The state’s smallpox inoculation plan is back on line, according to Bureau of Health director Dora Mills, with clinics scheduled for the near future.

But waning public concern over the threat of bioterrorism means fewer health care workers are lining up for the risky inoculation, and Mills said Wednesday the state is operating on the “if-you-build-it-they-will-come” premise.

Last week, new worries about the risk to patients with heart problems forced a postponement of planned clinics in Portland, Augusta and Brewer.

Mills said Wednesday that revised screening guidelines from the Centers for Disease Control and Prevention are now in hand, and Phase Two of the state plan – the inoculation of several hundred volunteer health care workers and support staff from hospitals and other organizations – can go forward. Phase One included the inoculation of about 40 public health workers.

A May 1 clinic is planned in Brewer, and a Portland clinic is scheduled for April 30. Two more clinics will be scheduled within a few weeks.

While the CDC has given its green light, Mills acknowledged that only Maine Medical Center in Portland has actually agreed to go forward with having a group of its workers vaccinated. Although most other hospitals in Maine have indicated that they’ll recruit, screen and train a group of volunteers, they also say they’ll wait for a more compelling threat of bioterrorism before asking employees to get the risky vaccine.

Eastern Maine Medical Center in Bangor reiterated this week that its workers would not get the vaccine unless the threat worsens.

At The Aroostook Medical Center in Presque Isle, Tammy Beaulier-Fuller, the infection control coordinator, said the hospital hopes to prepare 30 to 50 employees, but will not proceed with the vaccine at this time.

In Ellsworth, Fay Daigle, a representative from, Maine Coast Memorial Hospital, said about 15 of the health care staff have indicated interest in the vaccine, but there is no plan to have anyone inoculated.

Mills said interest in the vaccine plan is waning nationwide, especially as the war in Iraq seems to be winding down with no substantive evidence of chemical or biological weapons.

Still-unresolved issues of liability and compensation, the discovery of additional risk factors, and the perception that rural Maine is an unlikely target mean the turnout at the vaccine clinics may be low, she said.

It still makes sense to develop a frontline corps of immunized health care workers, not only for the smallpox threat but as part of a long-term state disaster team, Mills said.

She said it would have been helpful during the 1998 ice storm, for example.

But Mills is less sure of the wisdom of going ahead with Phase Three: the immunization of public safety personnel, paramedical teams and other first responders.

At this point, a smallpox release seems more unlikely as each day passes, she said. Offering the vaccine to a broader population implies the vaccine is safe and that there is a purpose to preparing for an attack. Right now, she said, “I don’t see the safety or the purpose.”