Letter to Senator Evan Bayh regarding the Smallpox Vaccination Program, April 2, 2003
April 2, 2003
The Honorable Evan Bayh
United States Senate
Washington, DC 20510
RE: Funding for Smallpox Vaccination
Dear Senator Bayh:
The National Association of County and City Health Officials (NACCHO) is committed to
preparing the nation to respond to an outbreak of smallpox, should such a terrible event ever
occur. Therefore, we strongly support additional funding for the large, unanticipated costs that
state and local public health agencies are incurring to implement the President’s smallpox
vaccination program. Nearly 80% of local public health agencies already report that they are
diverting resources from overall bioterrorism preparedness to work on smallpox vaccination. This
situation is unsustainable and threatens to undermine our nation’s ability to improve public health
preparedness for other acts of biological, chemical, or nuclear terrorism.
Existing federal funds for bioterrorism preparedness are neither available nor sufficient to pay for
both smallpox vaccination and other bioterrorism planning and preparedness work that is already
underway. Congress appropriated $940 million in FY2002 and $940 for FY2003 to help states
and localities improve their capacities to respond to public health threats and emergencies. The
Department of Health and Human Services made the first $918 million available to the states in
June 2002. This disbursement of federal funds occurred in a timely and responsible fashion and
states were directed to spend these funds in five different areas of public health preparedness.
Neither HHS nor states and localities contemplated undertaking smallpox vaccination at that time
and funds have been programmed and obligated to improve overall preparedness in multiple
ways, pursuant to HHS’ guidance to the states.
The Administration announced a smallpox vaccination program six months later and has
expected states and localities to pay the costs of this program from the FY 2002 bioterrorism
funds they had received. This expectation is unrealistic for two reasons. First, as is the case with
any federal program, the sums that states have spent according to HHS records do not reflect
plans and obligations that have already been undertaken and cannot be reversed either for legal
or practical reasons. Second, the costs of smallpox vaccination are proving to be far greater than
had been anticipated. Smallpox vaccination is not like giving flu shots in the local mall. Extensive
advance planning, training, and consultation in the community are necessary. Delivering the
vaccine requires careful screening and counseling. Follow-up to assure a proper “take” and to
prevent secondary transmission of vaccinia is essential, as are design and implementation of
systems to track adverse reactions. NACCHO has found that costs for smallpox vaccination being
incurred now by local public health agencies smallpox vaccination range from $154 to $284 per
person, with an average of $204 per person. These do not include costs to states or to other
entities, such as hospitals or police or fire departments.
NACCHO is deeply concerned that it is dangerously short-sighted to devote our resources for
public health preparedness to a single potential agent. We cannot anticipate what agents might
be used by a bioterrorist. Moreover, we remain highly vulnerable to natural disease outbreaks,
including West Nile virus and the newly-discovered Severe Acute Respiratory Syndrome, that
have a potential to cause more illness and death than would occur in many bioterrorism
scenarios. We believe that we must build our public health systems so that they are well-staffed,
effective and adaptable. We should avoid building separate systems for specific diseases; they
will tax our resources, and unless we use them day in and day out, they won't work well when
they are really needed. We must also achieve preparedness specifically for smallpox, which has
the unique feature of requiring vaccination of a number of public health and medical personnel,
but we cannot afford to sacrifice other improvements in that process.
We appreciate your leadership and concern for public health protection and look forward to
working with you to ensure that the public health system is able to improve preparedness for all
public health threats and emergencies, in addition to smallpox.
Sincerely,
Patrick M. Libbey
Executive Director