Could Divert Public Health Agencies
From Critical Preparedness Activities

BETHESDA, Md.--The federal government should suspend its smallpox vaccination program until it first addresses such issues as why so few public health and health care workers have volunteered, according to an article published today as a Health Affairs Web exclusive.

Phase I of the program is at a "virtual standstill," with only 38,000 health care and public health employees vaccinated out of a target of 500,000 people, say Daniel J. Kuhles, assistant director of disease control with the Nassau County, New York, Department of Health, and David M. Ackman, the county's health commissioner.
Despite the difficulties, the Centers for Disease Control and Prevention has indicated that it plans to move ahead with the second phase of the program, extending smallpox vaccination to ten million first responders (fire, police, emergency medical technicians) and health care workers.

In the first phase, workers declined to be vaccinated because of reports of adverse reactions, fear of inadequate worker compensation systems, uncertainty of the true risk of attack, and belief by potential vaccinees that that they would be protected by post-exposure mass vaccination plans, according to Kuhles and Ackman, who both hold medical and master of public health degrees.

Before the CDC moves ahead with the second phase, it should first learn from the first phase, the authors say. "The CDC should suspend phase II of the smallpox vaccination program for several reasons," Kuhles and Ackman say. "First, it is unlikely that the next ten million people will be more willing to accept the vaccine than hospital and public health workers were. At least until we better understand the reasons for health workers' reluctance and take action to address these concerns, delay is the only way to avert a second failed effort.

"Second, the federal government needs to better explain the risk posed by smallpox and reconcile the difference in approach between itself and other potential terrorist targets, such as Great Britain," the authors say.

Other reasons are questions over whether Iraq possessed weapons of mass destruction, and the diversion of resources from other public health preparedness duties to smallpox vaccination.

On the latter question, the authors cite earlier Institute of Medicine reports that emphasize overall public health preparedness over a target number of vaccinees. If local health departments are involved with further vaccinations, however, it will hamper efforts to achieve overall preparedness, the authors say.

"If the government expands its vaccination efforts, the $100 million dispensed for smallpox activities in fiscal year 2003-2004 will be insufficient to cover local costs," Kuhles and Ackman say.

"Because many state and local governments face large budget deficits, proceeding to phase II would further redirect bioterrorism funding away from critical preparedness activities such as developing quarantine and isolation protocols, integrating surveillance and communication systems, logistical preparation for the Strategic National Stockpile, and recruiting and training volunteers for mass prophylaxis clinics," the authors say.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health

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©2003 Project HOPE–The People-to-People Health Foundation, Inc.