Molly J. Hall, Ann E. Norwood, Robert J. Ursano, Carol S. Fullerton


Biosecur Bioterror. 2003;1(2) 

In This Article

Vaccination and Quarantine

The current smallpox vaccination program has faced many challenges. Medical professionals remain largely unconvinced of the need to reintroduce smallpox vaccinations to counter a terrorist threat that has not been disclosed in detail outside speculation about possibility. The first phase of the vaccination program called for 500,000 volunteer healthcare workers to be inoculated in the first 30 days, by February 24. By the first week of March, only 12,404 healthcare workers had received the vaccine.[30] Hundreds of hospitals have refused to have their employees vaccinated, and many major unions have declined as well. Reasons cited include known serious side effects; worries about litigation; increased risk to family members, pregnant women, infants, and people with certain medical conditions; lack of compensation in the event of adverse effects; and perhaps most concerning, lack of evidence that the risk of a bioterrorist attack using smallpox is highly likely. All of these factors make risk communication a very challenging endeavor.[31]

Quarantine of individuals at no or low risk of exposure, forced evacuation, mandatory vaccination, and mandated treatment are all issues that may arise in a bioterrorism scenario. The tendency to use these draconian means increases as fear and anxiety increase. The demand for these actions as well as the failure to use them may contribute to community conflict and erode the public's confidence in the government. Large-scale quarantine is rarely likely to be an effective strategy in disease containment. Case-by-case isolation is appropriate in conjunction with the separation of individuals known to have been exposed to a highly contagious infection during the incubation period, but imposing quarantine on large groups of individuals who are at low risk or who were not exposed is usually not feasible. The risk of unintended consequences is high and there is little data supporting its efficacy. Medical indications are usually not present and other steps are available such as rapid vaccination and treatment programs, measures to minimize exposure, voluntary home curfew, and restrictions on assembly of groups.[32]


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