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On December 13, 2002, President Bush announced his policy on pre-event vaccination against smallpox. The first phase included vaccination of troops beginning in December and vaccination of a core of approximately 500,000 volunteer front-line health workers beginning after January 24, 2003. He proposed a second stage begin as promptly as possible thereafter to offer vaccination to 5 to 10 million “first responders,” including police, firefighters, and emergency medical personnel. As a third phase, he stated his intent to subsequently offer, but not necessarily recommend, vaccination to the general public who request protection.1 Eighteen months earlier in June 2001, The Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention (CDC) had concluded that “preexposure vaccination is not recommended for any group other than laboratory or medical personnel working with non-highly attenuated Orthopoxviruses.”2 This radical change in policy evolved from the terrorist attacks of 9/11 and the subsequent bioterrorist attacks with anthrax.
Two murky issues cloud the new policy. How great is the threat of an attack with smallpox virus? How great is the risk of vaccination of a large virgin population?
The threat of smallpox.
The last case of natural human smallpox was observed in Somalia in 1977. No nonhuman reservoir of virus is known. On May 8, 1980, the World Health Assembly …
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