In response to the U.S. government's recommendation to vaccinate volunteer "first response" health care workers against smallpox, Johns Hopkins Medicine has adopted a "zero risk, go slow" approach, decided upon after review of known scientific facts and consultation with its own experts and ethicists, as well as colleagues at the University of Maryland Medical System, the Baltimore City Health Department and the state Department of Health and Mental Hygiene. The first volunteers at Johns Hopkins will receive their vaccinations from the Baltimore City Health Department shortly after the city initiates its vaccination program in February.

A small group of Johns Hopkins Hospital's volunteers will be vaccinated each month over a six-to-nine-month period until an appropriate number up to 250 is reached. At Bayview Medical Center, the target number of volunteers is 175; at Howard County General Hospital, the target number is 100. This "go slow" strategy will allow vaccinations without removing a large number of workers from the hospitals at one time.

As part of the "zero risk" strategy, all volunteers--nurses, physicians, therapists, technicians, security guards or other hospital workers--will not be allowed to have any contact with patients during the period they are reacting to the vaccination. The employees' vaccination sites will be monitored by the respective hospitals. If an employee becomes ill because of the vaccination, worker's compensation coverage will be provided, the employee will not have to use any paid time off, and treatment will be provided by Hopkins physicians.

"We believe these policies will enable us to protect our institutions, our patients, our employees and our employees' families while we aid the region and the nation," says Gabor D. Kelen, director of CEPAR--the Johns Hopkins Office of Critical Event Preparedness and Response--and of the Department of Emergency Medicine.

The vaccination program was developed under the auspices of CEPAR, the command center for Hopkins' enterprisewide planning for, and reaction to, a catastrophe, particularly involving bioterrorism, chemical or nuclear attack. Although each component of the health system and university maintains its own disaster plan, CEPAR sets priorities for the entire enterprise if a disaster with medical/public health consequences overwhelms one entity, or involves two or more of them. It has the authority to set policy, tap every asset of the Hopkins enterprise--and to speak as the official, unified voice on behalf of all of them--if such an all-encompassing calamity occurs.

Hopkins has spent a considerable amount of time educating its staff about the risks associated with smallpox vaccinations and stresses that this is strictly a voluntary program, Kelen emphasized.

The university undertook initiatives to address potential threats to homeland security long before Sept. 11, 2001. About six years ago, the Bloomberg School of Public Health founded the Center for Civilian Biodefense, which brings together medical, public health, military and law enforcement communities to address the threat of biological warfare. Two years ago, the Johns Hopkins Information Security Institute was founded, bringing together disciplines from computer science to political science to examine methods of increasing the security of digital information.

More than 60 years ago, the university established the Applied Physics Laboratory to oversee the assignment--given by President Franklin D. Roosevelt--to design an innovative air defense weapon, the proximity fuse. By the end of World War II, this fuse accounted for fully one-third of all U.S. electronics production and was recognized along with RADAR and the atomic bomb as among the key technological advances that helped win the war. APL now comprises 2,000 scientists who continue contributing to the nation's security.

"Although Hopkins hopes a smallpox biothreat never becomes a reality, we believe preparation is the best defensive public health weapon available," Kelen says.