Thumbs Down on Smallpox Vaccine Program

Published April 1, 2003

Health care professionals nationwide are refusing to be inoculated against smallpox, worried about the vaccine’s side effects and not sure the threat of a chemical attack justifies the risk posed by vaccination.

Federal officials hoped to inoculate almost 450,000 health care workers in February, the program’s first month. Despite President Bush’s request for voluntary participation, the vaccination rate came in at about 1 percent of the goal. As of the end of February, just 4,200 people in 27 states had been vaccinated. Many hospitals have said they will not participate.

Health and Human Services Secretary Tommy Thompson was disappointed by the response. “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.”

The first round of the federal vaccination program targeted members of first-response public health teams. They are most likely to encounter contagious patients and would be needed to care for sick people in the event of a chemical attack.

Risky Business

An official at the Centers for Disease Control and Prevention (CDC) explained to Health Care News the vaccine is risky. It is made with a live virus that can infect the body. Experts estimate between 15 and 50 people of every 1 million vaccinated for the first time will face life-threatening complications, and one or two will die.

Thomas Mack, MD, MPH, professor of preventive medicine at the Keck School of Medicine, University of Southern California at Los Angeles, recently told Medscape, “Vaccinating large numbers of staff identified by the hospitals as well as the general public is a mistake, because the deaths from vaccine complications will outweigh any limited increase in protection. Mass vaccination will guarantee a few deaths.”

Katharine Eaves, a nursing supervisor from Los Angeles, told the Washington Post, “There is a period after vaccination where a person is infectious and should not be at work or caring for patients. That’s two to three weeks. I can’t have my staff at home for that long.”

The Post also quoted Robert Scates, a representative of the Chicago firefighters union, as saying, “I’m not going to take [the vaccine]. I know too much about it. I was born in 1946, so I had the smallpox vaccine when I was growing up. As far as I’m concerned, I’ve already had it.”

The last known 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 supposedly destroyed, except for samples in special labs in Atlanta, Georgia and Moscow. Experts suspect some of the Russian stock might be in the hands of hostile nations, including Iraq.

With the United States moving toward war against Iraq, Bush started the vaccination program last December. He ordered inoculations for the military, and the Pentagon says it is reaching its goal of inoculating 500,000 military personnel. Fewer than 10 soldiers have been reported to suffer serious reactions. All have recovered.

Practical Questions

The vaccine’s risk has caused some to ask who will compensate those hurt by the vaccine for lost wages and medical expenses.

People hurt by other vaccines can tap into a federal compensation fund, but the smallpox vaccine is not covered. Some health care unions have urged their members to refuse the vaccine until the government can guarantee compensation for anybody injured by it. Some would be eligible for workers compensation, but those benefits often are skimpy.

“If everything is done perfectly, without any negligence, some percentage of people given the vaccine will be injured by it,” Louisiana State University’s Dr. Katherine C. Rathbun told the New York Times. “It’s a dangerous vaccine and they will not be compensated under the law.”

HHS Secretary Thompson has said he is working on a federal compensation program, but he has yet to formally present one. His plan, which will be subject to Congressional approval, is said to be based on a similar compensation agreement currently available to police officers and firefighters harmed in the line of duty.

A public statement released last month by HHS explains victims of adverse reactions to the smallpox vaccine would be compensated under rules established in the Public Safety Officers Benefit Program.

The plan currently pays a $262,100 death or total and permanent disability benefit. In addition, individuals would be compensated for two-thirds of lost wages after the fifth day from work, up to a maximum of $50,000. HHS also states that, as yet undefined, some compensation would be made available to third parties who contract vaccina from medical response team workers who have been vaccinated.

Compensation for injury is not the only issue raised by opponents of the vaccine program. Hospital administrators worry vaccinated health care professionals could accidentally spread the virus used in the vaccine to patients, many of whom are weak and particularly susceptible to injury. Many administrators are not convinced the risk of the disease is greater than the risk of the vaccine.

One hospital to decline participation is Grady Hospital in Atlanta, Georgia. Carlos del Rio, chief of medicine at Grady, explains: “You have a disease that hasn’t been seen anywhere in the world in nearly 30 years. The risk of the vaccine is higher than the risk of us having a case of smallpox.”

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.

In an Associated Press interview, Dr. M. Ward Hinds, health officer for the Seattle-area Snohomish Health District, explained, “Hospitals are deciding the risk is so low as to be immeasurable.” In his five-county region, just three of eight hospitals will offer the vaccine to their workers.

The unwillingness of first responders to participate in the vaccination program raises doubts about whether federal officials will move to the next stage of the plan, which targets as many as 10 million other health care workers, firefighters, police, and other emergency early response personnel. In December, federal officials said the vaccination project would move seamlessly from the first to the second stages. Today, some are questioning whether it is even needed.

Leslie Fisher, infection control coordinator for Santa Rosa Memorial Hospital is one who questions the need saying, “You’re taking healthy health care workers and asking them to undergo a procedure that has some degree of risk to it in the absence of a clear threat.”

Conrad F. Meier is managing editor of Health Care News.