Smallpox vaccine gets extended to all

WASHINGTON -- President Bush said Wednesday he will make the smallpox vaccine available to all Americans on a voluntary basis to guard against a bioterrorist attack.

As a first step, the president will order military personnel to begin getting smallpox vaccinations and will launch a plan to offer the vaccine to emergency medical workers and response teams within weeks, senior administration officials said.

The general public will be offered the vaccine on a voluntary basis as soon as large stockpiles are licensed, probably early in 2004. Bush will announce his plan Friday.

Smallpox was declared eradicated from the world in 1980, but experts fear that it could be used by hostile nations or terrorist groups in an attack. Intelligence experts believe that four nations, including Iraq, have unauthorized stocks of the virus.

Bush, who struggled with the decision for months, had to weigh the dangers of the disease against the risks associated with the vaccine.

He talked about the broad outlines of his plan Wednesday on ABC's "World News Tonight."

"I think it ought to be voluntary," Bush said of the civilian part of the plan. "It's going to be very important for us to make sure there's ample information for people to make a wise decision."

First lady Laura Bush, asked whether she would want her 21-year-old twin daughters inoculated against smallpox, replied:

"If the vaccine were available, which I think it will be, I would feel like that was certainly safe for them to do. ... I know there's a slight risk -- that's what people will weigh when they make the decision whether or not to have their children vaccinated."

Progress since summer

The decision represents remarkable progress since summer, when federal health advisers were recommending a much more limited vaccination program, perhaps totaling 15,000 to 20,000 people. Those plans scaled up quickly amid concerns about war with Iraq.

Bush is expected to recommend smallpox vaccinations for about 500,000 emergency workers and smallpox response teams that would investigate suspected cases. The White House officials said a similar number of military personnel would be ordered to get the shots.

It wasn't clear whether all military personnel being deployed to the Gulf region for possible war with Iraq would receive the shots.

Eventually, the vaccine will be made available to all Americans, though the government will probably not encourage them to get it, according to senior officials.

Federal health officials are preparing a massive education effort to help people decide whether to be vaccinated. Polls, including one released Wednesday, show most people would get the vaccine if given the chance. But health officials fear that many people do not adequately understand the risks.

"The success of a vaccination program is going to depend on our success in communicating with people accurately and openly," Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said Wednesday. That includes explaining the risks of the disease -- and of the vaccine.

Ended in 1972

Routine smallpox vaccinations ended in the United States in 1972, meaning nearly half the population is without any protection from the virus. Health officials aren't sure whether those vaccinated decades ago are still protected from the disease.

The new vaccine would be offered in stages, beginning with those most likely to encounter a smallpox patient. That includes people on state response teams, who would investigate suspicious cases, and people who work in hospital emergency rooms.

In a second phase of vaccination, the shot could be offered to other health care workers and emergency responders such as police, fire and emergency medical technicians. Federal officials probably will recommend the shot for these roughly 10 million people, too.

The officials are working with states and hospitals to identify those who most need to be inoculated.

The vaccine has risks of its own. Based on studies from the 1960s, experts estimate that 15 out of every 1 million people vaccinated for the first time will face life-threatening complications, and one or two will die. Reactions are less common for those being revaccinated.

Using these data, vaccinating the nation could lead to nearly 3,000 life-threatening complications and at least 170 deaths.

But the administration concluded that the government could not make the vaccine available to some people and not others who may want it.

Once vaccinations begin, it will be important that certain people not get the vaccine because they face greater risk of side effects. Among them: people with compromised immune systems, including cancer patients, organ transplant recipients and people with HIV; pregnant women; and people with a history of eczema.

People who live with others who have these conditions also should not be vaccinated, because the sometimes dangerous live virus used in the vaccine can escape and infect others.