Smallpox vaccinations began at the end of January in 17 states, amid lingering health and financial concerns.

As Nature Medicine went to press, the Centers for Disease Control and Prevention (CDC) had shipped 204,600 doses of smallpox vaccine to 40 states and counties, with initial plans to offer the vaccine to 450,000 public health and health care workers. So far, only 687 people have volunteered to receive the vaccine, according to CDC director Julie Gerberding (see page 252).

Smallpox vaccination scheme needs a shot in the arm

The low number of volunteers may reflect a lack of confidence in a system that has not adequately planned for liability or compensation in the event of vaccine-related illnesses. The Department of Health and Human Services is in the process of addressing these issues, although no specific details have been given. Local health agencies have also been reluctant to divert resources away from other public health programs when there is no immediate threat.

Smallpox vaccinations have not been routinely given in the United States since 1972. In past vaccination schemes, for every 1 million people vaccinated, approximately 1,000 showed serious side effects and up to 50 developed life-threatening illness. The live vaccinia virus used in the vaccine can also sicken or kill hospital patients, the elderly or very young, and other susceptible people who come into contact with those recently vaccinated.

Local public health officials and the CDC agree the vaccination program should move slowly so problems can be dealt with as they arise. None of the people vaccinated thus far under the new program have suffered adverse effects.