This study examines the public acceptance of smallpox vaccinations in the event of a terrorist attack using smallpox. The article also provides public health professionals with the information necessary for such smallpox management.

A questionnaire survey was conducted in a city in Japan asking about prospective action when smallpox vaccination is advised after a terrorist attack and factors that could influence individual decisions about such vaccination.

Only a tiny fraction of people (0.12%) expressed their rejection of vaccination. Of the respondents, 63.6% showed their intent to be vaccinated promptly when such a measure was required; 28.6% wanted to decide for themselves, having some reservations. Those in the younger age group, those suffering from hypertension/cardiac diseases, and those who considered the threat of smallpox terrorism less seriously were likely to reserve their vaccination decisions until after examining information.

Communication programs regarding smallpox vaccination should be well planned beforehand and should especially target those people who reserve their decisions at such times. Health professionals should also be well equipped with all information necessary for appropriate and effective smallpox management in the face of such a bioterrorism attack or the strong potential of one.