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Smallpox Home

CDC Telebriefing Transcript
Smallpox vaccine

June 20, 2002

Briefers: Drs. Gerberding and Modlin

CDC MODERATOR: Hi. This is the CDC telebriefing on the use of smallpox vaccine.

Today's telebriefing will include both calls from the telephone line and also from reporters here with us at this meeting. We want to open the meeting with brief remarks from Dr. Julie Gerberding, who is the acting deputy director of CDC. Also with Dr. Gerberding is Dr. John Modlin, who is the chairman of the Advisory Committee on Immunization Practices.

Dr. Gerberding.

DR. GERBERDING: Thank you, and thanks for your patience. What I really wanted to start off with today was a big thanks to the ACIP. The process that's unfolded over the last several weeks has been I think a rapid one, and one is that has just required an enormous amount of effort and time, and I'm very pleased that the overall process has gone so well. So thank you so much for the work that went into making these recommendations.

Just to recap what has been decided by the ACIP today was to recommend that smallpox vaccine be made available for smallpox responders in the states and municipalities, so that [inaudible] be responsible for investigating and evaluating initial suspect cases of smallpox would have that protection in advance.

In addition, personnel at predesignated hospitals responsible for taking care of the initial cases of smallpox in a community would also be eligible for vaccine. What was not decided today was the logistics for implementing this policy and that would be something, should the Department of Health and Human Services decide that is the appropriate federal policy, we would be working out over the next several months.

So the policy is limited in defining who should receive vaccine but does not deal with the implementation process.

I'd also like to announce some next steps that CDC will be taking. First of all, we will be reviewing this policy and identifying our position on it in conjunction with Secretary Thompson and Health and Human Services.

We've just briefed the Secretary, he does have the recommendations, he wanted me to specifically express my thanks on his behalf to the ACIP, excuse me, his thanks to the ACIP, and his process will be one of consulting with other experts within the Department as well as outside of the Department, and looking at this policy, which really is a public health policy in an environment where we're also mindful of homeland security and national defense.

So the public health position I think has been clearly articulated by the ACIP and the next step is to decide what ultimately will the federal policy look like within this context, and I'm sure the recommendations from the ACIP, as a panel of experts, will be taken very seriously and will be a very important component of that decision process.

CDC will be establishing an oversight board, a smallpox vaccine program oversight panel to monitor the use of vaccines. As you know we're already using it for people who work in laboratories who are handling smallpox virus, and we want to have an advisory group that can help us ensure that the vaccine is used appropriately, that it's used safely, and that we can gain information about its safety and efficacy in the overall feasibility and experience a we go.

So the next step for us is to begin to initiate that panel and make sure that however we end up using the vaccine, we're doing it in the safest and most scientifically credible way.

So with that I'll end my comments and ask John if he wants to add anything to that.

DR. MODLIN: Actually, I don't. I'd just like to underscore what Dr. Gerberding has just said, that this is a process that has involved a number of individuals who have given up a lot of their time to jobs that they normally have elsewhere, to devote a lot of time and energy to coming to several meetings to participate in a process that has been an open, public, deliberative process.

I think that's been one of the strengths of the process so far, and that I want to acknowledge that I have a number of colleagues who are here, who have been thoughtful, influential, deliberate, and I believe have helped us come to a balanced and appropriate decision today.

DR. GERBERDING: So we can take some questions.

CDC MODERATOR: Okay. Thank you. Again, we will be alternating taking one question from the phone line and one question from our audience here. Why don't we begin with a question from the phone.

AT&T MODERATOR: Ladies and gentlemen on the phone, if you would like to ask a question at this time, please press the one on your touchtone phone. You will hear a tone indicating that you've been placed in queue, and you also may remove yourself from that queue at any time by pressing the pound key.

Our first question comes from the line of Adam Marcus, HealthSouth [ph]. Please go ahead.

QUESTION: Hello, doctors, thanks for holding the briefing.

