http://id.medscape.com/reuters/prof/2001/11/11.06/20011105publ006.html

Enforceable, Mandatory Vaccination Seen Necessary in Event of Smallpox Attack

WASHINGTON (Reuters Health) Nov 05 - Should smallpox be used as a biological weapon in the USA, public health officials must have the authority to quarantine and forcibly vaccinate the entire population — with the help of the military if needed — an expert said on Monday.

"You can't have a patchy response. There has to be compulsion" to vaccinate in the event of an attack, said Dr. Stephen D. Prior, the research director at the National Security Health Policy Center. "Each state has different laws and that's one of the problems," he said.

Massachusetts and other states have laws allowing authorities to force mass vaccination to stem outbreaks of highly contagious disease, but the federal government has no enforceable way of guaranteeing widespread vaccination.

The government is in the process of procuring 300 million smallpox vaccine doses, enough for every person living in the US. Officials from the Centers for Disease Control and Prevention (CDC) say that they have no plans to institute mass vaccination because there is currently no identifiable threat of a smallpox attack.

Authorities currently plan to deal with any possible smallpox outbreaks by vaccinating in a widening circle around a newly discovered case. Such a practice is useful with a relatively fixed population, Dr. Prior said, but it is essentially useless in a highly mobile society.

Dr. Anita Barry, the communicable disease control director for the Boston Public Health Commission in Massachusetts, told a Senate subcommittee last Friday that states needed the authority to confine infected persons to their homes for quarantine.

Federal law gives the US Surgeon General the authority to vaccinate and quarantine individuals to protect the public health. "But he has no means of enforcing it," Dr. Prior said.

A spokesman for the chairman of the Senate Health, Education, Labor, and Pensions Committee, Edward Kennedy (D-MA), said that mass vaccination is not part of the bioterrorism bill lawmakers are expected to consider soon. "We've heard the issue but we've done nothing with it," said spokesman James Manley.

Military planners are currently mulling whether or not they should have a role in enforcing mandatory mass vaccinations or quarantines in the event of a highly contagious biological attack, said Edgar H. Brenner, co-director of the Inter-University Center for Legal Studies in Washington.

Brenner told reporters that he had discussed the potential plans with high-ranking military officials. "They had no answer yet," he said. But Pentagon spokesman James Turner could not confirm the conversations Brenner mentioned or that officials are discussing such plans.

Dr. Prior acknowledged that the potential for federally enforced mandatory vaccinations could arouse anti-government sentiments in some sectors of the American public. Any mass-vaccination policy would also have to take into account the vaccine's side effects. Historically, the smallpox vaccine caused serious reactions in about one in every 4000 persons and caused death in about four per million.

"The debate has to take place, and the public has to be involved," he said.