the committee has been developing its report, and it is possible that at the time of the report’s release, CDC will have already made changes congruent with some of our recommendations.

At the time the committee met on February 13, 2003, the vaccination program was 3 weeks old. Approximately 1,000 vaccinations had taken place in the civilian population, and the military program reported well over 100,000. Within 1 week, the number of civilian vaccinations had more than doubled. As of March 14, 2003, the total number of civilians vaccinated by the states was nearly 22,000 (CDC, 2003d). On March 6, 2003, the secretary of the Department of Health and Human Services (DHHS) announced a proposal for a compensation program for vaccinees who are injured as a result of receiving the smallpox vaccine. On the same day, states were instructed that they could expand voluntary vaccination to all health care workers and first responders (e.g., firefighters, law enforcement, and emergency workers) as a continuation of the first phase rather than as a distinct second phase of vaccinations (Connolly, 2003c). Also, vaccinations were to be offered to certain federal employees (e.g., Commissioned Corps of the Public Health Service, CDC staff). Despite the plan for expansion, many impediments to participation remain as they were in December 2002. Many health care workers and the officials of health agencies or organizations:

• do not consider themselves (or their institutions) at high risk of a smallpox attack;

• are confident that, in the event of an attack, vaccinations can take place quickly enough to protect them and the public;

• are troubled about the possibility, however small, of transmitting the virus to their patients, particularly those who are immunosuppressed;

• remain concerned about the lack of comprehensive, no-fault adverse event compensation (The committee is pleased that the administration has attempted to remove this barrier by proposing a smallpox vaccination compensation plan to Congress, in the hope that a resolution of this issue will lead to greater willingness to receive the vaccine. However, at the time of this writing, Congress had not yet made a decision regarding compensation.); and

• remain concerned about the implications of possible administrative leave or duty reassignment.

In this report, the committee addresses several important issues: the vaccination program’s need for evaluation (including program safety) and