not yet approved a plan to be forwarded to the White House, but details about the probable outline of the plan continued to circulate (Connolly, 2002). According to the New York Times, D.A. Henderson, then principal science adviser to the DHHS secretary for public health preparedness, explained the federal government’s tentative new plan for a larger number of vaccinees (Broad, 2002): “We could easily be at a half-million without too much difficulty…. Wide peacetime vaccinations,” he said, “would help educate not only the nation’s medical community on the practical aspects of smallpox immunization but also the public.” The pre-event smallpox vaccination plan, believed to reflect to some extent ACIP’s June 2002 recommendations, was sent by DHHS to the White House in August 2002 (Moscoso, 2002).

By fall 2002, the administration was beginning to build a case for war against Iraq and, as discussed later in this report, that fact may have provided some of the context within which decisions regarding smallpox vaccination were made. At an October 4, 2002, news conference,5 DHHS officials reportedly outlined the program’s three-part structure, beginning with vaccination of up to 500,000 designated personnel, continuing with the vaccination of other health care workers and first responders, and finally, offering vaccination to the public using a new vaccine yet to be developed (Altman and Stolberg, 2002; Meckler, 2002a; Meckler, 2002b). The Associated Press, the New York Times and the Washington Post reported on October 5 and 6, 2002, that the federal government’s smallpox vaccination plans were near completion and appeared to call for vaccinating millions of health care workers (Manning and Sternberg, 2002; McGlinchey, 2003; Meckler, 2002b). On October 7, 2002, an article in USA Today quoted CDC Director Gerberding’s explanation of why the federal government was planning to vaccinate a number much greater than that recommended by ACIP in June. She reportedly stated: “We were in an environment where we were confident the threat was low. Where we are right now is still an environment where we have no imminent threat … but we recognize that we are in the process of considering war on our enemies. The context has changed a bit” (Manning and Sternberg, 2002). 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) as part of a program that would provide “ongoing and ever-expanding access to immunization” (Meckler, 2002a).

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