The Bush administration previously announced that military personnel and health care workers would be among the first to receive the smallpox vaccine. Next in line would be first-responders, including police and fire workers. Despite concerns that the vaccination poses notable health risks, federal officials have now revealed a proposal for how Americans will be vaccinated against smallpox.

Vaccination plans from 50 states and four major cities have been evaluated by the Centers for Disease Control and Prevention (CDC), and half have been accepted. Further, of the 500,000 people expected to become among the first vaccine candidates, 430,000 individuals have been identified.

In December, 100 military doctors and nurses received the vaccine, and smallpox injections of health care workers could start mid-January. The CDC asked an Institute of Medicine (IOM) panel to help put the vaccination plan into effect.

Among panel members’ concerns were that the plan was being initiated too quickly and that politics were overriding safety, as no information has been given as to the risk of a smallpox attack.

Further, the smallpox vaccine poses the risk of infecting those immunized with the disease, in addition to some relatively rare, but serious and potentially fatal, side effects. Several groups of people, including the elderly, pregnant women, children, those with skin conditions like eczema, and those with weakened immune systems are advised against receiving the vaccine.

The CDC mentioned that anyone could refuse the vaccine, and vaccinees will receive information on the vaccine and side effects and be advised to be tested for pregnancy, AIDS, and other related conditions, and to determine if household members have any of those conditions, prior to vaccination. So far, 37 percent of those screened for the disease in the U.S. military turned down the vaccine because of contraindications.

Data from the first round of vaccinees will be collected and used to gauge risk to the general public. However, as recent studies have shown, it is likely not wise and unnecessary to administer widespread smallpox vaccinations.

In one study, researchers evaluated several bioterrorism scenarios and found that it may be beneficial to vaccinate health care and emergency workers. However, they said that vaccinating the general pubic could cause more harm than good, as vaccination makes some people very ill and can kill one to two people out of every million vaccinated.

One smallpox expert said that isolating the victim and quickly vaccinating those providing care would be effective in stopping transmission. He stated that if the United States set up a system to quickly isolate and treat those infected with the disease, no more than 15,000 people would need to be vaccinated. He went on to say that while a terrorist attack of smallpox could cause a short outbreak of the disease along with some deaths, a widespread vaccination policy would provide little protection against this threat and poses a substantial risk of deaths from vaccination complications.

Reuters December 20, 2002