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Smallpox: Panel Rejects Mass Vaccination A panel of specialists responsible for advising U.S. health authorities rejected a proposal yesterday to offer smallpox vaccine to the entire U.S. population (see GSN, June 20). The panel said the vaccine’s risk of complications and fatality outweighs the risk of a terrorist smallpox attack (Lawrence Altman, New York Times, June 21). Panelists recommended that the United States offer vaccine to 20,000 health care workers who would care for initial smallpox cases if an attack occurred. Each state would designate at least one response team — including physicians, epidemiologists, investigators, lab technicians, nurses, vaccinators and possibly some law enforcement officers — to be vaccinated. Hospitals would be designated to respond to a smallpox outbreak, and certain caregivers would receive the vaccine. The panel’s recommendation would not extend smallpox vaccination to paramedics, police officers, firefighters and other first responders. Vaccination would probably not begin before October due in part to legal and procedural issues that remain, such as determining who would pay damages for people who suffer complications from the vaccine (David Brown, Washington Post, June 21). The Debate Some experts disagreed with the panel’s decision and called for offering the vaccine to the general population. People should have the right to choose whether to take the vaccine, said Charles Pena of the Cato Institute. “That’s the government deciding who gets to live,” he said (Altman, New York Times). Advocates of general vaccination have said that if a smallpox attack occurred in several places simultaneously, multiple smallpox cases could arise and overwhelm health authorities’ ability to respond. The panel decided, however, that the risks of vaccination are greater than the risk of attack based on the information at hand. “We had to base our decisions on what we were told, which is that the risk (of attack) is low,” said Natalie Smith, a member of the Advisory Committee on Immunization Practices and a California state public heath official. “We will reconsider our decision if we get information that the risk is changing.” Widespread smallpox vaccination would probably cause one death per million people vaccinated, and others would have permanent disabilities. Also, there is a small chance that a newly vaccinated person would spread smallpox to others during a short time (see GSN, Nov. 21, 2001). “You can transmit it to people who haven’t consented,” Smith said. The panel’s decision to vaccinate certain first responders, however, would be the first expansion of such vaccinations since the disease was eradicated in the late 1970s. Currently, only scientists who deal directly with the virus receive vaccinations. The panel’s decision also indicates support for the current plan to quarantine smallpox victims and vaccinate their contacts in the event of an outbreak, according to the Washington Post. Health and Human Services Secretary Tommy Thompson said he will review recommendations from the panel and other experts to develop a smallpox vaccine policy (Brown, Washington Post). For further information, see: Journal of the American Medical Association Background
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