Federal smallpox initiative puts focus on physician education. (Voluntary for Medical Personnel).

Physician education about smallpox vaccination has become a priority for both the public and private health sectors now that President Bush has announced his plan to reintroduce the vaccine into the U.S. population.

In mid-December, the president called for mandatory immunization of military personnel, including himself as commander-in-chief He also decided to make the vaccine available on a voluntary basis to "medical professionals and emergency personnel and response teams that would be the first on the scene in a smallpox emergency

A precise timetable for this targeted vaccination effort had not been set at press time, but the effort was expected to begin in late January at the earliest.

The immediate focus of the president's initiative does not include widespread use of the smallpox vaccine for the general public.

"Given the current level of threat and the inherent health risks of the vaccine, we have decided not to initiate a broader vaccination program for all Americans at this time," President Bush said. Public health agencies will "work to accommodate" citizens who insist on being vaccinated now, he said, noting that his own family and staff would not be vaccinated at this time.

Nearly 450,000 public health and other health care workers would receive the vaccine at more than 3,300 health care facilities in the first phase of the plan, the Centers for Disease Control and Prevention concluded in a preliminary review of state and territorial health departments.

The CDC is working with private organizations such as the American Medical Association and the Infectious Diseases Society of America to inform physicians about recognition of smallpox, administration of the vaccine, anticipated side effects of vaccination, and emerging issues of vaccine cost and liability.