Smallpox Letter

December 12, 2002

President George W. Bush
The White House
Office of the President
1600 Pennsylvania Ave, NW
Washington DC 20500

Dear Mr. President:

I am writing on behalf of the nearly 100,000 emergency nurses across the United States concerning the development and implementation of a national smallpox immunization plan. As the voice of emergency nurses throughout the United States, the Emergency Nurses Association (ENA) represents nurses who will be the point of first contact in the event of a bioterrorist attack.

ENA strongly recommends:

  • The voluntary vaccination of emergency response and emergency medical personnel with their informed consent to the vaccination.
  • Although many medical experts argue that the benefits of preventative immunization prior to a biological attack do not outweigh the health risks to the public, we feel that the increased vulnerability of emergency nurses and other emergency health care providers supports the need for them to have the opportunity to make an informed choice about whether to be vaccinated.
  • Acceleration of efforts in the research, development, and production of both existing and new, safer vaccines.
  • We also believe that in the interests of quelling public panic and controlling the potential spread of the disease, the voluntary vaccination of first responders such as paramedics, police, fire and other emergency services personnel should take place as quickly as possible.

The events of September 11, 2001, and the subsequent attacks using anthrax spores focused attention on the vulnerability of the world population to the use of biological agents such as smallpox as weapons. The global eradication of smallpox, while one of the greatest medical achievements, has created vulnerability to this disease as a weapon of mass destruction. As it stands now, emergency departments and other health providers will be overwhelmed with patients in a smallpox crisis unless sufficient prevention and response plans are in place.

In the event of a bioterrorist attack, emergency nurses will play a vital role in triaging patients, providing care as the point of first contact for those patients with the disease, and monitoring for unusual patterns of infections. We strongly support education for all health care and emergency personnel on the disease, symptoms, treatment, and response initiatives. New information on smallpox is rapidly emerging; therefore, information will need to be continually and rapidly disseminated to emergency personnel.

For the past several months, ENA has joined with the federal government in the search for an effective response to the threat of a smallpox attack. We are concerned for the well-being of younger health care professionals who have never been vaccinated for this disease, and it is unknown if any resistance to smallpox remains for those vaccinated prior to 1972. In addition, the eradication of the disease and the discontinuation of the smallpox vaccination programs in the early 1970s means that only a very small number of health care professionals currently have the expertise to identify smallpox in its early stages in order to treat patients and reduce the spread of the disease.

As you move forward in implementing this vaccination program, we urge you to work rapidly to resolve the issues concerning the vaccination plan for the general public, such as education about the clear risks and benefits of preventative vaccination for adults and children, informed consent, and contraindications to vaccination. We also strongly urge an increased commitment to research into new vaccines for smallpox.

The members of ENA applaud your efforts to improve bioterrorism preparedness for the general public. We offer you our support and assistance in this effort to protect the public and America’s emergency health care providers from this threat, and we thank you for considering our views on this issue.


Sherri-Lynne Almeida, RN, MEd, MSN, DrPH, CEN, EMT-P

cc: ENA Board of Directors
Vice President Richard B. Cheney
Secretary Tommy Thompson
Director Tom Ridge
Dr. Julie Gerberding
Dr. James Hughes
Dr. Anthony S. Fauci