President Bush’s Dec. 13 announcement of the resumption of voluntary civilian smallpox vaccination has sparked much discussion and concern within the fire service as to what the proposal will actually mean to the first responder community.

In an effort to keep IAFC members apprised of the most current information available, the IAFC is providing the following summary of the president’s proposed protocol, including an expected timeline of anticipated events.

Most importantly, the IAFC has announced that a comprehensive document is presently in development which will serve as a guide for the fire service on a wide range of smallpox vaccination issues. The document, which is being developed by the IAFC Smallpox Vaccination Working Group, is expected to be made available to all IAFC members in mid-January.

Contents of the guide will focus in detail on the administrative and operational issues likely to arise from vaccination of fire service personnel including legal matters, workforce education and staffing. The guide will also discuss the nature of the smallpox vaccine and its health effects. The guide is expected to be the first of its kind tailored to the needs of the fire service since the presumed eradication of the disease effectively eliminated the need for such guidance in matters of public health.

The Smallpox Vaccination Working Group, which is composed of IAFC leaders from the EMS Section, Terrorism Committee and HazMat Committee, recently convened in Washington, D.C. on this issue to analyze available information and develop a set of recommendations specifically directed toward the fire service. They will continue to monitor the issue on behalf of the IAFC and to provide guidance and recommendations as the program rolls out.

“The IAFC has been working very closely with the Department of Health and Human Services from the very beginning of this issue to ensure that the needs of the fire service are addressed by federal officials as they plan this vaccination program,” said Chief Randy R. Bruegman, IAFC President. “We will continue to pay close attention to this extraordinary situation to ensure that our members have the best possible information with which to make sound and informed decisions,” he stated.

Bush's proposal
The Bush administration has announced plans to resume smallpox vaccinations for the first time in 30 years. The president’s proposal encompasses both civilian and military personnel in two separate plans. The military plan is being implemented immediately and is being directed by the Pentagon. The civilian plan will be implemented in three phases, each with a different timeline and target population. State and local public health departments have been charged with developing appropriate vaccination plans and implementing the vaccination programs. All civilian inoculations will be voluntary, including those being made available to first responders.

Phase I: The first phase of the president’s proposal will make the vaccine available to a very narrowly defined group of public health investigators and hospital workers designated by state public health departments. This group will be charged with conducting the initial investigations and treatment of a suspected smallpox case and initiating measures to control the outbreak. This phase is expected to begin near the end of January and is likely to take about one month to complete. It is expected that in phase I the vaccine will be offered to up to 500,000 people.

Phase II: The fire service and other emergency responders will be offered the vaccine in Phase II. The purpose of this phase is to offer the vaccine to those personnel who have a higher risk of exposure to smallpox because of their occupation. State and local health departments will again organize and implement the vaccination programs in this phase. Phase II is expected to begin on March 1. This start date is tentative and is likely to vary among states.

Phase III: In this phase the vaccine will be made available to the general public. The administration is not recommending that the members of the general public receive the vaccine. Details of this phase have not been released; however the DHHS is in the process of establishing a process to make the vaccine available to those adult members of the general public without medical contraindications who insist on being vaccinated sometime this spring.

References:

• HHS Smallpox Information Web site www.smallpox.gov

• CDC Response Plan and Guidelines – Main Page www.bt.cdc.gov/DocumentsApp/Smallpox/RPG/index.asp

• CDC National Immunization Program www.cdc.gov/nip/smallpox/default.htm

• Journal of the American Medical Association – “Smallpox Use as a Biological Weapon” http://jama.ama-assn.org/issues/v281n22/ffull/jst90000.htm

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