At the June 2003 ACIP meeting, the ACIP recommended that for safety reasons the federal government not expand smallpox vaccination beyond the health care and public health response team members still being vaccinated (ACIP, 2003b). (In May 2003, the present committee had called for a pause in the vaccination program to assess safety and to plan carefully before extending vaccination to more people.)
In June 2003, CDC reported that the number of vaccinees working in hospitals was small—only 40 percent of acute-care hospitals had at least one staff member vaccinated, and only 1 in 10 hospitals had two or more vaccinated staff members—a deficiency in numbers that could require a regional rather than a local response in some areas in the event of a smallpox-virus release (CDC, 2003a; Yee, 2003). The smallpox vaccination program did not come to an official stop in response to the ACIP recommendation, but the pace of vaccination continued to decline. By July 25, 2003, the total number of civilian vaccinees was 38,004—far short of the 500,000 that had been given as a program target and still short of the 50,000 that CDC had suggested in GAO’s assessment (CDC, 2003c; GAO, 2003). A year later, on July 31, 2004, civilian vaccinations had reached a cumulative total of 39,579 (CDC, 2004c). Nearly 2 years after the beginning of the program, smallpox vaccination has all but come to a halt, with a mere handful of vaccinations each month.
In the months after the vaccination rate began to fall, CDC did not formally urge states and other jurisdictions to increase their vaccinees to specified numbers, and it did not take any steps to formally reiterate the need for the vaccine. A Washington Post article in July 2003 noted the recent silence on the part of White House and federal officials who made the decision to vaccinate and legislators who had been vocal supporters of the vaccination program (Connolly, 2003b). The same article quoted CDC Director Gerberding: “ ‘Can we stand up clinics across the country tomorrow to immunize our nation in 10 days? No,’ she acknowledged. Still, we ‘have made enormous progress.’ ”
In July 2004, DHHS adviser D.A. Henderson stated that the smallpox vaccination of first responders was no longer needed, because enough vaccine was available to vaccinate the nation, if needed, and many cities had improved their capability to respond to a potential smallpox attack (Calabresi and August, 2004; Malenic, 2004).
At the time this report was written, the program was languishing, and