The new cell culture smallpox vaccine should not be offered to the general population.

Cell based smallpox vaccines are to be welcomed, but any decision to vaccinate whole populations must await firstly better intelligence about the gravity of the threat from bioterrorists, including their ability to release smallpox in such a way that wide dissemination could take place; secondly evidence that vaccines grown in cell culture are protective and safe; and thirdly that the vaccines would be generally acceptable and their introduction would not compromise the rest of national immunisation programmes. Smallpox vaccination should not be offered to the general population until these uncertainties have been resolved, by which time bioterrorism might possibly have been overcome or the development of antiviral treatment might have made renewed smallpox vaccination unnecessary. Meanwhile, preparations for rapid deployment of the historically well-tried containment measures at the epicentres of any smallpox release should proceed, their effectiveness should be tested, and their adequacy kept under review. Copyright 2003 John Wiley & Sons, Ltd.