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TUESDAY, Aug. 12, 2003 (HealthDayNews) -- Despite the threat of a possible terrorist biological attack, the risks of vaccinating millions of Americans against smallpox outweigh the benefits, a federally appointed panel of experts reports.
"We found that it did not meet the standards of medical ethics to offer the vaccine indiscriminately to the general public," says Dr. Brian Strom, chairman of the Institute of Medicine panel. "This is a disease that has not been present in the United States since 1948. We would be vaccinating people against something that doesn't exist."
The report is the latest in a series on a proposed national vaccination program. The Bush administration currently is requiring smallpox vaccination for about 500,000 military personnel and has started a voluntary program to immunize several million medical and emergency personnel who would be the first in danger of a biological attack.
That program is going very slowly, because of fears of side effects. Only 38,004 people got the shots as of July 25.
The panel concluded that any mass vaccination program should be done only as part of a carefully controlled clinical trial, says Strom, who is a professor of biostatistics and epidemiology at the University of Pennsylvania School of Medicine.
"This is a live virus vaccine, so if someone is vaccinated, there would be danger for anyone who comes in contact with him," Strom says. "While the net possibility of benefit to the public would be minuscule, the risk is real."
He adds, "The only place where the ethical balance would be correct is in a clinical trial, where society would be getting information about risk and benefit."
The focus of the smallpox vaccination effort should be on preparedness, determining who would need to be vaccinated in case of a terrorist attack, the panel report says. The report is being submitted to the federal Centers for Disease Control and Prevention.
The CDC should start preparing rosters of medical personnel who have already been vaccinated, the panel recommends, as a step towards determining who would receive the vaccine if an attack occurs. The CDC is also urged to conduct surveys to determine public demand for the vaccine and what resources are needed to meet the demand.
The CDC's decisions should consider the overall picture, Strom says. "Smallpox is not the only threat to the nation's health, and vaccination is not the only tool for preparedness," his introductory statement says. "The focus should continue to be on defining preparedness in each state or region and determining what else is needed to be fully ready."
The CDC already has asked states to prepare lists of personnel at highest risk of exposure if a smallpox attack occurs. The panel says the lists should be expanded to include personnel whose jobs have trained them in responding to such an attack.
The report was released one day after a report by Canadian and U.S. researchers said that leaving the decision to be vaccinated up to individuals, rather than organizing a program for mass vaccination, would be ineffective, because too many people would shun the vaccine out of fear of side effects.
More information
Read more about smallpox from the Center for Civilian Biodefense Strategies at Johns Hopkins University or the Centers for Disease Control and Prevention. You can read the Institute's report here.