A two-part question. One is is there anything new about the CDC's policy of ring vaccination and quarantine?

DR. GERBERDING: The recommendations do not specifically deal with what to do after smallpox exposure but make the statement that the surveillance and containment method is always a part of responding to smallpox and will remain a part of responding to smallpox exposure in the future. If additional circumstances warrant more widespread use of vaccine in a area or a community, then those steps of course would be taken.

DR. MODLIN: I'd like to only add that the recommendations we made today very much built and rely upon the CDC strategy of surveillance and ring vaccination, and assume, and expect that that is strategy that would almost certainly be successful in just about any sort of a attack scenario that could be envisioned.

I'll leave it at that.

CDC MODERATOR: Thank you. We'll now take a question from our audience.

QUESTION: I'm Rhonda Rollin [ph], CNN. There may be some members of the general public out there who will be disappointed that they can't get the vaccine. So what would you tell them, to give them some reassurance in the unlikely event that there would be an outbreak, that they could get the protection they want?

DR. MODLIN: Well, the major thing is I think in the event of an outbreak, that as we have said in the statement, that we would, in all likelihood, review our policies very, very quickly, and it's highly likely that our policy could change, and that we would certainly expect, in the event of an outbreak, to expand the number of individuals that we would expect to vaccinate in an outbreak situation.

Whether or not this would extend to--whatever we would do would be consistent with the current policy of--strategy of surveillance and ring vaccination, and containment.

QUESTION: [inaudible] tell me like how quickly do you think the vaccine could get to people if they needed it, and how quickly you could work with them?

DR. MODLIN: My understanding, that the vaccine could be distributed very quickly, and that within a few months a plan will be in place, that the vaccine that's available would reach wherever it needs to reach within 12 to 24 hours of the initial request.

DR. GERBERDING: Let me expand on that a little bit. One of the great successes of the fall experience was the national pharmaceutical stockpile deployment and we've learned through that practice that we can get the products in the stockpile to any place in the United States within 12 to 24 hours.

So I don't think the rate limiting issue is getting the vaccine to the area where there's a problem. What we're working on now is once it gets there, how does it get into the arms of the people who need to receive it, and part of the $1.1 billion investment that the Secretary just made in public health is to help states plan for vaccine distribution and use.

So the money is now available to the states. That planning process has already been started and we are expecting by the beginning of July for every state to have a plan for mass immunization.

CDC MODERATOR: Thank you. We'll now take a question from the telephone line.

AT&T MODERATOR: Thank you. Our next question comes from the line of Susan Ferraro [ph], New York Daily News. Please go ahead.

QUESTION: Hi. Thanks very much for having this briefing. First of all, if the people who are answering questions would spell their names, I'd be very grateful, and then there are two questions.

Will the--for the designated groups that you're recommending immunization for, is this voluntary or required immunization?

And secondly, how many people do you estimate will be covered or receive immunizations because of this new policy, both nationally and maybe even in New York City?

DR. MODLIN: My name is John Modlin . It's M-o-d as in David, l-i-n.

QUESTION: Thank you.

DR. GERBERDING: And I'm Julie Gerberding. G-e-r-b-e-r-d-i-n-g.

QUESTION: Thank you.

DR. MODLIN: The vaccination will always be voluntary. We're long past the days of which we send strong-armed people in to knock down doors and hold people down to vaccinate them. So it's important to emphasize that the administration of this vaccine would always be done on a voluntary basis for those individuals who would be designated to receive vaccine.

And your second question, I'm sorry, was...?

QUESTION: Numbers.

DR. MODLIN: The actual numbers. The best estimate that we have, that there would be probably somewhere between ten and twenty thousand individuals who might receive the vaccine under the current recommendation.

CDC MODERATOR: Thank you for your question, Susan. And now David.

QUESTION: David Brown, Washington Post. Realistically, when do you think the earliest would be, that large numbers of people would get vaccinated? Are you talking about October, November? Are you talking about next year? The summer, perhaps?

