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Last Updated

12 May 2003

Source: New York Times, May 12, 2003


Missing the Smallpox Goal

When the Bush administration announced plans last year to vaccinate some 500,000 health workers and then 10 million emergency responders and other health personnel against smallpox, we welcomed the initiative. With the World Trade Center attack and anthrax mailings still in mind, it seemed like a reasonable step toward protecting the nation against a possible bioterror attack. We still believe that the more health workers vaccinated the better, but the vaccination campaign has encountered such difficulties and is so far from meeting its goals that a reassessment is now in order.

There is little doubt that a vaccination campaign of some scope is desirable. The SARS epidemic offers dramatic proof of what can happen when health workers are unprotected against a contagious disease. Many health workers have become infected after treating SARS patients and then spread the virus to others, forcing some hospitals to shut down or sharply curtail their services in an effort to contain what is still a relatively limited epidemic. Just imagine what a disaster it would be if a smallpox outbreak occurred and major health institutions became centers for spreading the disease or were forced to close.

The prime goal of the vaccination campaign remains valid to protect enough health workers to investigate any outbreak of smallpox, care for the victims and vaccinate others in danger of being infected. The only issue is how large the cadre of vaccinated personnel needs to be. The initial goal of 500,000 was always a bit arbitrary and now seems wildly unrealistic. With the program slowed by resistance in the medical community and fights over liability and compensation, only about 36,000 people have thus far been vaccinated.

Federal health officials are now suggesting that perhaps 50,000 vaccinated health workers will be enough to do the job. A thorough reassessment and clear public explanation of the minimal requirement is urgently needed, not only for the first phase of health workers but also for the much larger second phase.

The campaign is proving a lot more costly than anticipated. Federal officials initially estimated it would cost $13 to administer the vaccine to each recipient, but surveys of state and local health agencies have pegged the average cost at more than $200. Some health agencies say they have had to divert staff and resources from other vital programs to carry out the smallpox campaign. That problem needs careful monitoring. With state and local governments facing enormous deficits, it would be a tragedy if federal bioterrorism programs inadvertently compounded their problems.

Meanwhile, federal officials are wisely pushing the states to demonstrate workable plans for detecting and coping with any bioterror attack after it occurs. That is even more important than having large numbers of personnel vaccinated in advance.