enced the course of the vaccination program (Krupnick, 2003; Kuhles and Ackman, 2003; Manning, 2003; McNeil, 2003). The comments of legislators and other officials that may have contributed to this perception are discussed in Chapter 4.

June 2002 ACIP Meeting

In 2001, CDC asked ACIP to review the recommendations for smallpox vaccination in light of the recent anthrax attacks. ACIP met in June 2002 to review and discuss vaccination needs for smallpox readiness. At the time of the meeting, the vaccination policy options being considered (see Box 2-1) revolved around two key issues: in the pre-event scenario, identifying who, if anyone, should be vaccinated before a smallpox virus release (issue is addressed by questions 1 and 2), and in the post-event scenario, identifying what vaccination strategy should be used (that is, ring vs. mass vaccination, addressed by a third question not included in Box 2-1). The second issue, in the post-event scenario, is outside this IOM committee’s charge and will not be discussed here. ACIP achieved consensus on Option 1 for Question 1 (against recommending vaccination of the general public in the absence of a confirmed smallpox case or attack) and on Option 2 for Question 2 (for restricting pre-event vaccination of designated persons who would have direct contact with or be called upon to investigate initial cases of smallpox) (ACIP, 2003). 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). Although ACIP did not provide a target number of vaccinees at its meeting, ACIP Chairperson John Modlin suggested in a CDC telebriefing that up to 20,0004 designated smallpox response team members with specific functional roles (health care and public health response) would be an appropriate target for pre-event vaccination (Brown, 2002b; CDC, 2002b; Roos, 2002; Maguire, 2003). That recommendation reflected the most limited of the pre-event vaccination options that ACIP considered. ACIP members explained that risks related to the vaccine and what was known about the risk of attack were factors used in making the recommendation (Brown, 2002a).


The ACIP chairperson provided an estimate of 10,000-20,000. Media reports have cited the figure as either 20,000 or 15,000, the midpoint of the range. To avoid confusing the reader, “up to 20,000” will be used in this report in referring to ACIP’s initial target number for pre-event smallpox vaccination.

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