DR. GERBERDING: I think once we have the logistic meeting, which we would expect to have some time at the beginning of July, we'll have a better sense of that, but certainly by the fall, somewhere in that October area.

CDC MODERATOR: Okay. We can now take another question from the phone.

AT&T MODERATOR: Thank you. Our next question is from the line of Tina Hessman [ph] with the St. Louis Post-Dispatch. Please go ahead.

QUESTION: Hi. My question is about the vaccinia immune globulin. Would the first responders who get initial vaccinations be asked to contribute serum, so that we can have a larger supply of the immune globulin in case we do, at some point, need to expand the vaccine program?

DR. MODLIN: It certainly wouldn't be a requirement. I'm afraid that to ask them to contribute would be coercive, quite frankly. I honestly don't know what the plan would be for harvesting vaccinia immune globulin, might be. Julie can probably expand upon that.

DR. GERBERDING: There is no plan to do that at this point in time. I think it's an option that will be considered along with the other [inaudible].

CDC MODERATOR: Thank you. Now a question from our audience. Ann?

QUESTION: [inaudible; off-mike].

DR. MODLIN: The best numbers that we have, that have been gathered from surveillance, from scientific studies, are approximately 40 years old, and come from data collected by the CDC from states, and local health departments, from individuals who were immunized in the early to mid 1960's.

And they suggest that the adverse events such as sore arms, fevers, local lymph node swelling are actually quite common and might occur in as many as one out of every two or every four individuals who are immunized. There are other adverse events that are slightly less common and may appear to be a little bit more serious, but usually have a good outcome, and they would number in the range of several hundred to several thousands of persons per million immunized.

Very serious adverse reactions that the committee more or less defined as those that required or needed vaccinia immune globulin administration to help control are probably fewer in number.

Amongst the most serious of those would be local inoculation involving the eye with vaccinia keratitis. Vaccinia encephalitis, which appears to occur in the range of somewhere between five and ten per million individuals, or perhaps I should say between five and twenty per million individuals vaccinated, which itself carries a mortality rate of about 25 percent, and roughly another 25 percent of individuals would have serious long-term neurological sequelae from encephalitis.

And then the risk of death overall was in the range of one per million. But it's important to point out that those rates differed by the individual who is receiving vaccine, and at the rates that I quoted for you are primarily limited to those who are receiving vaccine for the first time, so-called primary vaccinees.

Those are numbers that we were able to fall back upon but we also acknowledge that they were obtained in a population that probably is not as immunocompromised, or did not contain the number of immunocompromised individuals who would be free living in the population today.

Forty years ago, there were few if any cases of HIV infection. There were very few patients that had solid organ transplants, that had other immunosuppressive condition such as being treated for hematologic malignancies, and in all likelihood, without adequate screening for, prior to immunization, the number of adverse events that we would see in a contemporary population would be somewhat higher. We don't know how much higher.

QUESTION: [inaudible].

DR. MODLIN: Yeah. Well--

DR. GERBERDING: It's really important to help people understand that unlike all of the other vaccines that we use, this vaccine has special risks. It is not as safe as the things that we ordinarily and routinely recommend for people, and I think that you could help us by really getting that word out, because we don't want to confuse people that other vaccines are as potentially harmful or have as many adverse effects as this particular vaccine does. It's special.

CDC MODERATOR: Thank you. Jeannine, we're now ready for question.

AT&T OPERATOR: --to please repeat the questions in the room for the benefit of those on the phone.

We will move on to the next question from Kim Dixon with Bloomberg News. I beg your pardon, Steve Mitso with UPI, please go ahead.

QUESTION: Yeah, I've got a two-part question here. Can you elaborate on why you've decided on--why you made the recommendation not to give the vaccine to or not to offer the vaccine to the general public, and also several public health experts have questioned the quarantine method and how effective it would actually be, given the global traveling nature of our society, so how do you respond to that?

