PHILADELPHIA - (KRT) - Americans may criticize, disobey and sue their physicians, but when it comes to getting the smallpox vaccine, Americans will likely imitate them.

A new survey by Harvard University researchers indicates that 80 percent of Americans would refuse precautionary vaccination if they heard that their own and many other physicians were rejecting it.

Most Americans - 67 percent - also would decline to be inoculated if they heard that "some people" died from it.

The findings have implications for the Bush administration's two-stage plan for voluntary vaccination of more than 10 million health, emergency and police workers as a precaution against a smallpox attack.

Already, some physicians are declining to join the first stage, which involves vaccinating 500,000 health workers and "first responders" beginning next month. The doctors argue that the vaccine's risks are real and quantifiable, while smallpox, a disease that was eradicated 22 years ago, remains a theoretical threat.

Several major medical centers, notably Grady Memorial Hospital in Atlanta and Virginia Commonwealth University's hospital in Richmond, have officially opted out of the vaccination program. Some others, including Children's Hospital of Philadelphia, are considering it.

"The decision comes down to this: Which is the greater risk right now, vaccination or smallpox?" said Paul Offit, head of CHOP's Vaccine Education Center. "We are leaning toward saying there is more real risk in vaccination."

In October, Offit was the only member of the Centers for Disease Control and Prevention's vaccine advisory committee to oppose vaccination of 500,000 workers. Instead, he advocated inoculating a team of 15,000 who could respond to a smallpox outbreak.

Many physicians are worried that the vaccine might accidentally infect hospital patients, with deadly consequences. That's because the vaccine is a primitive type made from a live cowpox virus that can be spread, just like any virus.

Physicians also have expressed concern about Bush's promise to make the vaccine available to any adult American who "insists," because the public does not understand the risks and benefits of inoculation.

Indeed, the Harvard survey - published Thursday as part of a special online release by the New England Journal of Medicine - suggests Americans are largely clueless about smallpox, despite an avalanche of news coverage. (The nationally representative sample of 1,006 people was interviewed from Oct. 8 to Dec. 8.)

Almost a third of respondents said they believed smallpox had struck in the United States in the past five years, and two-thirds said they believed there had been outbreaks elsewhere in the world. (Actually, the disease was eradicated in the United States in 1949 and in the world in 1977.)

More than three-quarters believed smallpox can be treated to prevent death or disability. (Actually, the infection is untreatable, kills a third of its victims and disfigures or blinds most of the rest.)

Only 42 percent knew that the vaccine, if given within two or three days of exposure to smallpox, can prevent infection, and even fewer believed there would be enough vaccine in an emergency. (Actually, the government has stockpiles and plans to vaccinate the whole country if bioterrorists attack anywhere.)

The level of ignorance "is surprising to me because there has been a lot of coverage," said survey author Robert J. Blendon, a professor at Harvard's School of Public Health. "They just aren't taking away the basics."

That's probably because 66 percent had been ignoring or barely following smallpox news - a statistic that suggests healthcare workers will not bone up on the vaccine until they are required to.

Oddly, more than half of respondents were willing to be vaccinated - unless, that is, their doctors refused or they heard some people died from it - yet the vaccine was perceived as far more dangerous than it actually is. A quarter thought it would likely kill them, while 41 percent thought they would likely suffer serious side effects.

Such effects are actually rare, based on studies from the 1960s. For every million people vaccinated, the immunization causes about one death and about 52 life-threatening fevers, infections or brain-swelling.

CDC officials say they are working feverishly to overcome the knowledge gap. The agency has developed a website (www.cdc.gov/smallpox), CD-ROMs, videos and a public information hotline (888-246-2675). Friday, the CDC will conduct a satellite broadcast from noon to 1:00 p.m. EST to help educate healthcare workers; it will be rebroadcast on Jan. 9 at 1:00 p.m. EST.

The CDC is not surprised by resistance to the vaccination program, director Julie Gerberding said. The agency "fully expected" that some hospitals would refuse to participate. Even so, she said, all 50 states have submitted plans that, if successful, will vaccinate 440,000 workers at 3,600 medical facilities.

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