In Shift of Stance, HHS, CDC, NIH Officials Say They Support Smallpox Vaccine for All Americans

In a "profound shift in thinking" from previous recommendations, CDC, HHS and NIH officials on Oct. 4 said they support making the smallpox vaccine available to everyone in the United States once it is licensed by the FDA, the Washington Post reports. The voluntary vaccination plan calls for "ever-expanding access to vaccine" and would proceed in three stages. First, about 500,000 people at "greatest risk" for contracting the disease -- including public health investigators, emergency room workers and hospital janitors and security guards -- would receive the vaccine. Then about 7.5 million medical workers and three million firefighters, police officers and rescue personnel would be inoculated. Finally, the vaccine would be available to the general public, possibly by early 2004 (Washington Post, 10/5). "We live in a society that values individual choice," CDC Director Dr. Julie Gerberding said at an HHS briefing, adding that the government should "let people make up their own mind" about receiving the vaccine (Kemper, Los Angeles Times, 10/5). Gerberding "cautioned" that the inoculation plan is not an outright recommendation that people should receive the vaccine, but rather that they should "weig[h] the risks and benefits for themselves," the New York Times reports (Altman/Gay Stolberg, New York Times, 10/5). In addition, officials noted that their proposal does not necessarily reflect the views of President Bush, who has not stated his preferences on the issue. "We represent the public health perspective, but the decision also has to be made on the grounds of homeland security and national security," Gerberding said (Los Angeles Times, 10/5). White House spokesperson Scott McClellan said a vaccination policy is "under review." Developing the policy is "extremely difficult" given the risks of mass smallpox vaccination, Jerome Hauer, HHS assistant secretary for emergency health preparedness, said (Washington Post, 10/5). According to government estimates, for every one million people who receive the smallpox vaccine, about 15 would develop "life-threatening conditions" and one or two would die (Los Angeles Times, 10/5).

Ring vs. Mass Vaccination
The proposal "goes far beyond" an earlier proposal from the CDC's Advisory Committee on Immunization Practices, which suggested that only medical investigators and first responders should be inoculated before a smallpox attack occurred, USA Today reports. That report suggested all other people receive the vaccine through a "ring-vaccination" policy, in which people who first contract smallpox following an attack would be isolated and vaccinated, followed by an outwardly expanding series of vaccinations for people who came into contact with those infected (Manning/Sternberg, USA Today, 10/7). The AP/Nando Times reports that although the White House has not officially announced its position on the issue, "top Bush administration officials, including Vice President Dick Cheney" support a mass vaccination of a majority of people in the United States before a potential attack occurs (Meckler, AP/Nando Times, 10/5). However, the American Academy of Pediatrics today released a policy statement disagreeing with the mass-vaccination approach, calling for ring vaccination instead. Smallpox vaccines "are not nearly as safe as other vaccinations we routinely use, and they're for diseases that are around, unlike smallpox," Robert Baltimore of Yale Medical School and a co-author of the statement, said (Elias, USA Today, 10/7).

Reaction
The following is a summary of opinion and editorial reaction to the new vaccination recommendations.

• Sen. Judd Gregg (R-N.H.), Washington Post: The plan announced Oct. 4 is a "significant improvement" over previous proposals, and a smallpox vaccine, once licensed by the FDA, "should be made available to every person in America," Gregg, ranking member of the Committee on Health, Education, Labor and Pensions, writes in a Washington Post opinion piece. The vaccine should be available at "nominal or no cost," Gregg writes, and people should consult with their doctors to decide if inoculation is proper for them and their families. Gregg concludes, "In a system that values personal liberty and freedom, the decision to be vaccinated against the smallpox virus should be made by individuals and their doctors -- not the federal government" (Gregg, Washington Post, 10/6).
  
• Washington Times: "It is not clear" that the government could successfully inoculate all people in the United States after a smallpox attack has already occurred, and "[o]ffering Americans pre-attack vaccinations would seem to be a far better option," the Washington Times states in an editorial. While no one knows if the benefits of pre-attack vaccinations would outweigh the costs, "it is certain that the consequences of a smallpox attack would be terrible." For that reason, the Times concludes that "each American should be given the chance to make his and her own informed choice between the risks of preemptive smallpox vaccination and the catastrophic consequences of smallpox attack" (Washington Times, 10/5).
  

Media Coverage
NPR's "Weekend Edition Saturday" reported on the smallpox vaccination recommendation (Knox, "Weekend Edition," NPR, 10/5). The full segment is available in RealPlayer Audio online.

ABCNews' "World News Tonight" Friday also reported on the recommendation (Stark, "World News Tonight," ABC, 10/4). A video clip of the segment is available in RealPlayer online.