At the World Health Assembly in May 1980, the World Health Organization declared the world free of smallpox. Smallpox vaccination of civilians is now indicated only for laboratory workers directly involved with smallpox or closely related orthopox viruses. However recent questions raised by the terrorist attacks in fall 2001 have renewed concerns about possible outbreaks of smallpox resulting from its use as a biological weapon. In June 2002, the Institute of Medicine convened a public conference to discuss the scientific, clinical, procedural, and administrative aspects of various immunization strategies. Scientific and Policy Considerations in Developing Smallpox Vaccination Options summarizes the presentations and discussions from this workshop.
At the World Health Assembly in May 1980, the World Health Organization declared the world free of smallpox. Smallpox vaccination of civilians is now indicated only for laboratory workers directly involved with smallpox or closely related orthopox viruses. However recent questions raised by the terrorist attacks in fall 2001 have renewed concerns about possible outbreaks of smallpox resulting from its use as a biological weapon. In June 2002, the Institute of Medicine convened a public conference to discuss the scientific, clinical, procedural, and administrative aspects of various immunization strategies. Scientific and Policy Considerations in Developing Smallpox Vaccination Options summarizes the presentations and discussions from this workshop.
December 13, 2002, the president of the United States announced that smallpox vaccination would be offered to some categories of civilians and administered to members of the military and government representatives in high-risk areas of the world. The events that precipitated that historic announcement included a series of terrorist attacks during the 1990s, which culminated in the catastrophic events of 2001. Although preparedness for deliberate attacks with biologic weapons was already the subject of much public health planning, meetings, and publications as the twentieth century neared its end, the events of 2001 led to a steep rise in bioterrorism-related government policies and funding, and in state and local preparedness activities, for example, in public health, health care, and the emergency response and public safety communities. The national smallpox vaccination program is but one of many efforts to improve readiness to respond to deliberate releases of biologic agents. The Institute of Medicine (IOM) Committee on Smallpox Vaccination Program Implementation was convened in October 2002 at the request of the Centers for Disease Control and Prevention (CDC), the federal agency charged with implementing the government's policy of providing smallpox vaccine first to public health and health care workers on response teams, then to all interested health care workers and other first responders, and finally to members of the general public who might insist on receiving the vaccine. The committee was charged with providing "advice to the CDC and the program investigators on selected aspects of the smallpox program implementation and evaluation." The committee met six times over 19 months and wrote a series of brief "letter" reports. The Smallpox Vaccination Program: Public Health in an Age of Terrorism constitutes the committee's seventh and final report, and the committee hopes that it will fulfill three purposes: 1) To serve as an archival document that brings together the six reports addressed to Julie Gerberding, director of CDC, and previously released on line and as short, unbound papers; 2) To serve as a historical document that summarizes milestones in the smallpox vaccination program, and; 3) To comment on the achievement of overall goals of the smallpox vaccination program (in accordance with the last item in the charge), including lessons learned from the program.
Vaccines are among the most safe and effective public health interventions to prevent serious disease and death. Because of the success of vaccines, most Americans today have no firsthand experience with such devastating illnesses as polio or diphtheria. Health care providers who vaccinate young children follow a schedule prepared by the U.S. Advisory Committee on Immunization Practices. Under the current schedule, children younger than six may receive as many as 24 immunizations by their second birthday. New vaccines undergo rigorous testing prior to receiving FDA approval; however, like all medicines and medical interventions, vaccines carry some risk. Driven largely by concerns about potential side effects, there has been a shift in some parents' attitudes toward the child immunization schedule. The Childhood Immunization Schedule and Safety identifies research approaches, methodologies, and study designs that could address questions about the safety of the current schedule. This report is the most comprehensive examination of the immunization schedule to date. The IOM authoring committee uncovered no evidence of major safety concerns associated with adherence to the childhood immunization schedule. Should signals arise that there may be need for investigation, however, the report offers a framework for conducting safety research using existing or new data collection systems.
In 1980, the World Health Organization (WHO) officially declared that smallpox had been eradicated. In 1986, WHO's international Ad Hoc Committee on Orthopox Virus Infections unanimously recommended destruction of the two remaining official stocks of variola virus, one at the Centers for Disease Control and Prevention and the other at the VECTOR laboratory in Siberia. In June 1999, WHO decided to delay the destruction of these stocks. Informing that decision was Assessment of Future Scientific Needs for Variola Virus, which examines: Whether the sequenced variola genome, vaccinia, and monkey pox virus are adequate for future research or whether the live variola virus itself is needed to assist in the development of antiviral therapies. What further benefits, if any, would likely be gained through the use of variola in research and development efforts related to agent detection, diagnosis, prevention, and treatment. What unique potential benefits, if any, the study of variola would have in increasing our fundamental understanding of the biology, host-agent interactions, pathogenesis, and immune mechanisms of viral diseases.
