United States smallpox response plans: a commentary from the Bioterrorism Taskforce (BICHAT) perspective

The US plan As the United States (US) continues to expand counterterrorism capabilities, smallpox has emerged as perhaps the most feared biological weapon because it is so contagious and deadly. With the possibility of a war with Iraq, the US Defense Department has asked for enough vaccine from the national smallpox vaccine stockpile for 1 million military personnel, to be available by the beginning of November 2002. To protect US citizens against a deliberate release of the smallpox virus, US federal experts have been working on a comprehensive preparedness plan with two tracks: a (pre-event) vaccination programme for the emergency medical workers most likely to see an initial case of smallpox, and a (post- event) mass vaccination plan if an attack occurs. The latter is now available and has recently been distributed to all states by the Centers for Disease Control and Prevention (CDC) (http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp). The documentation provided includes many detailed instructions and recommendations on the logistics that go with such a massive campaign. Of particular interest are the forms included for obtaining consent from people about to be vaccinated - a crucial issue. The manual states that following a confirmed smallpox outbreak in the US, rapid voluntary vaccination of a large population may be required.