A Times Editorial

Polishing smallpox preparations

The national plan unveiled last month to counter a terrorist smallpox attack is startling for what it reveals about the work left to be done. Millions more doses of vaccine must be produced and shipped throughout the country. Thousands of clinicians must be recruited and trained, and the government must activate an outreach campaign that is nationwide, multilingual and reliable. The states may need more money from Washington, and the federal government should be prepared to help.

Officials at the federal Centers for Disease Control and Prevention called the updated plan a "working document." They are right in the sense that many basic questions remain about how an emergency vaccination effort would be carried out. As a broad guide, the plan is solid. It establishes lines of authority between the federal and state governments, affirms the use of a "ring strategy" -- vaccinating people close to an outbreak -- to prevent the spread of disease and provides local governments with a model for administering 1-million vaccinations in a 10-day period.

While the CDC plan is not new policy, it does help create an apparatus to help the states respond effectively to a crisis. The plan itself is fine; the problem is gauging how prepared state and local health departments actually are. This is where the smallpox plan will be carried out.

Local clinics need more vaccine, along with access to stadiums, schools and other venues to screen people and give shots. They need access to volunteers, fresh supplies and network communications. One glaring weakness of the CDC plan is lack of clarity in explaining who will call the shots. The federal government and the states also have a problem communicating in plain language.

The document's real value is as a planning tool and as a focal point for further debate over smallpox vaccination itself. The CDC did a good job of giving local authorities an idea of the range of problems involved, from clinic staffing and record keeping to the security and transit demands of serving so many people. Local communities should be better prepared as a result. The voluntary mass-vaccination plan would, in CDC's view, complement the ring strategy by reaching to people who want "to get themselves protected quickly."

But the CDC needs to provide guidance on the trickier questions, such as when vaccinations would be mandatory and how the federal government would decide which communities need more federal money to prepare. The Bush administration's top bioterror experts said last week they would recommend voluntary vaccination that began with health and safety workers before moving to a broader population.

The White House has made no decision on a vaccination policy, as officials struggle to balance their desire for readiness with the health risks associated with the vaccine. The government should be ready to supply communities with medicine to counter the vaccine's side effects, given the millions of Americans whose skin or immune systems put them at risk. Washington may need to augment the $918-million the federal government gave the states to bolster bioterror defenses. The CDC plan moves preparedness in the right direction. Having raised expectations, the federal government must now ensure that local health departments have the tools to do the job.

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