The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67457

Howard Backer, MD, MPH¹, Diana M. Bontá, RN, DrPH², Kevin Reilly, DVM, MPH², and David Souleles, MPH². (1) California Department of Health Services, Immunization Branch, 2151 Berkeley Way, Berkeley, CA 94704, 510 540-2382, hbacker@dhs.ca.gov, (2) California Department of Health Services, 714 P Street -- Suite 1253, Sacramento, CA 95814

The reinstitution of a smallpox vaccination program has created unique ethical, political, and programmatic issues for public health programs.

The vaccination program was driven by factors external to public health. Many public health professionals were uncomfortable participating at a program designated as a “countermeasure”. Although political realities often influence public health programs, this vaccination program magnified this influence and it appeared that public health was “following orders” rather than designing a policy based on the best science.

The nature of the smallpox vaccination risk-benefit equation with major variables determined by political and intelligence analysis was particularly uncomfortable to many health care professionals.

The program is being driven at a pace that precludes methodical planning. Technical information and policy were shifting sands.

Public health and health care personnel were in the unusual position of developing and implementing this program as well as being the targeted recipients of the intervention. Unresolved issues resulted in major unions taking positions against the program.

The difficult ethical and scientific issues polarized health care facilities, delivery systems, and even public health jurisdictions.

Massive redirection of resources at the federal, state and local levels interrupted ongoing programs.

Adverse reactions to smallpox vaccine could impede our efforts to convince skeptical parents of the safety of our routine childhood vaccines. Worldwide polio eradication efforts are close to achieving success, however, immunization will have to continue due to the risk that the virus could be used as a bioterrorism agent.

Learning Objectives:

• Identify programmatic, legal and ethical issues that have emerged during smallpox planning.
• Describe current and future impact on public health programs.

Keywords: Bioterrorism, Public Health Policy

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.