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Last Updated

23 Feb 2003

Source: Associated Press, February 23, 2003

Many Say No to Bush Smallpox Plan

By LAURA MECKLER, Associated Press Writer

WASHINGTON (AP) Despite President Bush's recommendation, hospitals and health care workers are turning down the smallpox vaccine, worried about the inoculation's side effects and unconvinced that the threat of a bioterror attack justifies the risk.

Federal officials had hoped to inoculate almost 450,000 health care workers in the program's first month. With the month ending Monday, the figure is coming in at about 1 percent of that goal.

Some health care unions have urged members to refuse the vaccine until the government can guarantee compensation for anybody injured by the shot.

States are not close to beginning a second stage of vaccinations for as many as 10 million emergency responders and other health care workers.

Health and Human Services Secretary Tommy Thompson is disappointed by the response.

"It is absolutely imperative we get more people vaccinated against smallpox to get more prepared,'' he told a congressional panel this month.

"I think there are a lot of people who believe that it's not an issue and haven't seen any evidence that they should be concerned about a smallpox epidemic,'' he added in an interview with reporters. "We have to do a better job of explaining to them that this is a possibility.''

Officials at the Centers for Disease Control and Prevention, which is running the program, say they never expected the total to reach 450,000, because some people have health conditions that make the vaccine too risky for them.

They also believe the numbers are likely to grow as hospitals receive more information and as federal officials resolve outstanding problems.

Smallpox killed hundreds of millions of people around the world before it was declared eradicated in 1980. Victims develop pox marks on their faces and bodies, and 30 percent die. Once infection sets in, there is no treatment.

But the vaccine is risky. It is made with a live virus that can infect the body. Experts estimate that 15 to 50 people out of every 1 million vaccinated for the first time will face life-threatening complications, and one or two will die.

The last U.S. smallpox case was in 1949, and routine vaccinations against the disease ended in the United States in 1972. All stocks of the virus were supposed to have been destroyed except for samples in special labs in Moscow and Atlanta. Experts now fear that some of the Russian stock could be in the hands of hostile nations, including Iraq.

With the United States moving ahead with plans for war against Iraq, Bush started the new vaccination campaign in December. He ordered inoculations for 500,000 in the military, and the Pentagon is on its way toward reaching that goal. So far, about a half-dozen soldiers have had serious reactions, but all have recovered.

Without an imminent threat, Bush said the vaccine is not recommended for the general public. But he urged health care workers and emergency responders to voluntary accept vaccinations.

In the first round were members of public health teams, who would investigate potential cases, and emergency room workers. They are most likely to encounter contagious patients and would be needed to care for sick people in the event of an attack.  In plans submitted to the federal government, states estimated the initial group would number about 450,000.

The first inoculations were delivered Jan. 24, and federal officials initially hoped states would complete the first stage in about a month. As of a few days ago, just 4,213 people in 27 states had been vaccinated, and many hospitals have said they will not participate.

The problems are both practical and philosophical, according to state, local and federal officials working on the program. Most obvious is the question of compensation for lost wages and medical expenses for people hurt by the vaccine. People injured by other vaccines can tap into a federal compensation fund, but smallpox is not included.

Some would be eligible for workers compensation, but those benefits often are skimpy. Thompson has said he is working on a federal compensation program, but he has yet to present one. Hospitals worry that their vaccinated workers could accidentally spread the vaccinia virus used in the vaccine to patients, many of whom are weak and particularly susceptible to injury. Many hospitals also are not convinced that the risk of the disease is greater than the risk of the vaccine.

CDC Director Julie Gerberding responds by saying she has been in meetings where intelligence information was shared, and she knows a real risk exists. So far, many remain unpersuaded. "Hospitals are deciding the risk is so low as to be unmeasurable,'' said Dr. M. Ward Hinds, health officer for Snohomish Health District, just north of Seattle. In his five-county region, just three of eight hospitals are going to offer the vaccine to their workers.

There is even greater concern about moving to the next stage of vaccination, which targets as many as 10 million other health care workers, firefighters, police and other emergency responders.

In December, federal officials said the vaccination project would move seamlessly from the first to the second stages. Today, some officials are questioning whether it is even needed. "We must take a pause between what we're doing now and anything we do in the future,'' said Mary Selecky, president of the Association of State and Territorial Health Officers. "We're not ready to move to stage two.''