Panel comes out against smallpox vaccinations for public

WASHINGTON -- A scientific panel recommended against smallpox vaccinations for the public Tuesday because of concerns about side effects -- both for those receiving the shots and others in contact with them.

The focus of smallpox preparedness should move away from the number of people vaccinated to concentrate on who needs to be prepared for a possible smallpox attack by terrorists and how communities should respond, the panel said.

The efforts of the Centers for Disease Control and Prevention to ready the nation for bioterrorism won praise from Brian Strom of the University of Pennsylvania, chairman of the Institute of Medicine committee that prepared the report.

"That said, we need to begin to shift the focus away from vaccination toward preparedness in general," Strom said in a telephone briefing on the new report.

Still under study

Dr. Ray Strikas, CDC's director of smallpox preparedness response, said the agency had no detailed response to the report because it is still under study. He said the CDC looks forward to working with panel members in setting performance standards for response programs.

The Bush administration launched a program last year requiring smallpox vaccination for about 500,000 military personnel and offering a voluntary program to immunize several million medical and emergency personnel who would be in immediate danger in a biological attack.

The civilian program has been lagging, however, with 38,004 people vaccinated as of July 25. Many health-care workers have resisted getting the shots out of concern over side effects.

That concern was expressed by the committee in urging that the vaccine not be offered to the public except in clinical trials because it can cause illness in some people.

The vaccine is not currently available to the public, but President Bush has urged that health departments try to accommodate individuals who insist on it. Before the 1970s, smallpox vaccine was commonly given to children, but how long that protection lasts is in question and studies are under way to determine whether vaccinated people are still protected.

Strom said that turning attention more toward general preparedness involves such things as determining who in a community will be first to respond to any attack and making sure they are trained. Other considerations, he said, might include making sure physicians who cross state lines to assist are licensed in the state they visit.

Further committee meetings are planned hear other preparedness proposals, he added.

As part of the preparation for a bioterror attack, the committee said, CDC should help create registries of health care workers and others who have been vaccinated, including former members of the military and reservists.

Trained and vaccinated military personnel will be returning to civilian life, and health workers change jobs and move to new communities, Strom said. Having a registry of these people would be vital in organizing a response to an attack, he said.

The committee was organized by the Institute of Medicine, a sister agency of the National Academy of Sciences, which is chartered to provide advice to the government on medical policy matters.

"Smallpox is not the only threat to the nation's health, and vaccination is not the only tool for preparedness," Strom said. "The focus should continue to be on defining preparedness in each state or region and determining what else is needed to be fully ready."

The committee added that vaccinating the general public could strain health agencies' budgets and staff. It urged that CDC do surveys to determine public demand for the vaccine and find out what resources are available to meet that need.

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