Questions & Answers
Smallpox - Policy
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Policy and Management Questions

  1. Why get vaccinated?
    Authorities are concerned that terrorists or governments hostile to the United States may have some of the variola virus that causes smallpox disease. If so, they could use it as a biological weapon in bombs or sprays or by other methods. People exposed to variola virus, or those at risk of being exposed, can be protected by vaccinia (smallpox) vaccine.

    Smallpox can be prevented through the use of the smallpox vaccine. The World Health Organization (WHO) used smallpox vaccine to eradicate natural smallpox from the planet. About 95% of people are protected within 10 days of getting a single smallpox vaccination.

    Until recently, most service members had not been vaccinated against smallpox. The rest don't have much immunity left from vaccine given years ago. Until the late 1970s, many billions of people around the globe received smallpox vaccine. Smallpox vaccine is still used routinely to protect a small number of people who work with smallpox vaccine virus (vaccinia) or similar viruses. Between December 2002 and January 2008, more than 1.4 million service members received smallpox vaccination.

    There is no proven treatment for the smallpox disease, but research to evaluate new antiviral medications is ongoing. Patients infected with smallpox can benefit from supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that occur from all the skin problems smallpox causes.

  2. What if somebody has already been vaccinated years ago?

    Research indicates that the first dose of smallpox vaccine offers an increased level of protection from smallpox for 3 years. Immunity decreases thereafter. Substantial, but waning immunity persists for 7-10 years. Subsequent vaccinations increase and extend protection. After 3 doses substantial protection persists for >30 years.

    In that European study, about 30% of unvaccinated people infected with smallpox died. About 1.4% of people vaccinated up to 10 years earlier died. Among people vaccinated 11 to 20 years earlier, 7% died. Among people vaccinated 21 or more years earlier, 11% died. These data show that immunity falls off over time and that revaccination is needed to maintain immunity. [Mack TM. Smallpox in Europe, 1950-1971. J Infect Dis 1972; 125:161-169]

  3. Who in DoD is going to get the smallpox vaccine?

    In December 2002, the Secretary of Defense decided to vaccinate certain emergency response and medical personnel and other designated personnel that constitute critical mission capabilities to include those essential to the accomplishment of U.S. Central Command's (CENTCOM) missions. In June 2004, DoD expanded the program to include more forces and people in Korea, the US Pacific Command Forward Deployed Naval Forces and CENTCOM Area of Operations (AOR). In September 2007, the ASD (P & R) changed the pre-deployment timeframe for smallpox vaccine administration to 120 days.

    For complete information regarding policy, please review the "Policy" section of our website under "Resource Center".

  4. Will Service members still be deployable if they have not received the smallpox vaccine?
    Yes, if they are in one of the groups that should not receive the smallpox vaccine they will still be deployable. In the event of an actual smallpox attack, their vaccination status will be reevaluated and they would likely be vaccinated.

  5. How much vaccine does the DoD have?
    The DoD has sufficient FDA-licensed vaccine to continue implementation of this program.

  6. If the threat is low, why is the Department of Defense administering the smallpox vaccine?
    We cannot quantify the threat that smallpox would be used as a bio-weapon, but we do know that the consequences of its use could be great. Military missions must go on even if a smallpox outbreak occurs. If an outbreak occurs, America will expect military units to be on the job, not on the sideline. It may not be feasible to vaccinate military forces soon after exposure if they are deployed to remote locations and/or engaged in military operations. Some military personnel will not be able to postpone vital missions if smallpox is used as a weapon. Vaccination is a prudent course for preparedness and may serve as a deterrent.

Military Discipline

  1. What will happen to a Service member who refuses the vaccine?

    We begin with the assumption that any service member covered by this policy who refuses vaccination may be uninformed about the facts related to the deadly effects of the smallpox virus and the protection afforded by the vaccine. Our first action with those who might refuse the vaccine will be to determine their concern and provide information.

    This is a force protection issue. If a service member continues to refuse the vaccine, then a commander will manage the situation as he or she would for any failure to obey a lawful order, including educating the member about the smallpox vaccine as appropriate.