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Smallpox Home

CDC Telebriefing Transcript

Smallpox Vaccine Adverse Events Monitoring and Response System

February 6, 2003

CDC MODERATOR: Thank you, Andrea, and thanks to everybody for taking time to join us today as we discuss a smallpox update as well as talk about the article that's published in today's MMWR on smallpox vaccine adverse events.

What we'll do first is have the director of CDC, Dr. Julie Gerberding, provide a brief update on where we stand in implementing the program and also provide and also provide an overview of how we're going to go about gathering information and reporting information on adverse events. Also with us is Dr. Eric Mast, that's spelled M-a-s-t, who is from our National Immunization Program, and is one very close to gathering the data on adverse events and reporting data.

So he will be here also to answer any of your questions that you might have.

So at this point I'll turn it over to Dr. Gerberding and then we'll open it up to Q&A.

DR. GERBERDING: Thanks, Tom, and thank you for joining us today for another smallpox vaccine program update. Before I really provide an update on where we are, I just want to make sure that we are all on the same page. The purpose of this program is to ensure our capacity to respond to smallpox attack, should one occur, and so our goal is to really ensure that we have smallpox response teams that can initiate the first stages of a vaccination program and take care of the first patients that might be afflicted with smallpox while we're gearing up for a large-scale immunization program. So this is really about enhancing our readiness and we want the state and local jurisdictions to continue to implement this program as fast as they can, but more importantly, as safely as we can.

We know that many individuals and institutions continue to have questions about compensation. I am confident about our ability to address these issues. We're actually getting closer and closer to being able to provide you with some specifics. HHS is continuing to address the issue and I do expect we will be hearing something very soon.

I'm not going to discuss the details of what's being worked on today but I am optimistic that we will be able to close these gaps.

Now just to fill you in on the current status of the program, to date, we have 46 states and four counties who've requested a total of 256,100 doses of smallpox vaccine. CDC has shipped 204,600 doses of vaccine to 40 states or counties that have requested it, and if you want a breakdown of these numbers by state, you'll be able to go to the Web site in the "In The News" section and you can get more specific information about smallpox shipments.

So far we have verified that at least 18 clinics are actively engaging in vaccination. As of yesterday, we have documentation of approximately 687 people being vaccinated and we expect by close of business tomorrow, we'll have more than that.

Finally, I'd just like to tell you a little bit about how we're going to report these numbers as this program expands over time. Today, in the MMWR, as you know, we had a notice to readers to explain this in some detail. We hope to release information to all of you in the media on a comprehensive table on Tuesday and Friday of each week.

This will give you information about what states are vaccinating and how many individuals each state has vaccinated, and overall, we will be providing aggregate information about adverse events that follow into the relevant categories.

Keep in mind, we are just in the very early stages of the vaccination program and as your information needs grow, and our information grows, we may need to scale up or speed up the release of this information.

Our goal is to give you as much as we can. Right now, our limitations are the fact that we're in the state-up phase of the program, but, in addition, some information, particularly information about adverse events that affect individuals could potentially be identifying to that individual.

So we want to make sure that we have gotten the appropriate confidentiality procedures i place. If you've had a chance to review the Department of Defense Web site on the update of their smallpox vaccination program, I think you can see that they're holding to a similar standard of trying to make information available to provide details about significant cases of adverse events when they occur in a timely manner.

We want this information because it helps us communicate with clinicians and our data safety monitoring process to ensure the overall safety of the program, and we know you're interested in this information also. So we will keep you updated, we'll improve the process as we go forward, and if you have specific issues of inputs, please don't hesitate, as I know you won't, to express them to us.

I'd just like to say a couple of things about the safety monitoring. I'm going to ask Dr. Mast to answer the technical questions as we go forward.

But I think it's very important to frame this assessment of the safety of the program in the context of our other existing vaccination programs. We are really engaged here in a gold standard assessment of the safety. Characteristics of this assessment include inclusion of all vaccine recipients in the process, a real-time monitoring and ascertainment of significant adverse events, a prospective assessment of individuals who've enrolled in the program, and I think rapid communication with a preexisting body of experts who are helping us to interpret the information about side effects, and to also help us assess the relationship between potential adverse effects and the vaccine program about as rapidly as I think any system could possibly be created.

