Smallpox Vaccination of Health Workers to Begin Soon, CDC Says

CDC director Dr. Julie Gerberding said in a telephone briefing that as of Friday afternoon, 11 states had asked to have smallpox vaccine shipped next week, suggesting that they could start immunizations soon after.

The shipments were announced the same day that the CDC received a report from the Institute of Medicine expressing concern that the current timetable for smallpox vaccinations was too rushed. Gerberding said that the CDC is “carefully reviewing” the report but that the vaccination plan “needs to go forward.” According to Gerberding, states will begin implementing the program when they are ready.

The CDC requested that the Institute of Medicine convene the fifteen-member panel after the Bush administration announced its smallpox vaccination plan in December. The plan calls for vaccinating as many as 500,000 emergency and medical workers, and eventually millions more.

The smallpox vaccine contains a live virus and kills approximately one or two in every million people who receive it. A rise in the number of Americans with compromised immune systems means that the U.S. population is more vulnerable to side effects than it was in the 1970s when general vaccination against smallpox ended. But the Bush administration decided the risk was worth taking in view of the possible threat of biological attack.

The panel recommended that the CDC watch the first phase of the vaccine program — the voluntary immunization of health and emergency workers — and analyze what happens there before vaccinating anyone else.

The CDC emphasized that it will be reviewing the vaccination program in “real time” and that since the vaccine has been used in the past they do not expect any major problems.

The Institute of Medicine panel expressed concern that the current vaccination plan does not explain whether or how workers who possibly become ill after receiving the vaccine would be compensated.

Congress enacted legislation to protect people and institutions conducting the smallpox inoculations from most lawsuits from those who become ill, leaving such patients with little recourse, the panel argued. Under the policy, those injured may have access to state workers’ compensation programs, but those programs are not likely to cover all medical expenses and time lost from work.

An existing compensation fund helps people injured by other vaccines, but it does not cover smallpox. So far, the administration has not proposed any similar fund for smallpox.

Gerberding said Friday that the CDC would advise health care workers considering the vaccine to check with their employers for details on their workmen’s compensation coverage in the event of an adverse reaction to the vaccine.

“We are certainly not going to delay this program because of concerns about compensation,” Gerberding said.

Meanwhile, unions registered their agreement with the Institute of Medicine [IOM] report.

“It is wrong for President Bush to ask health care workers to participate in a vaccination program that is not safe,” said Andrew L. Stern, president of the 1.5-million member Service Employees International Union, which represents doctors, nurses, paramedics, and other health workers across the country. “The vaccination program should be delayed until the concerns raised in the IOM report have been properly addressed.”

“If a worker or patient gets sick as a result of this vaccine, they’ll be lucky if they receive a get well card from Washington,” Stern said.

When asked about the reluctance of some doctors and hospitals to participate in the vaccination program, Gerberding said that 100 percent participation is not necessary to achieve the goal of creating response teams to treat the first victims of a smallpox attack. She also said that the CDC was hearing from many doctors who wanted to be vaccinated even though their hospital had declined to take part in the vaccination program.

Gerberding also pointed out that the smallpox vaccination program is not just a public health issue — but is also an issue of homeland security and national defense.”

“We are in fact in a dangerous world where the chance of a terrorist attack with smallpox is possible,” she said. “We must be prepared.”

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