DR. GERBERDING: Let me see if I can paraphrase what I understand the experts have advised about immunizing the general public and their rationale for that decision to not include the general public in their recommendation at this point in time.

First of all, this is an investigational vaccine, and that means that to use it requires informed consent and all of the kinds of protocols that one would use for any sort of clinical research program.

Second, right now the assessment is that the smallpox risk is very low and the general public would have a greater risk of sustaining a serious adverse event from receiving the vaccine than they would from catching smallpox if there were a bioterrorism event.

Third, the vaccine is new, and we actually don't know everything we need to know about the safety and efficacy of the vaccine.

Then, finally, in this case, if an individual decided that they accepted the risk of the vaccine, they are not accepting the risk that the person that they are in contact with experiences. In other words, if you get immunized with Vaccinia, you can infect people around you from your Vaccinia scab. And so while you may accept the risk for yourself, you would be imparting a risk to your contacts, and that makes this a little bit different from other vaccines as well.

So, for all of those reasons right now, the recommendation was to limit the access to people who would be at highest risk for exposure in the case of a terrorist event, but to not immunize the general public until such time that we had more experience and perhaps more public health infrastructure developed around the vaccine program and knew a lot more about this particular product.

CDC MODERATOR: And now a question from our audience?

MS. : Delphia Ricks [ph]?

QUESTION: [Off microphone.] [Inaudible.]

DR. MODLIN: I would point out that there have already been clinical trials, Dryvax is the vaccine that we have been using for decades, and so we know a lot about the undiluted vaccine already, that there have recently been completed, and published, clinical trials on the use of that vaccine, diluted both 1 to 5 and 1 to 10, and we had some of that information presented yesterday, and it has also been presented at prior meetings, at least of our work group, and of course were published in the New England Journal of Medicine about six weeks ago.

Clinical trials of the Acambis cell culture-based vaccine are now underway. They are at a relatively early stage, but they have very ambitious plans for expanding those trials on an appropriate basis, as the safety data allow the trials to be expanded.

As we heard, both yesterday and today, the anticipation is that those trials will be conducted and completed in a very, very timely manner, probably over a matter of a few months to a year or two; would that be fair?

CDC MODERATOR: Thank you. We are now ready for a question from our callers?

AT&T OPERATOR: Thank you. Our next question from the line of Richard Knox, National Public Radio. Please go ahead.

QUESTION: Thank you. I just want to be clearer than I am, at least at this point, about who you are recommending be vaccinated in the localities. I gather that part of it has to do with people in designated hospitals, but who in those hospitals, and I wonder about first responders, such as EMTs, fire fighters and police.

DR. MODLIN: We are recommending that two groups of individuals be immunized, in both cases in concert and according to state and local bioterrorism preparedness plans. One group would be those predesignated to be amongst the first to come in contact with a case of smallpox, should there be a smallpox bioterrorist event, who would be predesignated to be on teams that would respond, teams that might include a team leader, a team physician, team nurses, public health personnel that would aid in quarantine, and surveillance, and surveillance contacts and immunization of contacts. Those would be the individuals.

The numbers of such teams would vary from place to place, although the committee did provide some guidance that each state have at least one team and that, for many locations, based on the population, that more than one team would be appropriate.

The second group would be health care workers located in a hospital or hospitals that have been also predesignated to receive smallpox victims, and these would be individuals who would be primarily focusing on the clinical care of those individuals who required or who were hospitalized.

I would like to emphasize that the intent was to provide both some direction to state and local health departments along these lines, but also to provide some flexibility to that. The make-up of these teams would appropriately vary from one location to the next, depending upon the circumstances and the nature of the need and their requirements.

CDC MODERATOR: Thank you. Now a question from our audience?

QUESTION: [Off microphone.] [Inaudible.] I am a little uninformed, as probably a lot of the people who are going to be watching this on TV, how is this different than maybe 40 years ago they had vaccines, and it's almost like there's a whole new ball game. There's nothing known, but they gave vaccine or I guess this is all new or something?

