Opportunity Costs

The committee is concerned and heard concerns from CDC’s state and local partners that the smallpox vaccination program will incur great costs that are hard to document (AHA, 2002; ANA, 2002; Burstein, 2002; Connolly, 2002a, 2002b; Hardy, 2002; NACCHO, 2002; Altman and O’Connor, 2003; Associated Press, 2003; Mitchell, 2003; Richmond, 2003)—these costs include items such as:

  • fewer resources (e.g., time, staffing, money, public service announcements, etc.) for public health programs than planned, due to the needs of the smallpox program, which could delay the development of plans for dealing with a smallpox release;

  • hospitals’ costs to enhance bioterrorism preparedness and response capabilities, often with limited financial assistance from the federal, state, or local governments;

  • negative effects on the public’s perceptions of inoculations in general due to misunderstanding of the special characteristics of the smallpox vaccine; and

  • medical errors that occur because of short-staffing due to absenteeism subsequent to vaccine-related illness (Nakamura and Weiss, 2002).

The committee recommends that CDC work with their public health partners to document as well as possible the true costs of the smallpox program. The committee has no specific recommendations at this time on how to do this, but a concerted effort to assess these costs is important and could help in shaping the smallpox immunization program as it expands.

SPECIFIC CONSIDERATIONS

Informed Consent Process

As noted above, the committee believes that it should be recognized that the pre-event smallpox vaccination program is not a typical public health program, but rather, a matter of national public health preparedness against a national security threat. Given the difficulty in characterizing or quantifying the actual threat, the benefit to vaccinees is unknown, and this reality should be recognized and communicated to potential vaccinees to enable an informed decision regarding vaccination. Health care workers who are volunteering to be a part of smallpox response teams are making a decision for the public good, as well as for personal protection. Some data, as well as reports from media sources, indicate that the potential personal benefit (i.e., protection) is an important factor in health care worker deci-



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