By LAURA MECKLER, Associated Press Writer

WASHINGTON (AP) - Health and Human Services ( news - web sites) officials are recommending that smallpox vaccinations be given to about 250,000 to 500,000 people, including hospital and emergency workers most likely to see smallpox patients and special response teams in each state, officials said.

HHS Secretary Tommy Thompson said he has sent his recommendation to the White House and is awaiting a decision from President Bush ( news - web sites).

At issue is the likelihood that certain groups of workers would see an infectious smallpox patient versus the likelihood they would get sick, or possibly die, from the vaccine itself.

Officials caution that the numbers are still in flux and could change before a final decision is announced. The 250,000 to 500,000 figure was disclosed over the summer, and officials said Tuesday that it had not changed.

A final decision is expected this month, Thompson said.

Smallpox, a highly contagious and fatal disease, has been wiped out worldwide expect for specimens kept in laboratories. Experts fear terrorists could unleash the virus in an attack.

The proposed number of vaccinations is significantly more than the 10,000 to 20,000 recommended earlier this year by an advisory committee, which was worried by the vaccine's side effects. In its deliberations, the committee assumed that the risk of a smallpox attack is very low. A host of mathematical models made it clear that any one person faces a much higher risk of being hurt by the vaccine than being hurt by smallpox.

But Thompson said he has to assume that it's possible.

"My gut tells me you have to assume the worst right now with bioterrorism," he said Tuesday. He added that there has been considerable speculation that North Korea ( news - web sites), Iraq and other hostile nations may have the virus.

At a bioterrorism advisory council meeting last month, Dr. Michael Osterholm, a close Thompson adviser, made a similar point. He said that last Sept. 10, experts would have said the risk of airplanes hitting skyscrapers was incredibly low.

Routine smallpox vaccinations ended in 1971, though some studies suggest that people who were vaccinated decades ago may still have some protection against the disease. Some have said all Americans should be given the chance to assess the risk of smallpox on their own and get the shot if they want it. But there appears to be little appetite among federal officials for that course.

Asked about that option in July, Bush said: "I worry about calling for a national vaccination program and that it could cause a loss of life."

Experts believe that one to two people will die for every million who get vaccinated.

Thompson also said he was worried that the nation still is vulnerable to an attack on its food supply.

"I still believe that is the area we are subject to a terrorist attack in the future and one that could cause problems," he said.

Overall, the nation is significantly better prepared for bioterrorism today than it was last fall, when the anthrax attacks hit, Thompson said.

"We are better prepared than we've ever been. We're getting stronger each and every day," he said.

But he singled out food inspections as an area of particular concern.

Even before Sept. 11, he said, it was clear that the Food and Drug Administration ( news - web sites)'s food inspection system had major holes. FDA had only 125 inspectors, with 56,000 places to inspect at 151 places of entry, he said. Less than 1 percent of food was being inspected.

"I was just appalled," he said.

The problem, he said, was that Congress was still angry with former FDA Commissioner David Kessler, who pushed for tobacco regulation. Therefore, FDA didn't see any budget increases, he said.

Then after, Sept. 11, Congress offered new dollars — enough to hire 750 more inspectors. Most of them are trained and they are all college graduates, he said.

At the same time, new technology is allowing for quicker lab checks of food.

He said he is proud of the bioterrorism team assembled at HHS and that the department acted so quickly to move out $1 billion allocated to the states. The money is helping to improve state and local planning, upgrade labs and communications systems. The improvements will help officials respond, whether the attacking agents are terrorist or natural, he said.

Thompson added that he eventually plans to return to Wisconsin, where he was governor for 14 years. He said he hasn't decided how long he will keep his job at HHS.

Last month, he said that he was only committed to the job for two years — until February 2003 — prompting speculation that he may be on his way out.

"The president has asked me to stay on," he said. "We will talk after the (fall) election."