Finally, I'd also just like to say that when you step back away from this process and realize that at the beginning of December, no state had a plan for this phase of smallpox vaccination, and by January, all states have approved plans, and within less than really a two-month time frame, we were able to initiate a vaccination clinic and a program that I think we feel a great deal of pride in.

But our metric is still, number one, safety, and number two, expeditious preparedness for what we hope will never happen, a smallpox attack that would prompt us to initiate immunization of a larger population of people.

CDC MODERATOR: Okay. Thank you, Dr. Gerberding. Andrea, I think we're ready for questions, please.

AT&T MODERATOR: Thank you, ladies and gentlemen. If you wish to ask a question, please press the one on your touchtone phone. You will hear a tone indicating that you have been placed in queue. If you pressed one prior to this announce, we ask that you please do so again at this time. You may remove yourself from queue at any time by pressing the pound key.

If you are using a speaker-phone, please pick up the handset before pressing the numbers.

Once again, if you have a question please press the one at this time.

Miriam Falco from CNN, please go ahead.

QUESTION: Good morning, Dr. Gerberding. Have there been any adverse effects reported from those 687 people who've been vaccinated so far, among the health care workers?

DR. GERBERDING: No, no significant adverse events have been reported so far.

QUESTION: What kind have been?

DR. GERBERDING: Actually, no adverse events. Let me be specific.

QUESTION: Okay. Thank you.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Thank you. Our next question comes from Donald McMill [ph] from the New York Times. Please go ahead.

QUESTION: Hi, Dr. Gerberding. How do you feel about having reached 687 at this point. Had you hoped to reach more? Or do you feel its' going on plan?

DR. GERBERDING: Yes. I think we recognize that the concerns about compensation are resulting in people being slow to accept the vaccination program, particularly in situations where they don't have confidence that they won't fall through the cracks. But I also think it's important to appreciate that even if we did not have those barriers to the program, that right now, primarily what's going on is that we are vaccinating vaccinators, and we have to get the people who are going to be handling the vaccine protected so that they can safely administer the program.

So we are actually not surprised to see this rate of immunization, and yeah, I think after the vaccinators are protected, they'll be in a position to scale up the clinic.

Also, we've put a lot of emphasis on numbers but I would just urge you to please recognize that we do not have a target number of people to vaccinate. What we have is the targeted capacity to protect the American people and each jurisdiction is looking at their own public health system, their own care delivery system and identifying what do they truly need to be able to initiate a broader protection program for people.

So I know it's tempting to concentrate on the number 500,000 and the number 10 million, but I just urge you, again, to understand that our goal is not achievement of a number. Our goal is achievement of a preparedness capacity.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Thank you. Laura Meckler with the Associated Press.

QUESTION: Thank you. A couple questions. Was it originally in the original guidance you sent to the states, you suggested that this first phase of vaccination would take approximately 30 days. Was that unrealistic, looking at it now?

Secondly, could you tell us which states have already begun vaccinating.

DR. GERBERDING: Yes. Tom Skinner will be able to tell you the list of states but let me address your first question.

When we put guidance out, we initially had an open-ended time frame on the timing of this initial stages of program. We got a lot of feedback from our state and local public health agencies, that they needed some kind of planning framework in order to help motivate getting the clinics up and running, and that if we didn't put some time frame around this, that people might not ever get around to starting the program or might not ever gear it up to really achieve the level of preparedness we were trying to accomplish.

So we put a 30-day time frame in there, as it suggested, time to shoot for. I think it was optimistic. I'm not worried about the fact that we may not have fully accomplished our stage one by the end of February but I'm not making a lot of it at this point in time.

CDC MODERATOR: And Laura, this is Tom, and I'll provide those 16 jurisdictions to you right now, and we hope to be able, again, as Dr. Gerberding said, start posting these on our Web, you know, twice a week with updated numbers.

But, so far, the 16 jurisdictions that have begun to vaccinate are Colorado, Connecticut, Georgia, Iowa, Kentucky, LA County, New Hampshire, New Jersey, New York State, North Carolina, Pennsylvania, South Dakota, Tennessee, Vermont, Virginia and Wyoming.

Next question, please.

AT&T MODERATOR: Thank you, sir. Our next question comes form Steve Mitchell with United Press International.

QUESTION: Hi. Can you give us an update on the two soldiers who were reported to have had some serious adverse events from the vaccination.

