GAO says smallpox program lacks guidance

The General Accounting Office Thursday said the struggling national smallpox immunization program lacks direction and leadership.

In its report, "Smallpox Vaccination: Implementation of National Program Faces Challenges" (GAO-03-578), GAO said the program is "unprecedented and complex," and called on the Centers for Disease Control and Prevention to provide more guidance to state and local health officials.

When President Bush announced the program in December, U.S. health officials said they hoped to immunize 500,000 medical personnel by the end of February and 10 million emergency workers immediately after. To date, fewer than 34,000 health workers have received the vaccination.

CDC Director Julie Gerberding said the earlier goals could be unnecessary, and only 50,000 immunized health workers might be needed to prepare the country for a biological terrorism attack, according to the GAO report.

"She has indicated that as few as 50,000 would suffice but has not explained how CDC arrived at that number. CDC has not said how these workers should be organized and distributed within the smallpox response teams and across the nation. As of late April, CDC had yet to set new targets," the report said.

A lack of leadership from top U.S. health officials has resulted in a disjointed national immunization effort, according to the report.

"Some jurisdictions have indicated that they are attempting to follow their original plans … others have said that they have begun to revise their targets downward for the first stage without waiting for a request from CDC," the GAO said.

As the immunization program unfolded-and the turnout of volunteer health workers proved underwhelming-the CDC sought to lower expectations. Health officials denied they were attempting to reach targets of 500,000 or 10 million immunized workers. Officials also said the ultimate goal is not a number, but a level of readiness.

Public health experts have agreed with the CDC that the United States can be ready for a smallpox terrorist attack with fewer than 10 million immunized personnel, but they said a comprehensive response plan is needed in lieu of massive, widespread pre-attack vaccinations.

The GAO agreed that a plan is necessary, and missing.

"If estimates are reduced for the numbers and types of vaccinated health workers in smallpox response teams, CDC would need to provide guidance to ensure that smaller or fewer teams are organized and distributed in a manner that will provide adequate response capacity," the GAO said.