APHA Policy Statement on Smallpox Vaccination (EB02-1)

The American Public Health Association (APHA) is the leading professional association that promotes and protects the health of all people. Throughout its 130-year history, APHA has been in the forefront of numerous efforts to prevent disease and promote health. As such, the Association has affirmed the importance of immunizations as one of the most effective means of preventing infectious disease. The smallpox virus is one infectious agent that, whether intentionally or unintentionally released, presents a grave threat to the public's health. Planning for an outbreak of smallpox and implementing a safe and effective vaccination policy is essential to ensure the health and safety of the American people.

The Advisory Committee on Immunization Practices (ACIP) recently issued recommendations for smallpox vaccination, including recommendations on who should receive the smallpox vaccination and guidance on implementation issues. The American Public Health Association concurs with the general principles of the ACIP recommendations and believes that any voluntary smallpox vaccination program should be based in science.

To ensure the nation is equipped to respond to a smallpox outbreak, the American Public Health Association asserts the following:

• Planning for a smallpox outbreak and implementing a vaccination effort must include essential public health stakeholders, including local, state and federal officials and other critical experts. Plans must be evaluated based on defined outcomes.
• Public health and hospital response teams and military personnel are our nation's first line of defense in the event of an intentional release of smallpox and must be protected. It is prudent to vaccinate these high-risk personnel first.
• Expanding vaccination to a broader array of first responders, including other health workers, firefighters and police, is important if a credible risk of smallpox exposure exists.
• Vaccinating the general public should be conducted only if there exists a substantial risk of exposure to smallpox supported by a scientific assessment or identification of significant national security threat.
• Implementing a pre-exposure vaccination plan requires careful monitoring and evaluation to assess the risks and efficacy of the vaccine. In addition, research is needed to identify a safer vaccine.
• Adequate resources are needed to support any vaccination plan implemented. Administering a vaccine costs approximately $12 per vaccination. These estimates do not include costs derived from monitoring adverse events, treating complications and training personnel.
• Mechanisms should be developed to compensate individuals for health care costs incurred as a result of adverse events resulting from the smallpox vaccination.
• Workers and the public should be educated about the risks of taking the vaccine, privacy rights must be ensured and those who decline to receive the vaccine should not be subject to discrimination at work.
• Public health systems and services must be consistently supported in order to adequately implement and respond to the myriad of public health problems and emergencies, including, but not limited to, smallpox.

Click here to download a printable version of this policy.