CDC recommends limits on use of smallpox vaccine

Unless a smallpox outbreak occurs, U.S. residents will not be allowed to receive the vaccine, according to a recent recommendation issued by the Centers for Disease Control and Prevention, sources told Global Security Newswire this week. Health and Human Services Secretary Tommy Thompson is now reviewing the proposed policy. The CDC and other public health experts have said the agency's recommendation for a U.S. smallpox vaccine strategy will provide enough protection without individuals attempting to be vaccinated on their own. A critic of the CDC's approach, however, said individuals had the right to make the decision whether or not to be vaccinated.

Public comments received during a recent series of forums held on U.S. vaccine policy indicated that people are supportive of reserving smallpox vaccine for emergencies only, said CDC spokesman Llelwyn Grant. He added that people also seem to feel comfortable with the proposed U.S. "ring vaccination" plan, in which officials would contain an outbreak by vaccinating people in close contact with those infected.

A senior defense policy analyst at the CATO Institute, a Washington think tank, however, said U.S. residents should be free to obtain smallpox vaccine from their physicians.

"As a taxpayer, you've already paid for this," said Charles Pena. "It belongs to you. After all, you've paid for it."

Health and Human Services controls the entire U.S. smallpox vaccine stockpile, blocking individuals' access to the supply, Pena said. The choice whether to be vaccinated should be based on whether a person has the perception of being at risk, he said, adding that such decisions should not be dictated to the public.

Any person should be able to learn about the potential side effects of the vaccine, be tested for risks and then be allowed to choose whether to be vaccinated, Pena said. If people know they could die or suffer serious side effects from the vaccine, as studies have shown, then demand would probably be low, he said.

The CDC does not expect a high level of public demand for the vaccine prior to an outbreak, Grant said. Mohammad Akhter, executive director of the American Public Health Association, agreed and said there has not been the same level of demand from the public for the smallpox vaccine as there was for Cipro during last year's anthrax attacks.

"Nobody stepped forward and said we want the vaccine now," Akhter said.

If the vaccine were made available to physicians before an outbreak, however, public fears might increase demand, Akhter said. Currently, there are only 16 to 17 million doses of vaccine available, and they must be kept on hand in the event of an outbreak, he said, adding that he is generally against distributing medicines needlessly.

"It's like taking any other medicine," Akhter said. "We didn't tell people to stock up on Cipro."

Pena challenged the CDC's claims that there is low public demand for the vaccine, citing polls in which 60 percent of those surveyed said they want the vaccine available. The CDC public forums on the vaccine were hastily put together, poorly advertised and lightly attended, hampering the agency's ability to gauge public opinion, he said.

The Advisory Committee on Immunization Practices has decided to recommend that only smallpox response teams--those who would administer the vaccine in the event of an outbreak--be prevaccinated, Grant said. If an outbreak occurred, the CDC would continue to use a ring vaccination strategy, he said.

Akhter agreed with the CDC's decision not to provide the vaccine to physicians, adding that the focus should not be on individuals.

"We need to protect our community," Akhter said. "We need to protect our nation."

Ring vaccination, however, would not be able adequately halt the rapid spread of smallpox once an outbreak began, Pena said.

"If you can remember seven people you had contact with in the last few days, I'd be surprised," he said.

The United States could take a preventive measure against smallpox by making the vaccine available to those who want it now, according to Pena. Doing so could help facilitate any future ring vaccination plan and could also serve as a deterrent to terrorists contemplating launching a biological weapons attack using smallpox, he said.

U.S. health officials' view is that they will wait until a smallpox outbreak has occurred before it will react, Pena said. "You just have to look at Sept. 11 to realize government can't be perfect."