Despite worry about the possibility of a terrorist attack using smallpox, a panel of scientists is recommending that members of the general public not get vaccinated against the disease unless they are part of a carefully monitored research study.
The Institute of Medicine committee cited potential risks from the vaccine, for those receiving it as well as people with whom they have close contact. The committee was sending its recommendation to the Centers for Disease Control and Prevention on Tuesday.
Currently the Bush administration is requiring smallpox vaccination for about 500,000 military personnel and is conducting a voluntary program seeking 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 just 38,004 people vaccinated as of July 25. Many healthcare workers have resisted getting the shots out of concern over side effects.
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. Those people could help organize a prompt response to bioterror attack, said the panel.
Committee chairman Brian Strom of the University of Pennsylvania praised the CDC for its efforts to increase the nation's preparedness for a potential smallpox attack.
"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.
The focus shouldn't be on numbers, he said, the focus needs to be on who needs to be prepared to respond.
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.
The report also said blending smallpox preparedness into overall public health preparations for a variety of threats will help strengthen the public health system and avoid readying for one threat at the expense of being able to meet another.
"Preparedness for an attack using smallpox or any other bioterrorist agent depends as much on the availability of a good response plan and the ability to quickly coordinate responders as it does on the number of responders who have been vaccinated in advance," said Strom.
"Smallpox is not the only threat to the nation's health, and vaccination is not the only tool for preparedness. The focus should continue to be on defining preparedness in each state or region and determining what else is needed to be fully ready," he said.
The CDC has urged states to develop registries of health and security personnel whose occupations put them at greater risk of exposure in the event of a smallpox release.
The committee suggested those lists also include former military service members and reservists vaccinated or trained in smallpox response; people who could be quickly mobilized to respond to an outbreak.
When the smallpox vaccination program was launched it did not include a recommendation that the general public be included. However, it was suggested that public health agencies try to accommodate members of the public who insisted on receiving the vaccine.
The committee concluded that vaccinating the general public could strain health agencies' budgets and staff. It urged that CDC first do surveys to determine public demand for the vaccine and find out what resources are available to meet that need.
Vaccines for the public should be offered only through carefully controlled clinical programs, the report said, because the vaccine carries greater risks than other vaccines. Rashes, a couple of cases of encephalitis and a heart infection have been reported in the military vaccination program. In addition, a live virus called vaccinia is used in the shots and can cause illness in both recipients and people they associated closely with.
The Institute of Medicine report is the fourth in a series of studies monitoring CDC's smallpox preparedness program.
Its release comes a day after a study by U.S. and Canadian researchers concluded that leaving smallpox vaccinations up to individual decision could result in many more deaths in the event of terrorist attack with the germs, according to a new study.
The result could be an increase of between 22 percent and 54 percent in deaths after an attack, according to a mathematical model developed by U.S. and Canadian researchers. The researchers concluded that, because of the fear of side effects, too few members of the public would seek the vaccine.