- The Washington Times - Thursday, November 28, 2002

President Bush is expected to order smallpox vaccinations for 500,000 U.S. military personnel and just as many civilian medical workers as a precaution against a biological terrorist attack, White House officials said yesterday.
The vaccine eventually will be made available as an option for all Americans, though they will not be encouraged to get it, senior administration officials say.
The officials, who spoke on the condition of anonymity, said Mr. Bush does not intend to announce his policy for at least a week and details could change.
Barring a change of plans, Mr. Bush plans to order vaccines for a half-million military personnel, the officials said. On the civilian side, where the president's thinking is less certain, he is inclined to accept recommendations to order vaccines for 510,000 medical workers, the sources said.
Questions about who should be offered the vaccine, which carries risks including death, and whether to recommend it or just make it available have occupied federal health officials and now the White House for months.
Smallpox was eliminated worldwide two decades ago, but specialists fear the contagious, often fatal disease could return through an attack by terrorists or a hostile nation.
Routine vaccinations ended in the United States in 1972. Today, nearly half the population is without any protection from the virus. Health officials aren't sure whether those vaccinated decades ago have any level of residual protection.
Under the administration's plan, the vaccine would be offered in stages, beginning with those most likely to encounter a smallpox patient. That includes people on state response teams who would investigate suspicious cases of smallpox, and those who work in hospital emergency rooms.
Federal officials were planning to recommend the shot for this group, expected to number about a half-million, said two administration officials who spoke on the condition of anonymity.
In the second phase of vaccination, the shot would be offered to other health care workers and emergency responders such as police, fire and emergency medical technicians. Federal officials probably will recommend the shot for these roughly 10 million people, too.
Federal officials plan to work with states and hospitals to identify who within that larger group must be inoculated and who may not need to be, one official said. Another explained that officials want to give states flexibility to reduce the number for whom the shot is recommended.
Plans are not complete for how the vaccine will be offered to the public, but officials do not plan to recommend it for Americans who have no particular risk of exposure.
That is because of the risk of the vaccine itself. Specialists using studies from the 1960s estimate that 15 out of every 1 million people vaccinated for the first time will face life-threatening complications, and one or two will die. Reactions are less common for those who are revaccinated.
These data show that vaccinating the nation could lead to nearly 3,000 life-threatening complications and at least 170 deaths.
But the administration has concluded that the government cannot make the vaccine available to some people and not others who also may want it, said a third administration official.
Most of the vaccine on hand has not been licensed by the Food and Drug Administration, and what is licensed will be saved for people in the first and second stages.

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