o the Editor:

Re "Missing the Smallpox Goal" (editorial, May 12):

Public health and medical professionals have not fully embraced the call for smallpox vaccination. This is not surprising, since most professionals concluded that the risks greatly exceeded the immediate benefit.

A strategic vaccine program is appropriate, but the potential for a deliberate outbreak of smallpox pales next to the threat from SARS or influenza, which kills 20,000 Americans each year.

Bioterrorism preparedness requires strategic decisions and risk assessment. Yet we seem to have forgotten that there is an anthrax killer on the loose. Where is the call for an anthrax vaccination program for the public or, at least, for postal workers, who are the most vulnerable?  
DAVID S. PERLIN
Newark, May 13, 2003
The writer is scientific director, Public Health Research Institute, International Center for Public Health.

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To the Editor:

Re "Missing the Smallpox Goal" (editorial, May 12): Should the improbable happen, a well-prepared public health system would handle smallpox by adding immunization — using existing vaccine stocks — to the tools our public health agencies have used to contain SARS. These include information sharing, isolation, contact investigation and official communication between jurisdictions.

We should not expose more people now to the potentially adverse health effects of smallpox vaccination. Instead, we should press the Bush administration to give up its plan to cut $50 million from disease control, so America can maintain its excellent public health infrastructure in perpetuity.
PHILIP ALCABES
New York, May 13, 2003
The writer is an epidemiologist and associate professor at Hunter College, CUNY.
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To the Editor:

Even with only 7 percent of health workers vaccinated (editorial, May 12), the country is immensely better prepared to handle a smallpox emergency than it was six months ago.

Now that all interested medical workers have been vaccinated, it's time to open up vaccination to all willing emergency workers, and then (at cost) to the low-risk general public.
J. HUSTON MCCULLOCH
Columbus, Ohio, May 13, 2003
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To the Editor:

Reassessment of the smallpox vaccination goal is needed (editorial, May 12), and it will require a frank examination of the origins of the goal and of the resistance in the medical community.

Some of us urged our colleagues to resist vaccination because of the potential harm and the heavy burden the program imposes on public health resources. Also, the need for the program was based largely on intelligence estimates that were presumably of the same quality as the "intelligence" about weapons of mass destruction in Iraq.

Some of us suspected that one goal of the vaccine program was to generate support for the war. There should be an independent investigation into whether such intelligence existed and whether there was manipulation to justify a political agenda. If there was, officials should be held responsible for the deaths and illnesses attributed to vaccination.
HILLEL W. COHEN
SHARON L. EOLIS
Bronx, May 12, 2003
The writers are, respectively, an assistant professor of epidemiology at Albert Einstein College of Medicine and a nurse practitioner at Cabrini Medical Center.