President’s smallpox vaccination plan covers several phases

President Bush’s smallpox vaccination plan projects a phased program that starts with those most likely to come in contact with the smallpox virus first and then proceeds to people in the general population.

Initially, the smallpox vaccination was offered to approximately 500,000 military personnel located in high-threat areas, some 20,000 State Department employees working in U.S. embassies in the Middle East, and approximately 450,000 members of civilian smallpox response teams — people most likely to come in contact with a contagious smallpox patient, including people who work in hospital emergency departments (ED) and people on public health teams who would investigate suspicious cases of smallpox. Phase 2 covers approximately 10 million additional people who work in hospital intensive care units, infectious disease specialists, dermatologists, and first responders, including police officers, firefighters, and paramedics.

Secretary of Health and Human Services Tommy Thompson said his agency worked with state officials to decide who should be on the smallpox response teams.

Julie Gerberding, director for the Centers for Disease Control and Prevention, said that several thousand clinicians and public health officials received several hours of training in how to organize and conduct vaccination clinics, how to monitor side effects, how to safely store the vaccine, and other logistic elements necessary for the program to be conducted safely.

Ms. Gerberding said two types of response teams were envisioned. The first, known as public health response teams, consist of public health officials, doctors with special knowledge about skin conditions and smallpox, and disease detectives who will help understand the cause and source of an exposure. These teams may also include emergency medical personnel who help transport initial cases to treatment facilities and perform other tasks.

The second group, known as health care delivery system response teams, includes not only clinicians but also other hospital workers necessary to take care of an affected patient over a period of time, such as ED doctors, critical care physicians, infectious disease and dermatology specialists, housekeepers, some laundry workers, people who deliver services in intensive care units, and any others who are likely to come into direct contact with a patient with smallpox during their course of treatment.

Ms. Gerberding said the effort going into smallpox vaccination programs "is actually enhancing our entire preparedness system that we’re using to respond to all kinds of terrorism threats as well as other public health emergencies. So our capacity to detect and mount large-scale responses to emerging health threats has certainly been enhanced through this whole effort. As a result, we can respond not only to the agents of bioterrorism, but also to other deadly diseases.

"This is a challenging endeavor, and there are going to be some bumps in the road," she said. "We expect to learn some lessons as we go forward, and we intend to be flexible, adaptive, and responsive. We will also have ongoing communication with our partners and the public, and we seek suggestions that strengthen our efforts and enhance our success."

(Download information from