DR. GERBERDING: The best source for information on the status of the soldiers is really the DOD. Our most recent update indicated that they were doing well but I would definitely encourage you to contact them for the specifics.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Thank you. Ceci Connolly with the Washington Post.

QUESTION: Dr. Gerberding, I know that you don't want us to be consumed with numbers, but just to get back to this issue for a minute, that 500,000 figure wasn't simply pulled out of thin air.

I mean, as I understand it, when each of the states filed their plans to CDC on December 1 or 2, they had numbers in terms of what they would need for their smallpox response teams and preparedness, and I think at the time you said that was right around 450,000.

All indications now are that the vast majority of states are scaling those numbers way back, and so, you know, to focus in on your point about how the goal here is achievement of preparedness capacity, if as recently as December 1, the states thought that, in total, preparedness capacity meant 450,000 in this first stage, what now is the realistic preparedness capacity level for the United States?

DR. GERBERDING: Ceci, let me be very clear about what these numbers are all about.

When we estimated 500,000 before we had received anything at all from the states, we were making a calculus based on the number of hospitals and what somebody guessed would be the average number of people per hospital and the proportion of hospitals that would participate.

So that 500,000 was our best guess, taking sort of an average situation and applying it across multiple jurisdictions.

Then we asked states to submit plans and included in the plan was the number of health care personnel they intended to offer vaccine to. That is not related to the number of people necessary to achieve the level of preparedness we are seeking. obviously, there was a lot of tension around not--about being too exclusive with the vaccine. We were trying to send a message that this was an open process. We weren't trying to exclude certain categories of health care workers or certain people. So in the states we're planning, they identified the category of people that we were going to offer vaccine to. That number cumulative came to about 450,000, but the actual number of people required to achieve the level of preparedness we need to initiate vaccine clinics for the public, we know that number is significantly less than that.

QUESTION: Well, about how much?

DR. GERBERDING: We're trying to get a balance here between the absolutely essential level of preparedness we need and a more open-ended inclusive process to include a broader number of hospitals or individual health care workers, and the actual number is something that very much depends on the jurisdiction where the preparedness is being planned.

Some communities have a central hospital that basically would be in a position to service the entire community. Other situations, the number of hospitals necessary to ensure that the initial patients with smallpox would receive care is much different, but very variable, and we can only look at it on a jurisdiction by jurisdiction basis. The best place to go to make that assessment is to talk to people at the local level and see where they think they are in terms of their preparedness. And we are obviously going to be looking at that with them as we go forward.

QUESTION: [Inaudible] -- been made of CDC carefully reviewing and approving each and every one of these plans, and there's a lot of talk about benchmarks for the $1 billion that CDC shipped out once already, and is anticipating shipping out again. So it seems to me if you want us to back off of the number 500,000, there ought to be some credible measure.

And I guess sort of the follow up question on this then is, well, why did the President then say that he wants to go to stage 2 immediately, which is the 10 million? I mean, what is it that this country needs, in your words, to have the capacity to respond?

DR. GERBERDING: Keep in mind that preparedness is a process and not an event, and that there is no absolute definition of preparedness.

What the President asked us to do was first of all ensure that our military was prepared for a smallpox exposure, and secondarily to ensure that the civilian workforce that would be essential to initiating a broader immunization program to protect our public was prepared. We expanded that, as you know, to include what you are referring to as the stage 2 of this because there are scenarios when having a broader group of responders and health care workers protected would potentially be important. So you know, we could expand that to include situations where there may be a smallpox attack simultaneous with some other kind of terrorism event.

So preparedness can expand to include a level of responsiveness that goes beyond simply smallpox immunizations, and that is part of the thought process that led to the decision to expand the program to include that wouldn't necessarily be involved in a smallpox vaccination program or treatment of smallpox patients, but would be called upon in a larger framework of preparedness.

CDC MODERATOR: Next question, please.

AT&T OPERATOR: Thank you. Murray Jacobson with the NewsHour, your line is open.

QUESTION: Yes. Hi, Dr. Gerberding. A couple questions. One, on the compensation fund. I know you say you can't talk details of it, but do we think that this announcement might be forthcoming inside of, say, a week, when we talk about HHS trying to hammer out these details?