DR. GERBERDING: There are two aspects to what is new now and what is different from the past. The first is, in the past, there were cases of smallpox in the community, so there was a known risk of smallpox present, and in that environment, the risk of immunization was acceptable because the threat of the disease was imminent.

The second thing that's new is that the product itself has changed over time. So, although the Dryvax or Vaccinia is the same, the way it's diluted and prepared has changed, and that's why it's an investigational approach.

CDC MODERATOR: Now a question from our callers.

AT&T OPERATOR: Our next question comes from the line of Marion McKenna with the Atlanta Journal. Please go ahead.

QUESTION: Hi. Could you be a bit more specific--I think this question goes more to Dr. Gerberding--about what happens next on the CDC side, how quickly you plan to appoint the oversight panel, where you hope to draw the members of that panel from and sort of what a time line might be for the next couple of months?

DR. GERBERDING: Yes. First of all, let me emphasize again that what has happened today is that the advisory committee has recommended a policy to CDC and the Secretary of Health and Human Services Secretary Thompson. So this is not a CDC policy, it is a recommendation to the Department about the expert view of what public health response should be.

CDC will be part of the decision process, working with the Secretary, to determine ultimately what will happen next, in terms of use of this vaccine.

Independent of that, we intend to appoint this oversight committee and are in the process now of looking at ways that we can do that in the fastest possible manner. One approach is to take advantage of experts that already are part of Government advisory groups so that we don't have to go through the process of recruiting them and approving them. They already exist, and we can call upon them.

But I think we would like this to be sort of a public-sector aspect, particularly since the safety of the people who are receiving the investigational drugs is important to us, and the views of the patient or of the taxpayer are also very relevant in the process.

So I expect that we will be coming out with the idea of this might work or at least proposing this to the Secretary in the next couple of weeks.


Now a question from our audience.


QUESTION: [Off microphone.] Do you have a knowledge of how many states, if any, have the teams that you have described already set up, and if they do, could they count[?] on vaccinated tomorrow?

DR. MODLIN: I don't, but Dr. Natalie Smith, who is sitting right next to you, might have a little bit more information. If it is okay, maybe she would like to address that issue.

Is that all right?

DR. SMITH: All states are planning for bioterrorism, are developing smallpox plans, have been developing bioterrorism plans for quite some time. I think all states are going to need some time to work out logistical issues, review these recommendations, and we are committed together with states to come up with the best way to implement this.

DR. GERBERDING: This just is one other piece of information along those lines. One of the critical benchmarks for the cooperative agreement program to support the state and local preparedness effort includes the benchmark that addresses the specific issue of the smallpox response team.

QUESTION: [inaudible].

DR. SMITH: My name is Dr. Natalie Smith.

DR. MODLIN: Natalie's with the California state department immunization program.

QUESTION: Just to clarify that, supposing there is a state that has the team already set up, that would meet the qualifications as described in the recommendation and they say we want to vaccinate next week, and could they do so? Would you allow them? Would you give them the vaccine?

DR. MODLIN: I don't think that the preparations at the federal level are quite prepared to distribute vaccine to the state teams just yet, and as Dr. Gerberding said earlier, it's probably not likely to occur before early fall, at the earliest.

DR. GERBERDING: And that's predicated on the assumption that this is the policy that we elect to follow.

QUESTION: Thank you.

DR. SMITH [?]: Some of the logistical issues include there are a number of, for instance, liability issues that need to be worked out, among other things, because states don't really want to [inaudible] accepting the risks, and would prefer that that be a national policy.

So there are a number of states that are starting to come up with response teams. It's really variable by which state, and of course these guidelines have just come out in the last hour or two, so we're going to need some time to work as groups and states, and at the local level, to figure out who should be predesignated and who would be the best folks to be vaccinated, and these folks also will need to have the responsibility for going out and investigating and taking care of smallpox patients.

CDC MODERATOR: Thank you. Now a question from one of our callers.

