HEALTH WORKERS UNION WARY OF SMALLPOX VACCINATIONS
11 Dec 2002
Source: New York Times, December 10, 2002.
Health Workers Union Wary of Smallpox Vaccinations
By LAWRENCE K. ALTMAN
The nation's largest health care workers union warned yesterday that the government's plan to vaccinate against smallpox for the first time in 30 years needed strong protections to avoid jeopardizing the health of hospital patients, health workers and the public.
The vaccination program moved a step closer to reality yesterday as the deadline passed for states and large cities to file their full plans to immunize health workers against smallpox, a disease that was eradicated in 1980.
But the plans must wait until President Bush announces whether he will limit vaccinations to about 500,000 health care workers or offer them to all Americans. No vaccination can occur until Mr. Bush's decision because the government owns all stocks of smallpox vaccine.
Since last summer, health officials have repeatedly said that the president's decision is imminent. Now, health officials say, the decision could come by midweek.
Many health officials, administrators and doctors said that if vaccinations resumed, it would be after New Year's Day, to avoid problems at a busy time for hospital emergency rooms. Many hospitals are short of nurses and would find it difficult to find replacements for workers out sick because of sore arms, fevers and other reactions to vaccination.
"We are trying to be as flexible as we can and still stay on a timetable," said Jerome M. Hauer, who directs the Office of Public Health Preparedness in the Department of Health and Human Services.
In issuing a strong warning, Andrew L. Stern, president of the Service Employees International Union, said that President Bush and Congress "have not done enough to protect and care for health care workers, their families, and patients" who could be harmed by the vaccine.
The union said that the government needed to educate the public and health care workers to ensure that patients with AIDS and other conditions are not given the vaccine and are not exposed to people who have been vaccinated. Workers should also not be subject to repercussions at their jobs if they refuse vaccinations.
The union also contended that workers who volunteer to take the vaccine should not lose income if they have to stay home because of reactions.
Mr. Hauer said that "none of the issues were new" to the Bush administration and that "some have been addressed, some are being addressed and some are not issues the federal government should get involved in."
Mr. Hauer also said he and union officials fully discussed the issues in a "very productive meeting" last Wednesday. The union said "serious gaps" remain.
The Centers for Disease Control and Prevention, the federal agency in Atlanta that is responsible for preventing and monitoring diseases like smallpox and overseeing the states' plans for vaccinations, said it had received full plans from about two dozen states and cities by yesterday afternoon and expected many more last night.
In the next few days, the centers' smallpox experts will review the plans to determine whether they need revision before any vaccine is released, said Thomas W. Skinner, a spokesman for the centers. The C.D.C. will be reviewing a number of issues: how many health workers the states and cities plan to vaccinate; how many clinics are ready to vaccinate; how many public health and medical response teams have been identified; and how many hospitals in each state will be able to care for smallpox patients if any cases occur.
The recommendation for vaccinating up to half a million health workers came in October from an advisory panel to the C.D.C. The panel chose not to recommend offering the vaccine to the estimated 10 million paramedics, firefighters, police officers and other workers who might also be among the first to respond to a biological attack.
Earlier, the nation's top public health officials said they favored offering smallpox vaccine to the public, even in the absence of a bioterrorism attack, but only after the nation's 10 million health care workers were immunized and a new vaccine that is now in preparation is licensed for general use, which is not likely until 2004.
Smallpox vaccine, which is made from a live virus related to the one that causes smallpox, is considered the most dangerous immunization for humans. Before the United States stopped routine smallpox vaccinations in 1972, life-threatening complications occurred at a rate of 15 per million among those who received their first smallpox vaccination, and the number included about one to two deaths.
Those at risk for such complications include people whose immune system have been weakened by cancer, AIDS or other diseases, the advisory committee said. It also cited two common skin conditions, eczema and atopic dermatitis. These conditions could disqualify as many as 50 million Americans from vaccination.
Vaccination can also cause problems like soreness and swelling at the inoculation site. In recent trials of the vaccine on healthy young volunteers, about 40 percent to 50 percent had substantial local reactions, 30 percent felt impaired in their daily activities, and about 5 percent took time off from work or studies.
Dr. William Schaffner, the chairman of preventive medicine at Vanderbilt University, who also works for the Tennessee health department, said experts expect that health workers would take more sick time than the research volunteers.
Health officials are concerned about a possible timetable of vaccinating health workers in a month after a go-ahead is given. "Several real-world considerations like the holiday schedule suggest revising the timetable," Dr. Schaffner said. He also said that most hospitals and many local health departments have not started planning for vaccinations.
"Compressing the vaccination program into one month will create a near simultaneous outbreak of absenteeism in all the emergency rooms in the country," he said.
The health care workers union also contended that the two-pronged needles that the government bought for the vaccinations did not sufficiently protect against accidental needle sticks that could transmit the viruses that cause AIDS and hepatitis. The union suggested another brand of needle.
But Mr. Hauer said that that brand was too big to fit in a vial of smallpox vaccine. He also said that health officials judged the risk of needle-stick transmissions to be small.