And second of all, I do realize that the compensation issue is a big part of the reluctance of many workers, but I'm wondering from what you all are hearing in your position, how much the compensation fund will resolve workers' reluctance, their concerns about side effects, about what the SEIU says may not be a necessary vaccination. How much will this compensation fund issue really resolve this problem in a broader sense?

DR. GERBERDING: I wish I could give you more specifics about the steps that are being taken now, but I just can't. I can just simply that we hope to hear something soon, but I don't have a specific time frame for that.

With respect to the impact of an expanded compensation program on the initial uptake of the vaccination program, that would be speculating at this point in time, but our perspective from pretty credible folks within the health care community suggest that this is an important issue for them and that if they had the confidence that they were not going to fall through the cracks, they would be likely to participate in the program.

CDC MODERATOR: Next question please.

AT&T OPERATOR: Thank you. Marie McCullough with the Philadelphia Inquirer, your line is open.

QUESTION: Thank you. I'd like to ask about hospitals. I'm wondering how many hospitals have opted out of the program and how many have formally opted in and how many have not said one way or the other whether they will be participating in this? And are there any hospitals that at this point have begun to vaccinate their workers?

DR. GERBERDING: I don't have specific information on opting out or opting in, and I think that what we're hearing from our [inaudible] of input, that this is not a yes or no response, it's: "We're starting, we're starting slow, and we may scale up as we go forward in time." But remember that right now we're primarily vaccinating vaccinators so it would be premature to really get an assessment about whether or not the hospitals are beginning to participate because we wouldn't be vaccinating them until we had people to go there and vaccinate.

CDC MODERATOR: Next question please.

AT&T OPERATOR: Thank you. We have a follow up from Mary M. Falco with CNN.

QUESTION: Getting back to the small numbers that have been vaccinated, and also the good news that there have been no adverse effects yet, I know that in Connecticut the initial vaccinations were only for people--the only people who were candidates were those who had already been previously vaccinated, so no virgins as they put it, just the revaccinated folks. Do you think that has had an impact on, (A), the small number of people so far, if other states were looking for people who had been previously vaccinated, and also the lack of adverse events because the body wasn't completely new to the vaccine?

DR. GERBERDING: No. The frequency of vaccine side effects is certainly not zero, but it's relatively low, and we can draw no conclusions about the numbers that we have so far, because there are just simply too many people in the denominator to draw any assessments at all about whether we're seeing fewer side effects than expected.

We know that we are going to see side effects as we scale this program up, and I just am trying to prepare us for that right now because just as the military experience says they scaled their program up, the more people we vaccinate, the more likely it is that someone is going to experience a serious adverse event. So I want you to be prepared for that and we will tell you about it as soon as we have information that we can make available publicly.

But having said that, the fact that people who have been immunized in the past appear to be at lower risk for vaccination is something that we expect to be the case now, and we'll be looking at our experienced folks from the standpoint of first-time vaccinations versus repeat or follow-up vaccinations to see what we can learn about the differences in the contemporary time frame. This is again just part of our commitment to really emphasizing the safety of the program, and there are several jurisdictions that have chosen to immunize previously vaccinated people first.

CDC MODERATOR: Next question please.

AT&T OPERATOR: Thank you. We have a question with Ann Carnes with the Wall Street Journal.

QUESTION: Hi, good morning. One more numbers related question to help understand this preparedness goal. Is there any sort of number in terms of the number of vaccinators per 1,000 or 100,000 population that you're giving the different jurisdictions to use as a guideline for at least a goal of how many people they should have vaccinated?

DR. GERBERDING: When we first started thinking about the program, we had that thought, and we looked at whether or not that made sense. But as we talked to people in local jurisdictions and the state health departments, we realized that really didn't make any sense because there are so many differences in the way the public health system is organized in our country, and so many differences in the way the health care delivery system is organized that trying to get a per-capita metric really doesn't work out very well, and you could probably understand that if you just thought about the differences in what you would need in an urban area versus a very geographically distributed rural area.

So we abandoned that sort of bench-marking approach to promoting more local flexibility and assuming and trusting that local health officials would really be the best judge of how they would get a system together in their jurisdiction.

QUESTION: So at this point--just to follow up--are you basically taking the position that when the local jurisdiction say they're prepared, that they're prepared, and you're not going to go beyond that?

DR. GERBERDING: States submitted their Smallpox Preparedness Plans, these are very comprehensive plans that have a number of criteria in them, and so we have assessed their documentation of adherence to these criteria very carefully, and this includes the documentation that they have sufficient trained personnel on the screening parameters and the adverse event reporting parameters and so forth necessary to do this program safely.

