The new cell culture smallpox vaccine should be offered to the general population

A series of major factors must be weighed in deciding whether or not, and to what extent, a particular country should consider pre‐exposure vaccination for smallpox. These include the risk of a bioterrorist attack using smallpox, the risk of secondary spread from another country, the risks and benefits of vaccination, the effectivenes s of vaccination pre‐ and post‐exposure, the prevalence of immunocompromised persons, the capacity of the medical care delivery system and the wealth of a nation. We review here the issues and variables relevant for policy making, propose a framework for country‐specific decision making and suggest the World Health Organization has a key role to play, particularly with regard to lower‐income countries. In doing so, we support the proposition. Copyright © 2003 John Wiley & Sons, Ltd.