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Last Updated

30 Apr 2003

Source: New York Times, April 30, 2003

Report Faults Federal Officials for Problems in Smallpox Program


WASHINGTON, April 29 Congressional investigators said today that federal health officials were responsible for many of the problems that have crippled the nation's smallpox immunization program.

President Bush and other administration officials had said they hoped that 500,000 health care workers would be vaccinated against smallpox within a month after the program began on Jan. 24. The actual number, 33,444 as of April 18, is only 7 percent of the goal.

The investigators, from the General Accounting Office, said the administration was considering a huge reduction in the number of people to be vaccinated, in the belief that a smaller number, perhaps as few as 50,000, might be enough to respond to a smallpox attack.

The accounting office examined difficulties in carrying out the vaccination program at the request of Senator Susan Collins, Republican of Maine, who is chairwoman of the Committee on Governmental Affairs.

In a report to Congress, the investigators said they found that the federal Centers for Disease Control and Prevention was reconsidering the goal of vaccinating 500,000 health care workers.

The Bush administration told the investigators that "there is no longer a deadline for the first stage, and that as few as 50,000 vaccinated health workers nationwide would provide sufficient capacity to respond to a smallpox attack," the report said.

But, the report said, the Centers for Disease Control has not set a new nationwide goal, has not said how it arrived at the lower figure and has not asked states to revise their plans for immunizing health care workers.

The accounting office said the federal government should work with state and local health officials to revise their goals and to assess their capacity for responding to a smallpox outbreak. Dr. Julie L. Gerberding, director of the Centers for Disease Control, agreed.

Up to 10 million civilian health care and emergency workers are supposed to be vaccinated in a second phase of the smallpox program, which begins next month in some states. In the past month, the number of people receiving the vaccine averaged 2,000 a week. Federal officials said they hoped the number would rise because Congress recently authorized compensation for people injured by the vaccine.

William A. Pierce, a spokesman for the Department of Health and Human Services, said the program was well run. But the accounting office said federal health officials shared responsibility for the problems, for these reasons:

*The government underestimated the cost of administering the vaccine. It initially put the cost at $13 a person. State and local officials found that the actual cost is $75 to $265 a person.

*The administration rushed into the program and tried to expand it too rapidly. It distributed contradictory information about who should get the vaccine and who should not. Education and training materials were confusing.

*The government refused to distribute needles that were potentially safer than those used to give the vaccine. Nurses and other health care workers were therefore apprehensive about the risk of needle-stick injuries that would expose them to live virus in the vaccine.

"Progress has been slow," the report said. "Hundreds of hospitals have opted not to participate in the smallpox vaccination program at this time, contending that the risks outweigh the benefits."

When Mr. Bush announced the vaccination campaign on Dec. 13, he said, "There's no evidence that smallpox imminently threatens this country."

Figures compiled by the federal government show that about half of all the people vaccinated to date are in eight states: California, Florida, Minnesota, Missouri, Nebraska, Ohio, Tennessee and Texas.

The Institute of Medicine, an arm of the National Academy of Sciences, said last month that the government should re-evaluate the costs, risks and goals of the vaccination program, to determine if some states had already inoculated enough health care workers to cope with a bioterror attack.