December 13, 2002, the president of the United States announced that smallpox vaccination would be offered to some categories of civilians and administered to members of the military and government representatives in high-risk areas of the world. The events that precipitated that historic announcement included a series of terrorist attacks during the 1990s, which culminated in the catastrophic events of 2001. Although preparedness for deliberate attacks with biologic weapons was already the subject of much public health planning, meetings, and publications as the twentieth century neared its end, the events of 2001 led to a steep rise in bioterrorism-related government policies and funding, and in state and local preparedness activities, for example, in public health, health care, and the emergency response and public safety communities. The national smallpox vaccination program is but one of many efforts to improve readiness to respond to deliberate releases of biologic agents. The Institute of Medicine (IOM) Committee on Smallpox Vaccination Program Implementation was convened in October 2002 at the request of the Centers for Disease Control and Prevention (CDC), the federal agency charged with implementing the government's policy of providing smallpox vaccine first to public health and health care workers on response teams, then to all interested health care workers and other first responders, and finally to members of the general public who might insist on receiving the vaccine. The committee was charged with providing "advice to the CDC and the program investigators on selected aspects of the smallpox program implementation and evaluation." The committee met six times over 19 months and wrote a series of brief "letter" reports. The Smallpox Vaccination Program: Public Health in an Age of Terrorism constitutes the committee's seventh and final report, and the committee hopes that it will fulfill three purposes: 1) To serve as an archival document that brings together the six reports addressed to Julie Gerberding, director of CDC, and previously released on line and as short, unbound papers; 2) To serve as a historical document that summarizes milestones in the smallpox vaccination program, and ; 3) To comment on the achievement of overall goals of the smallpox vaccination program (in accordance with the last item in the charge), including lessons learned from the program.
Stanley Williamson’s meticulously researched history of the British government’s smallpox vaccination program begins with Edward Jenner’s development of the vaccine at the end of the eighteenth century, charts the astonishing speed at which it became compulsory for children, and documents the decades of resistance that resulted in its repeal in 1946. Along the way Williamson examines the social, political, and ethical motivations of both factions. The power to make medical choices, including those regarding vaccination, remains a hotly contested issue today, making The Vaccination Controversy a timely contribution to our knowledge of medical history.
“The bard of biological weapons captures the drama of the front lines.”—Richard Danzig, former secretary of the navy The first major bioterror event in the United States-the anthrax attacks in October 2001-was a clarion call for scientists who work with “hot” agents to find ways of protecting civilian populations against biological weapons. In The Demon in the Freezer, his first nonfiction book since The Hot Zone, a #1 New York Times bestseller, Richard Preston takes us into the heart of Usamriid, the United States Army Medical Research Institute of Infectious Diseases at Fort Detrick, Maryland, once the headquarters of the U.S. biological weapons program and now the epicenter of national biodefense. Peter Jahrling, the top scientist at Usamriid, a wry virologist who cut his teeth on Ebola, one of the world’s most lethal emerging viruses, has ORCON security clearance that gives him access to top secret information on bioweapons. His most urgent priority is to develop a drug that will take on smallpox-and win. Eradicated from the planet in 1979 in one of the great triumphs of modern science, the smallpox virus now resides, officially, in only two high-security freezers-at the Centers for Disease Control in Atlanta and in Siberia, at a Russian virology institute called Vector. But the demon in the freezer has been set loose. It is almost certain that illegal stocks are in the possession of hostile states, including Iraq and North Korea. Jahrling is haunted by the thought that biologists in secret labs are using genetic engineering to create a new superpox virus, a smallpox resistant to all vaccines. Usamriid went into a state of Delta Alert on September 11 and activated its emergency response teams when the first anthrax letters were opened in New York and Washington, D.C. Preston reports, in unprecedented detail, on the government’ s response to the attacks and takes us into the ongoing FBI investigation. His story is based on interviews with top-level FBI agents and with Dr. Steven Hatfill. Jahrling is leading a team of scientists doing controversial experiments with live smallpox virus at CDC. Preston takes us into the lab where Jahrling is reawakening smallpox and explains, with cool and devastating precision, what may be at stake if his last bold experiment fails.
In the wake of September 11th and recent anthrax events, our nation's bioterrorism response capability has become an imminent priority for policymakers, researchers, public health officials, academia, and the private sector. In a three-day workshop, convened by the Institute of Medicine's Forum on Emerging Infections, experts from each of these communities came together to identify, clarify, and prioritize the next steps that need to be taken in order to prepare and strengthen bioterrorism response capabilities. From the discussions, it became clear that of utmost urgency is the need to cast the issue of a response in an appropriate framework in order to attract the attention of Congress and the public in order to garner sufficient and sustainable support for such initiatives. No matter how the issue is cast, numerous workshop participants agreed that there are many gaps in the public health infrastructure and countermeasure capabilities that must be prioritized and addressed in order to assure a rapid and effective response to another bioterrorist attack.
