In September 2002, CDC asked ACIP to provide additional guidance on eight smallpox vaccination implementation issues: types of health care workers to be included in smallpox health care response teams, vaccination site care, need for administrative leave, screening for atopic dermatitis, screening for HIV, screening for pregnancy, simultaneous administration of smallpox vaccine and other vaccines, and the vaccination of smallpox vaccinators (CDC, 2002d).
ACIP responded to CDC’s request at its October 17, 2002, meeting. 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), provided guidance on vaccination site care, confirmed that smallpox vaccination could be administered together with other immunizations except chickenpox and concluded that administrative leave would not be required for vaccinated health care workers but recommended phasing in vaccination in participating hospitals, beginning with a small number of hospitals and staggering vaccination to minimize the impact on workforce.
ACIP developed contraindications screening guidelines for the conditions identified by CDC and recommended that previously vaccinated people be preferentially targeted for vaccination, given the decreased incidence of adverse events in revaccinees (CDC, 2002d). ACIP also provided specific guidance to CDC on the type of health care staff and support personnel to be included in the composition of smallpox health care teams, and the potential number of vaccinees was noted later on October 17, 2002, during a CDC press telebriefing. The ACIP chairperson estimated that if each of about 5,100 acute-care hospitals in the United States participated in the program of precautionary, pre-event smallpox vaccination, and each hospital had a team of approximately 100, that would add up to about 500,000 health care workers (CDC, 2002c). However, both the ACIP chairperson and CDC officials participating in the call emphasized the importance of the composition of response teams and the adequacy of coverage within a given hospital rather than the number of vaccinees. In the same telebriefing, the timeframe of 30 days was given as a rough goal for the first phase of vaccination.
One member of ACIP, Paul Offit, dissented from ACIP’s endorsement of the new, larger number of vaccinees (500,000) and observed that “the sense was that the course was already set and we wouldn’t make any difference” (ACIP, 2002; Manning, 2002; McCullough, 2003). The timing of ACIP’s revision of its recommendation, after news of the federal