WASHINGTON -- Moving aggressively to steel the nation against bioterrorism, the Bush administration is preparing to offer the effective but risky smallpox vaccine to every American before an attack ever occurs.
The decision, which goes well beyond earlier thinking, stems from practical and philosophical concerns, including the looming war with Iraq and the fact that, for the first time in decades, the government will have enough vaccine on hand to inoculate everyone.
Just three months ago, federal advisers were recommending that only select hospital workers get the smallpox vaccine, maybe 20,000 total. Now Bush administration officials say that eventually, it will be offered to all 280 million Americans. The questions being debated are how fast and under what circumstances, according to three officials involved in the planning.
Experts don't know if the nation will ever be attacked with smallpox, which kills one-third of its victims. Eradicated from nature two decades ago, it is still feared as a bioterror agent. But the vaccine itself carries rare but serious risks, including death, complicating any decision to inoculate people absent a certain risk.
The Bush administration has yet to make final decisions or announce plans for what is called "pre-attack" smallpox vaccination. But administration officials say the consensus is to begin vaccinating those at greatest risk of encountering a highly contagious smallpox patient, such as hospital emergency room workers. That could total a half million people. Then the vaccine would be offered to non-hospital health workers, such as primary care doctors, and to police, firefighters and other emergency workers.
At some point after that, it would be offered to the general public.
"You start with one group and based on their potential risk, you keep expanding," one administration official said Thursday, speaking on condition of anonymity.
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