AT&T MODERATOR: Our next question is from the line of Laura Beal [ph] with the Dallas morning newspaper. Please go ahead.

QUESTION: Yeah. I have two questions. One is a lotta people who would be getting this vaccine would presumably be old enough to have had it as a child.

If they didn't have a reaction when they got it in childhood, would that be predictive of whether you would have side effects as an adult?

And I was also wondering if you could tell me the last time that the smallpox vaccination policy was updated or changed.

DR. MODLIN: Certainly. The first question, if I heard it correctly, was if you were vaccinated as a child but did not have a reaction, would you be at risk of having an adverse reaction to the vaccine being given today.

The answer is yes. If you truly did not have a reaction, what we would call a, quote, take [?], unquote, that could mean that that was an unsuccessful vaccination as a child, and therefore you would be susceptible, and have the same degree of susceptibility to an adverse reaction that anybody being immunized or being vaccinated for the first time would be.

There are some uncertainties around that because there may be other reasons why you failed to have a reaction as a child.

Maybe while we're on that topic, we should point out that one of the questions that often we are asked is if I was vaccinated as a child, or at any time in the past, and did have a successful take, what would be my risk if I were to be exposed to smallpox today?

And, I think that the best short answer is is if we believe that there would still be some risk of acquiring smallpox, and even some risk of having serious disease and dying from it, in all likelihood it would be a lot less than from someone who had not ever received any vaccine in the past.

Just what the differences may be may vary somewhat by according to how long it was, the length of time, the duration since you were first immunized at your age, your underlying immune status, and others.

QUESTION: Thank you.

CDC MODERATOR: And now a question from our audience. Joan?

QUESTION: How important is public acceptance of this policy and is there a plan in place to [inaudible] or to get them behind it?

DR. GERBERDING: You bring up a question that's important in kind of preparedness planning and since we learned from lessons the hard way in the fall about communications, we've put a special emphasis on that aspect of the planning process.

So there's the whole communications plan around smallpox vaccine and smallpox, both pre-event and post-event.

In addition, CDC is working with our partners in the state and local governments around training and risk communication and helping to build the communications capacity that we need.

It certainly will be a major focus of the logistics workshops that we intend to put together this summer.

DR. MODLIN: Maybe I could add to that, if that's okay. Again, as has been pointed out earlier, this is a process that has been carried out for a very short period of time, in terms of at least a sense of needing to make some decisions in a fairly urgent manner.

One thing that I think is critical to the success so far has been the decision [inaudible] short-term basis to make this as open a process as possible, to hold the community forum consultations that were held at four different cities in the past two to three weeks. The logistics and the work involved in pulling those off was obviously considerable and I think perhaps in past times one may not have gone to the time and trouble to consult partners, the public, in the same way, and I really view that process as being very important now to at least the success that we've had so far, and I would very much credit the people at the CDC who have made that happen.

I think it's made our, really, work of the committee, in many respects, easy in some respects.

CDC MODERATOR: Thank you. Now a question from our callers.

AT&T MODERATOR: Thank you. Our next question is from the line of Tina Hessman with the St. Louis Post-Dispatch. Please go ahead.

QUESTION: First I'd like to follow up on Laura Beal's previous question and then I have another question.

I believe what Laura was asking is if you had a successful take as a child, but didn't have any adverse reactions then, would you be less likely to have adverse reactions as an adult?

And my second question is how much did the public's opinions collected at the forums that you held go into this, figuring this recommendation, and what were the major factors influencing this decision by the panel?

DR. MODLIN: The question as I understand it was if you did have a successful take as a child, what would be your risk of having an adverse reaction if you were immunized today.

We believe that the risk would be quite a bit lower, but there still would be some very small residual risk of adverse reaction, including serious adverse reactions, even if you had been successfully immunized in the distant past.

The second question was to what degree did the committee consider the input from members of the public and others at the consultation, the community forums that were held.

