A review of the ill-fated U.S. smallpox vaccination campaign charges that the Bush Administration overruled scientific advice and moved ahead on a major vaccination effort without a clear explanation. The report, issued today by Institute of Medicine (IOM), also blames "constraints" on the Centers for Disease Control and Prevention (CDC) for the program falling short of its goals.
After the 9/11 attacks and anthrax letters, President Bush announced a plan to vaccinate 500,000 health care workers, and eventually up to 10 million other emergency responders and interested members of the public, against smallpox (Science, 20 December 2002, p. 2312). But the effort soon foundered, especially after--as expected--the vaccine caused side effects such as cardiac problems in a small fraction of people. When the program wound down in mid-2003, only about 40,000 people had been vaccinated.
The IOM report notes that "top officials of the executive branch" departed from recommendations from advisors to vaccinate only 500,000 people. The officials offered "only vague explanation" for vaccinating a much larger number of people even though the vaccine carries risks and there was no evidence of an imminent attack. Because the "public health reasoning behind" the vaccination policy "was never fully explained," workers implementing the program "remained skeptical" and that led to "poor participation," the report says.
What's more, the CDC's normally open communication of scientific rationale to public health departments "seemed constrained by unknown external influences" and this hindered the campaign. IOM panel chair Brian Strom, a biostatistician at the University of Pennsylvania in Philadelphia, declined to elaborate on these "influences" for reporters, saying the panel did not know "who dictated what to whom."
The report refrains from calling the effort a failure, however. Even though only 40,000 people were vaccinated, the episode has apparently improved preparedness, Strom says, citing the quick response to a subsequent monkeypox outbreak and to the threat of SARS. But the report calls for a thorough look at the nation's smallpox preparedness. And above all, Strom says the report concludes that while national security concerns have to be balanced against scientific information, the CDC "or any other agency needs to speak from the science."