MR. RUSSERT: One of your many tasks in the administration, the point person on bioterrorism; you’ve been spending some time at the Center for Disease Control. Do you believe that all Americans should eventually be vaccinated against smallpox?

VICE PRES. CHENEY: We’re in the middle of improving our capability to do that. A year ago, we had enough vaccine for maybe 15 million people. We’re now well on the way to producing enough vaccine for 350 million people. There is serious consideration now being given to what kind of vaccination program we want. You go to first responders, people who have to deal with this when it first arises. Do you do a broader group than that? Do you do it on a voluntary basis for anybody who would like to have it? These are issues under active discussion, deliberation. Tommy Thompson over at HHS has been actively involved in it as well, too. It’s not a zero sum kind of proposition; that is, it’s not a cost-free operation. There are side effects and consequences for most vaccines. And you have to weigh those against the benefits that would be derived by protecting the population.

MR. RUSSERT: If you vaccinated 300 million Americans, a thousand would die from side effects.

VICE PRES. CHENEY: I don’t remember the exact numbers, but clearly there would be some people who would be harmed as a result of the vaccination.

MR. RUSSERT: But the risk may be such we may come to that.

VICE PRES. CHENEY: That’s entirely possible.

More than 80 hospitals from every region in the USA, including leading teaching hospitals and large, urban public hospitals, are forgoing the vaccinations. The dissenters are a tiny fraction of the 3,000 hospitals recruited by state health officials to vaccinate doctors, nurses and other hospital staff members who are most likely to care for smallpox patients.

But their numbers are growing as doctors and administrators at hospitals around the USA are concluding that the known health risks from the vaccine, which can cause illness and even death, outweigh the unquantifiable risks of smallpox being used as a terrorist weapon.

The refusal to vaccinate raises new questions about the president's plan just as the first phase is expected to begin this week. And some health care experts and government officials fear that any reluctance to participate in the first phase could lessen the willingness of others to participate in the second phase -- and undermine the administration's goal of eliminating smallpox as a viable option for terrorists.

Richard Wenzel, chairman of internal medicine at Medical College of Virginia Hospitals of Virginia Commonwealth University, finds the resistance neither surprising nor unwarranted.

"This is not an issue that should be framed in terms of patriotism," he says. "This is an issue that's medical risk-benefit. We haven't seen this disease for more than 25 years. We are reacting to a perceived threat that's not well defined."

The hospitals are reaching their decisions individually after their own in-house infectious diseasesspecialists study the Bush plan.

Almost as a rule, hospital administrators say they are reluctant to make some of their employees sick to protect them from a disease that no longer exists and would reappear only in the chance of a terrorist act.

"The thing that stops you from doing this is the complexity of the smallpox vaccine, which is not a safe vaccine," says William Schaffner, head of the preventive medicine department at Vanderbilt University Medical Center in Nashville, one of the hospitals that is opting out. "There's a real disease that kills people unnecessarily: the flu. Mr. President, I would love to see you endorse a national flu vaccine campaign with the same vigor."

Q: Are there any lessons for you in the way the smallpox vaccine program sort of ran into public opposition? Is that an example of where the public is less aware of the dangers than they ought to be?

CHENEY: Well, we — I'm trying to be careful here so I don't start another wave of concern out there about smallpox. People clearly were concerned about the side effects of the vaccine. I think there was a certain amount of complacency in terms of people not being willing to take it as seriously as we thought it should be taken. And so far we've been fortunate. Hopefully we will continue to be fortunate. It's to some extent the responsibility, though, of those of us in government to think about the what-ifs, to worry about the worst case, to look at the evidence that's out there and connect the dots.

And we were criticized, the government was criticized generally prior to 9/11 for, "you didn't connect the dots." I think we did, but that charge is made. Here you're in a situation where you clearly want to make certain that you take all the intelligence available, you look at the capabilities of your adversaries, you draw reasonable conclusions, and you act on those conclusions. And that's what we did with respect to smallpox.

And the main effort there, the focus was to try to get enough people in the medical community, first responders, inoculated, so that if we did get hit, we could move aggressively to implement a national immunization program. We're better off now than we were before we started, but clearly we fell short of what we had originally anticipated, in terms of the numbers of people we would like to have seen inoculated.