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2 Policy Context of Smallpox Preparedness
Pages 22-38

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From page 22...
... With eradication came a series of policy changes that brought to an end general vaccination against smallpox and the production of smallpox vaccine in the United States. In 1980, the Advisory Committee on Immunization Practices (ACIP)
From page 23...
... began to assess the status of smallpox vaccine stocks and initiated planning and activities for increasing the vaccine stocks, and CDC, the National Institutes of Health, and the Department of Defense intensified their work in the development of new vaccines (such as safer or less reactogenic smallpox vaccines) to prepare effectively for a potential smallpox virus release (Cohen and Marshall, 2001)
From page 24...
... . CDC also adopted a two-pronged approach to strengthening the ability of the nation's state and local public health agencies to respond effectively to a smallpox virus release: pre-event planning and activities (largely involving the advance vaccination of specific types of personnel who would respond to an attack)
From page 25...
... On November 22, 2002, CDC issued Supplemental Guidance for Planning and Implementing the National Smallpox Vaccination Program; this guidance added specific smallpox vaccination and planning requirements to the Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism. States, territories, three municipalities and the District of Columbia were asked to submit their pre-event vaccination plans by December 9, 2002 (CDC, 2002e)
From page 26...
... However, the nature of the decisions about the smallpox vaccination program use of a vaccine with known potential complications to protect against an eradicated disease has brought into question the evidence, data, and reasoning that contributed to the fashioning of the final policy. Rationale for the Policy The smallpox vaccination policy announced in December 2002 was unusual in bringing together a national security program with a public health strategy.
From page 27...
... . The groups targeted for such limited vaccination were later defined in greater detail as smallpox public health response teams and smallpox health care teams, or people who would conduct public health investigation and implement other public health activities and those who would provide medical care to people infected with smallpox virus (CDC, 2002c)
From page 28...
... (This is a negative recommendation by ACIP, but there is choice by members of the public.) Option 3: In the absence of a confirmed smallpox case or a confirmed smallpox bioterrorism attack, ACIP recommendations for smallpox vaccine do not now include members of the general public; however, members of the general pub lic may choose to be vaccinated.
From page 29...
... Reported Viewpoints of Top Officials As ACIP deliberated and DHHS and CDC discussed pre-event vaccination options and their ramifications, information about the discussion and debate occurring within the administration was also relayed in the mass media. President Bush expressed concern about immunizing the general public before a smallpox virus release (pre-event)
From page 30...
... In June 2002, CDC held a series of public forums in New York, San Francisco, St. Louis, and San Antonio, to inform health professionals and the general public about smallpox and smallpox vaccine, to discuss the risks and benefits of reviving smallpox vaccination, and to solicit opinions on the use of smallpox vaccine before and after a potential smallpox virus release (Serafini, 2002)
From page 31...
... . The New York Times also reported that at the October 4, 2002, news conference at DHHS, members of the press learned that the federal government was planning to make the smallpox vaccine available eventually to all Americans who wanted it (Altman, 2002b)
From page 32...
... It recommended the vaccination of smallpox vaccinators (who would then vaccinate the public health and health care response teams) to reduce the possibility of inadvertent inoculation (and to contribute to the development of a cadre of experienced vaccinators who could be deployed immediately in the event of a smallpox virus release)
From page 33...
... . However, ACIP Chairperson John Modlin and members of ACIP explained that the first, smaller number was based on the assumption that only staff at designated "smallpox hospitals" would be vaccinated (in addition to public health response teams)
From page 34...
... When the smallpox vaccination program was announced, there was no specific funding linked with it; the November 2002 planning guidelines provided by CDC stated that the vaccination program would be funded by the already disbursed bioterrorism funds provided to grantees under the CDC cooperative agreement. After state and local public health agencies began to express concerns about the costs of the smallpox vaccination program and about their having to absorb a substantial proportion of funding earmarked for more general bioterrorism preparedness, in addition to other resources, the federal government provided $100 million in one-time supplemental funding for smallpox-related activities (DHHS, 2003b)
From page 35...
... 2002a, June 21. Limited Smallpox Vaccine Use Eyed; Expert Panel Rejects Mass Inoculations.
From page 36...
... 2002c. CDC Telebriefing Transcript: ACIP Smallpox Vaccine Meeting Briefing, Octo ber 17, 2002.
From page 37...
... 2002, October 5. Public Access to Smallpox Vaccine Is Urged; People Should Be Allowed to Opt in After Emergency Workers Are Inoculated, Officials Say.
From page 38...
... 2002. Smallpox vaccinations: who should decide?


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