We, also, obviously, will be working with them on an ongoing basis, and we'll be making assessments and site visits, and so on and so forth, and so it's an ongoing process as we go forward.

CDC MODERATOR: Next question, please.

AT&T OPERATOR: Our next question comes from CeCi Connolly, Washington Post.

QUESTION: I'm going to change the subject just slightly and ask about the proposed budget that came out earlier this week.

As I understand it, your bioterrorism preparedness budget appears to have actually been cut by about $230 million, also, ironically, childhood immunization programs under CDC have been cut--I say "ironically" because the administration was touting that before the actual budget came out--and I believe your EIS program has also been reduced, and it seems as if EIS would be a pretty integral part of surveillance efforts that tie in not only to bioterrorism, but so many other public health issues.

DR. GERBERDING: CeCi, we actually are very pleased with the proposed FY '04 budget. If you're comparing line-by-line, you can derive some erroneous conclusions.

Keep in mind that the financial management of the stockpile program has been moved to the Department of Homeland Security, and that financial management was in the CDC budget. That's a very large piece of the bioterrorism budget. So that accounts for what appears to be a reduction in our terrorism budget. In fact, we are receiving some enhancements in our support of the terrorism and preparedness program.

And in terms of the childhood immunization program, again, there's been a shift of money supporting childhood immunizations from one line item into another program, which we are extremely pleased about. It actually enhances access to underinsured and uninsured children and makes them qualify for the vaccine program.

So it is a little misleading to just look line item-by-line item.

I can't remember your third question, but if you want to go into this in a little more detail, I'd be happy to follow up with you after the call.

CDC MODERATOR: Next question, please.

AT&T OPERATOR: Donald McNeill with the New York Times.

QUESTION: Hi. The complaints that I've heard from nurses around the nation who are backing out of the program is that, one, they've been asking questions of Washington since December, particularly about compensation, but also about the safety of their families and also about protected needles, and that, one, they don't know what the compensation--how the compensation issues are going to be handled and, two, they can't get answers to their questions.

The answer to the question seems to be you can't get specific about steps being taken. What do you say to them now? It sounds like this is just another reason to continue backing out of the program, if you can't answer the question.

DR. GERBERDING: Workers' Compensation is a local issue. It's determined by the employer--

QUESTION: I mean compensation, overall, I'm sorry, including for family members that might be hurt if the antivirus is not done--

DR. GERBERDING: But the benefits that are provided to workers who are injured as a consequence of occupational activities are very much variable, depending on where you work and what state you're working in. So the first resource is to identify what's happening locally, and obviously CDC doesn't have all of that information, so we can't provide specifics to an individual worker That's why, in our vaccine information sheet and so forth, we advise people to find out what is the situation that would affect them at the local level.

In terms of what the gaps are in a program that are causing the concern to individuals that they may fall between the cracks, those gaps are the things that we're trying to devise a solution for. As I said, I just can't go into the specifics, but I think we've all heard from a variety of inputs that there are very specific needs and people really need to have reassurances that those gaps are going to be addressed, and that includes risk to contacts of someone who's been vaccinated.

CDC MODERATOR: Next question, please.

AT&T OPERATOR: Thank you. Laura Megler [ph] with the Associated Press.

QUESTION: Thank you. I wanted to ask a follow-up to an earlier line of questioning that deals with what the appropriate level of preparedness is in this first stage.

When that number of 450,000 first came back from the state plans, I specifically asked people at CDC whether that was the number being offered the vaccine or whether that was the number who states expected to actually vaccinate, and I was told that it was a mix, that in many cases states were estimating the total number they needed on their teams, and so therefore if people were deferred due to adverse risk conditions or if people didn't want to get it, they would have to find somebody else to take that spot because it was actually a 20-person team or something like that.

Was that information wrong that was told to me at the time or has it changed since then? I feel like this whole number thing, and I understand that you don't want to be held to any particular number, but it seems to be shifting, the ground seems to be shifting over the last, just the last couple months.

And since this call began, I actually went back and looked at the transcript from the briefing on December 13th, and those numbers of 500,000 and 10 million were cited on the record that day by Dr. Fauci. So I just want to understand exactly what's happening.

