The group also cautioned that more preparation is necessary to ready the U.S. for a possible bioterror attack.
“Smallpox is not the only threat to the public health and vaccination is not the only tool for smallpox preparation,” Dr. Brian Strom, a professor at the University of Pennsylvania School of Medicine and chair of the committee, told a telephone news briefing.
The Institute of Medicine, an independent organization that advises the federal government on health matters, organized the committee and sent its findings to the Centers for Disease Control and Prevention.
The committee concluded that vaccinating the general public could strain health agencies’ budgets and staff. It urged that the CDC first do surveys to determine public demand for the vaccine and find out what resources would be required to meet that need.
Vaccines for the public should be offered only through carefully controlled clinical programs, the report found, because the vaccine carries greater risks than other vaccines.
The smallpox vaccine uses a live virus related to smallpox called vaccinia. In rare cases, it can cause serious side effects, ranging from a rash to a swelling of the brain called encephalitis. It is estimated that one or two people per million who are inoculated will die from adverse reactions.
Virus from the vaccination site can also spread to other people, perhaps causing disease in those with damaged immune systems — such as cancer and AIDS patients.
As part of the preparation for a bioterror attack, the committee recommended that the CDC 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 any attack.
The committee also recommended that the CDC draft possible attack scenarios so hospitals and communities can ready response plans.
Dr. Ray Strikas, CDC’s director of smallpox preparedness response, told the Associated Press that the agency had no detailed response to the report because it is still under review. He said the CDC looks forward to working with committee members in setting performance standards for response programs.
The Bush administration in December 2002 launched a plan to vaccinate 500,000 military personnel and an equal number of health and emergency workers. The 500,000 health workers would make up the front-line response in case of attack. Under the president’s initial plan, the government eventually planned to inoculate a million health care professionals.
So far, some 38,000 civilian health care workers and more than 450,000 military personnel have been vaccinated. Many health care workers have resisted getting the shots out of concern over side effects.
Strom praised the CDC for its efforts to increase the nation’s preparedness for a potential smallpox attack, but added that, “we need to begin to shift the focus away from vaccination toward preparedness in general.”
Preparation for an attack requires more than vaccinations, the report cautioned.
“It includes planning for a range of possible scenarios, including contingencies for crowd control, quarantine, and isolation; training, retraining, and management of response teams; education and training of health care providers, emergency responders, and many others to facilitate rapid surveillance, reporting, and notification; planning and coordination with many partners, including some at the state and federal level; and testing and continuous improvement of plans,” the report stated.
The report also said combining smallpox preparedness with overall public health preparations for a variety of threats would strengthen the public health system and avoid readying it for one threat at the expense of being able to meet another.