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The Smallpox Vaccination Program: Public Health in an Age of Terrorism
The Relationship Between the Civilian and Military Vaccination Programs
The focus of this report is the implementation of CDC’s civilian smallpox vaccination program. However, past committee reports and activities reflect its continuing interest in the parallel program implemented by DoD. The civilian and military programs are inherently related, and the committee believes that there is much to be learned from the two programs taken individually and together. DoD staff made presentations at the committee’s meetings and responded to committee inquiries about the military program’s progress, its administrative and educational efforts, and its safety system and related research.
The military vaccination program began immediately after the president’s announcement on December 13, 2002, and has advanced at a steady and rapid pace, reaching and surpassing 600,000 vaccinees (DoD, 2004b). The smallpox vaccination program provided a unique opportunity for collaboration between CDC and DoD, and although the two programs involved very different circumstances and populations, there was much to be learned from both. The military population included a much higher percentage of young people never before vaccinated (and likely to be in very good health because of the nature of their job and their ages), whereas vaccination among the civilian population involved generally older people, most of whom had been vaccinated in the past. Also, the military program required vaccination for designated personnel, whereas the civilian program was voluntary. Unlike civilian vaccinees, who would pose a potential risk of inadvertent inoculation to spouses or household contacts, military personnel who were vaccinated were likely to live in settings and have duties that could expose a higher number of contacts to inoculation, not just spouses and intimate partners. For example, military activities and facilities are likely to require close physical interaction among personnel, several people may be required to use the same bedding consecutively, and laundry is processed in a communal fashion. Those factors had the potential to increase inadvertent exposure of nonvaccinated people to vaccination sites and secretions.
Both the military and civilian programs conducted follow-up of adverse events (CDC, 2003k), and the ACIP Working Group on Smallpox Vaccine Safety reviewed safety data generated by both programs. Although efforts were made to facilitate the flow of information between DoD and CDC, administrative difficulties and questions arose. For example, both CDC and DoD posted weekly updates of adverse events in their programs, but at times, information about adverse events in the military program was not communicated to the public or to the public health community in a