DR. GERBERDING: I think the statement you made, Laura, that there was variability in how the states described the numbers that they were requesting vaccine doses for is correct. Some states made it very explicit that they were going to offer to a large group, but they weren't expecting to be immunizing that large of a group. Other states presented their plan in the framework of this is the number that we think we're going to actually vaccinate.

But there still is a difference between number included in a plan presented by the states and the number that we actually think is necessary to achieve a level of protection. If you remember back in early June, when the ACIP came out with its first recommendation about this phase of preparedness, the initial estimates of the number of people actually required to do this job was somewhere around 50,000.

And so what I think we need to really appreciate is that we're trying to achieve a level of preparedness that will get us where we need to go in an emergency. There is a basement to that number, but there is not necessarily a ceiling, and so we are confident that we'll be able to achieve the necessary level of preparedness as we go forward with this program.

And we're learning, as we go, what the obstacles are, and we intend to do everything we can to remove them.

QUESTION: What are the, other than the compensation issue, what obstacles are out there for people, as you see it, of people declining?

DR. GERBERDING: I think one of the concerns really is that people are confused about the risk of a smallpox attack, and part of that is we cannot give them a quantitative estimate of the risk, as you know. It's just not a possible thing to assess.

And so when we say we don't know what the risk is, but it's not zero, that is not a very helpful parameter for people who are used to having very precise information about weighing risks and benefits of a policy or an individual health decision, and so there is a great uncertainty about the probability of a smallpox attack.

That risk may change over time, as international events unfold, but in addition, the understanding and appreciation of risk varies, depending on what people hear, what people they are talking to, what local opinion leaders are saying are reflecting about the risk, and we are trying to take care not to be dogmatic about it.

In the materials that I've been involved in preparing to help individuals, the volunteers make decisions about whether they want to participate in the program, I tried to be very explicit that we don't know the risk and that we respect that people will evaluate the risk differently.

And I think the other side of that is that we're asking, basically, civilians to volunteer where there is a small benefit to them, if any, of the vaccination, but a larger benefit to society if we have a smallpox attack.

So there's an element here of weighing sort of your responsibility to society with your individual risk and benefit, and that just makes this a very unique and complicated equation for people to figure out. I'm not surprised that there are a lot of different interpretations of this information, and I'm glad people are making very independent and individual decisions because I think that means that the informed process is working.

It would be concerning to me if everyone looked at this and came to the same conclusion.

CDC MODERATOR: Andrea, we'll take one more question, please.

AT&T OPERATOR: Thank you, sir.

The next question comes from Michele Merrill from Hospital for Employee Health Newsletter.

QUESTION: Thank you, Dr. Gerberding.

I had a question about Phase 2 and I was wondering are you going to wait until all of Phase 1 is completed, all states have vaccinated all of their eligible workers before starting Phase 2? And the compensation issues that are being discussed, will they be relevant to people who might be vaccinated during Phase 2?

DR. GERBERDING: We have talked about the stages of the vaccine program when we were pulling it together. More recently, you've noticed we're less-inclined to use those terms because it implies a very discrete separation between first we're doing this and then we're doing something else.

The short answer to your question is there is not going to be a stop date where we say, okay, Stage 1 is over, now Stage 2 begins. Rather, each jurisdiction will be able to expand to accommodate the larger group of people volunteering for vaccination at their own pace.

Again, the metric is as quickly as we safely can, but there is going to be variability, just as we're seeing variability in start-up times, and we're going to see variability in the rate and capacity of individual jurisdictions to expand.

Part of our job at CDC is to identify where there are barriers to that expansion that we can help with through technical support or through personnel support or other measures that would help jurisdictions who need something to be able to do their program successfully.

So it is not a uniform phenomenon across the country, and we will do our best to support all of the jurisdictions to do this safely and quickly.

CDC MODERATOR: Andrea, we'd like to conclude our briefing at this time, and I want to remind all reporters to please continue to check back at the CDC website for the posting of the numbers we described earlier that would be posted or call the main press office, at 404-639-3286, periodically, to see when those numbers are going to be available.

Thank you. Bye-bye.

AT&T OPERATOR: Ladies and gentlemen, that does conclude our conference for today. Thank you for your participation and for using AT&T Executive Teleconference. You may now disconnect.

Listen to the telebriefing

For more information, visit the smallpox web site.

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