The need to prepare for an attack is just as urgent, Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said Wednesday. Federal officials must work hard to explain this to state and local health officials, who have been slow to get vaccinated against smallpox, partly because they do not believe the virus poses a real threat, she added.
"It concerns me very much that people have been lulled into a false sense of security about the smallpox threat," Gerberding said in an interview. "Nothing has changed our estimate about the threat of smallpox."
She added that plans for the vaccination program began last summer and were not tied to Iraq. While a bioterror attack with the virus was not considered likely, she said, "the consequences of an attack were so severe we had to be prepared ... no matter what happened in Iraq."
Officials had aimed to vaccinate hundreds of thousands of hospital and public health workers and then millions of police, fire and other emergency responders by now. But nearly six months into the program, fewer than 40,000 people have received the shots. Over the past month, the program has come to a virtual standstill with fewer than 100 — sometimes fewer than 50 — people vaccinated each week.
Federal officials had hoped that the creation of a compensation package for people injured by the vaccine, which carries rare but serious risks, would jump start the program, but it has not.
Gerberding said she expects the vaccination numbers to increase after states are given money to help pay for their programs. Earlier this year, states complained that they did not have money to run vaccination clinics, but they will come August.
"This is an accountability issue," Gerberding said. "We have an expectation, and they have a responsibility."
She said that federal health officials are still working to make the smallpox vaccine available to the general public, though it's unlikely to be offered by this summer, as they had originally hoped. She said CDC officials are talking with various contractors who could offer the vaccine nationally, but there is no timetable. It's still possible that the general public will have to wait until the vaccine is licensed, probably next summer.
The vaccine is not recommended for the general public, because officials believe the dangers of the vaccine outweigh the risk of encountering the disease. But President Bush promised to make it available to those who insist on being vaccinated.
"I do get e-mails from people who say they're waiting for their vaccine," Gerberding said, but she added, "There's certainly no large demand for it that I'm aware of it at this point in time."
People can get vaccinated now by signing up for one of several clinical trials that are testing various versions of the smallpox vaccine.
Officials say the delay results partly from the amount of work required in trying to vaccinate the hospital workers and others who would care for patients if there were an attack with the virus.
"We're not going to distract attention away from that to initiate a whole new program," she said.
A combination of events has kept people from getting the vaccine, said Michael Osterholm of the University of Minnesota, a national bioterrorism expert and federal adviser. Among them: perception of a diminished threat, questions about compensation for injuries and unexpected heart problems in some people who have been vaccinated.
The program is like an ocean liner, he said.
"It takes a long time to get it moving, and if it hits an abutment it takes a short time to stop it," he said. "Fortunately, it didn't sink. Now we have to start it up again, and that's what's happening."
By Laura Meckler