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Last Updated

05 Dec 2002

Source: Washington Post, December 5, 2002.


Thinking About Smallpox

Without much fanfare, the Bush administration has been slowly preparing American health care workers to be vaccinated against smallpox, the deadly disease that was eliminated in its natural form in 1980 but that exists in laboratories in the United States, Russia and, possibly, Iraq and North Korea. State public health officials have submitted plans detailing how they would organize a mass smallpox vaccination if the disease were deliberately reintroduced by terrorists. Next week they will identify which health care workers will need to be vaccinated in advance simply in order to carry out those plans. This week the Centers for Disease Control and Prevention will begin a formal training program for the doctors and nurses who will give the vaccination to those workers who volunteer to receive it. After the president gives the word -- an announcement is expected any day now -- deliveries of the vaccine, out of use in the United States since 1971, will begin.

In a remarkably short period of time, the administration has completed preparations for this unprecedented and even historic vaccination against a disease no one has thought much about for a quarter of a century. Yet while the speed is commendable, it has come at a cost. A small percentage (perhaps 15 in a million) of the doctors, nurses and emergency workers who receive this vaccine will become seriously ill, and one or two will die. An unknown percentage of those who come into contact with vaccinated people may become sick as well. The homeland security bill went out of its way to protect the vaccine's manufacturers, as well as those doing the vaccinating, from any liability for these injuries and deaths. No provisions were made, however, to compensate anyone injured by the vaccine, or the families of those who die from it.

This was not an accidental omission. Fears that a victims' compensation fund might be abused and legal complications created by previous funds led legislators to drop the idea. Not wanting to hold up the entire procedure, the administration didn't push it. There is talk of creating such a fund at some point in the future, if the decision is made to offer the vaccination to a wider group of people. Those set to receive it now, however, are left without any support -- particularly health care workers who have no health insurance, and there are some. At fault, in part, is a legal culture that has made injury compensation such a minefield. Also at fault is a Congress willing to take everyone's pet concerns into account when drawing up the homeland security bill -- except those of the health care workers who will be most critical to homeland security itself. At the next opportunity, Congress should look at this issue again, remembering who it is that the nation will rely on when the first case of smallpox is announced.