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Last Updated

17 May 2003

Source: Boston Globe, May 17, 2003

Drive to inoculate vs. smallpox stalls

Few in region receive vaccine

By Stephen Smith, Globe Staff

Four months after the high-profile launch of a campaign to vaccinate a half-million US health care workers against smallpox, that effort has largely stalled in New England and appears to be slowing nationwide, with only 36,000 people vaccinated across the country.

In New England, with about 23,000 doses planned, barely 1,300 shots have been given and at some major hospitals, no doctors or nurses have been immunized. Massachusetts alone was scheduled to receive 12,000 doses of the vaccine, but only about 100 medical personnel have been inoculated.

Some hospital leaders insist their smallpox programs are still gearing up, but public health authorities acknowledge that fears about the vaccine's side effects, along with a diminished sense of urgency since the war in Iraq ended, have combined to dampen enthusiasm for the voluntary campaign.

''We have just gone through war -- a war without any weapons of mass destruction involved,'' said Robert Marshall, assistant director of health at the Rhode Island Department of Health, which has vaccinated 29 people against smallpox. ''That has changed people's perception about the need for vaccinations.''

Even in New Hampshire, the New England state closest to its vaccination goal, only half as many shots have been given as hoped, and the state has effectively abandoned efforts to persuade more health care workers to participate. About 70 percent of the smallpox shots nationwide were given in the first two months of the campaign.

But the official directing the federal campaign insists that it should still be considered a success.

''It's not a report card,'' said Joseph M. Henderson, associate director for terrorism preparedness and response at the US Centers for Disease Control. ''Nobody should say, `You should get a D because you've only vaccinated 36,000 people.' We should get an A because we're better prepared.''

The smallpox campaign, he said, has made hospitals and public-health agencies more ready to deal with an outbreak of the disease.

Smallpox was eradicated in 1977. But because it is so infectious -- and a potential weapon -- the vaccination campaign emerged as the centerpiece of the Bush administration's efforts to prepare against acts of bioterrorism. President Bush was vaccinated in December.

The vaccination campaign has been dogged by controversy and resistance since Jan. 24, when three doctors in a Connecticut hospital cafeteria became the first civilians in three decades to be immunized as part of a mass campaign.

Nurses' unions across New England told their members to refuse shots. Doctors remained leery. And concerns about the vaccine's safety, as well as questions about who would pay medical bills and salaries if workers became ill from the shots, prevented the initiative from gaining widespread traction in the initial weeks. Those fears were inflamed when the CDC reported in March that at least seven people developed heart problems -- including angina and heart attacks -- after receiving the vaccination. Two of those people died.

Although a definitive link between those heart complications and the vaccine was not established, federal physicians became alarmed and issued a warning that there might be a connection. That prompted a suspension of vaccination efforts in many states, and when public-health agencies resumed giving shots in recent weeks, few health care workers participated.

''The cardiac thing scared a lot of people, frankly,'' said Janet Austin, planning and research associate in the Office of Public Health Emergency Preparedness in the Maine Bureau of Health. Thirty-nine health care workers have been inoculated in Maine, but two clinics are scheduled next week.

Connecticut has given more shots than any other New England state, 634. But that is only one-tenth the number the state's commissioner of public health said he hoped would get immunized when Connecticut made history by being the first to launch a smallpox campaign.

Still, said William Gerrish, a spokesman for the Connecticut health agency, the effort has achieved several important goals, including proving that the vaccine could be given safely while providing hospital and emergency workers with experience in administering it.

Premier Massachusetts hospitals weighed with extreme caution whether to begin vaccination campaigns at all and are only now beginning efforts to recruit volunteers. They said yesterday that it is unclear how many workers will get shots.

At UMass Memorial Medical Center in Worcester, no workers have been vaccinated, although a spokesman said yesterday that a campaign is still being planned.

At Massachusetts General Hospital, a May 6 memo indicated that a vaccination campaign will proceed. So far, the memo said, ''a small group of MGH volunteers has been vaccinated and trained to administer the smallpox vaccine.'' The hospital hopes to recruit 100 to 150 volunteers, as the state has requested.

And at Tufts-New England Medical Center, nine workers have received shots.

''We've just finished putting the program together, and now we're trying to recruit volunteers to be vaccinated,'' said Cheryl Webber, nurse manager for the Tufts-New England emergency department and one of the workers involved in organizing the campaign. ''It sort of fell down for a little bit, but the state does say it is going to go forward.''

The Massachusetts Department of Public Health set a goal of vaccinating 10,000 health care and emergency workers, with the remaining 2,000 doses in reserve in case the initial vaccinations failed. By yesterday, the number of workers vaccinated stood at about 100.

''It's not 10,000, not quite,'' said Dr. Alfred DeMaria, director of communicable disease control in Massachusetts, ''but we're getting there.''

DeMaria said the challenge is generating interest in being vaccinated against smallpox while health workers are preoccupied with severe acute respiratory syndrome among other prominent medical issues.

''It's fair to say that people have moved on to other things, and it's not as high on the agenda as it was in January and February,'' DeMaria said. ''We need to get our message out that we still want to achieve our goal.''