But I would just point out that I attended only one of them in New York. Colleagues from the working group and from the committee attended the other public forums, and I think we were all impressed that the persons who came came prepared to discuss the issues, they had done their homework, they had done considerable background preparation, and came prepared to provide some very insightful, useful, thoughtful comments.

I believe that the process was--the public forum and the public input was quite influential, at least up to the current point.

DR. GERBERDING: I just want to add to that. The CDC has a Web site and has been collecting information from people logging on to our Web site as well and that process can continue, because CDC is interested in input at this point [inaudible] interested in input before the ACIP policy recommendations were made.

So the time for input is not over. It's an ongoing process.

CDC MODERATOR: [inaudible] question from our audience.

QUESTION: There's some frustration expressed by members of the panel that there was no good way to get a handle on the risk of a bioterrorist attack with smallpox. How are you able to go about weighing the risk and the rewards of vaccine without any way to quantify the risks?

DR. MODLIN: Well, you've identified, really, one of the key, critical issues, and I think we all have a degree of discomfort over that.

The committee has been told that the risk is low but not zero. We obviously can't put a number on that but we are assuming and continue to assume that it's low, and I think the decision that we made was a balanced one, that balanced that low or very low risk with the risk of--the known risk from the vaccine.

I don't have a better response for you.

DR. GERBERDING: I think that's why, though, we need to allow for two things. One is that the policy recommendations may need to change as the risk assessment changes, and, second, the public health policy recommendations that we received today have to be looked at in context of homeland security and national defense issues.

QUESTION: Thank you.

CDC MODERATOR: Thank you. Jeanine, we'll now take one final question from the phones, followed by one question from our audience.

AT&T MODERATOR: Thank you. Our final question from the phone comes from the line of Monica Conrad with ABC News. Please go ahead.

QUESTION: Hi. I want to get this straight on who actually is going to get vaccinated. Response teams, predesignated response teams. Is that firemen, police, ambulance workers?

DR. MODLIN: The question is do the predesignated response teams include ambulance, police, and emergency medical technicians. The answer is, in general, no, it does not.

There may be public security individuals, policemen, transport workers that may be included in these teams, but, in general, this would not include a general recommendation for immunization for most firemen, policemen and other public safety workers.

CDC MODERATOR: Now from our audience.

QUESTION: An issue that comes up from the public is in selecting even small groups, such as you have the recommendation, that it's not a policy of fairness. Fairness is if you would make it available to all or none. But if you make it to selected groups, even based on [inaudible] considerations, there's a fairness issue. So how [inaudible] chairman of the committee address that question?

DR. MODLIN: I think the issue [inaudible] the individual probably outweighs any considerations over, that we might consider fairness. This is a public health decision and there have been many instances in the past where public health interest has not always jived completely with one's personal interest.

And we've made our best effort to weigh and balance what we perceive the risk to the individual to be, and at the moment, since we consider the risk of an event, a smallpox event affecting the general population to be low, it's appropriately balanced with the risk of immunizing those who are most likely to be put in harm's way if such an event were to occur.

I think that's the best way to respond to that.

CDC MODERATOR: Ladies and gentlemen, at this time we will allow Drs. Modlin and Gerberding to give us closing remarks, if they so choose.

DR. GERBERDING: My closing remark is thank you, this is a real tough topic, and I appreciate that people have stuck it out and are doing the best to help us get the accurate information out. This is just the first step towards educating the public about this vaccine and I hope we will be working together in the future to assist, and if you have any specific input or advice on how we can improve the process, or improve the quality of the information that you need please let us know.

DR. MODLIN: Thank you. I would say exactly the same thing. As has been stated throughout the last two days, a very, very important part of this process is the education of the public in general. That includes health care workers, practicing physicians, whom we hope in turn will help interpret and explain many of these issues to their patients. That's a critical part of the process and I don't believe that all of this will work unless we are successful at [inaudible] the educational [inaudible].

CDC MODERATOR: Thank you for your participation and a transcript of this telebriefing will be available on the CDC Web site.

AT&T MODERATOR: 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.

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