Smallpox Vaccinations

SPENCER MICHELS:

The federal government's plan to vaccinate up to half a million health workers against smallpox, to protect against a possible bioterror attack, is meeting resistance in many communities. At the end of last week, only 17,000 people across the country were reported to have received the smallpox vaccine.

Because of worldwide inoculations decades ago, there hasn't been a single case of smallpox reported since 1977, so vaccinations were stopped. Smallpox is known to have been developed into a bioterrorist weapon by the former Soviet Union. And some experts say that Iraq and North Korea, as well as some terrorist groups, could use weaponized smallpox.

That's why President Bush ordered military personnel to receive the vaccine and recommended that health professionals also get it.

PRESIDENT GEORGE W. BUSH (Dec. 13, 2002):

We will make the vaccine available on a voluntary basis to medical professionals and emergency personnel in response teams that would be the first on the scene in a smallpox emergency.

SPENCER MICHELS:

But some in the health community have resisted full cooperation, citing concerns over costs, health risks to workers and adequate compensation for those who get ill.

There also has been political resistance to the idea. Surgeon General Richard Carmona got a very public vaccination last week in an attempt to try to drum up enthusiasm for the inoculation program.

Being vaccinated, doctors say, produces a minor adverse reaction, like fever and aches, in about 30 percent of those who get the vaccine, sometimes serious enough to stay off work. Thus far, six moderate to severe reactions have been reported, none life-threatening. Of even more concern is the prediction that of every million people vaccinated for the first time, up to 50 could have life-threatening side effects, and one or two will die. But the surgeon general argues that vaccinations will help the nation.

RICHARD CARMONA, U.S. Surgeon General:

We can immunize you now, and we can make this not a weapon for our adversaries. Smallpox then comes off the table for our adversaries. If you elect not to, and we are threatened in the future with smallpox, then we have to make sure that you get immunized as quickly as possible.

SPENCER MICHELS:

Those who have followed the surgeon general's advice, like the Health Department in Alameda County, California, say it's part of their local bioterrorism plan. Dr. Robert Benjamin is the county health officer.

DR. ROBERT BENJAMIN, Alameda County Health Officer:

If, actually, the U.S. government intelligence sources are correct, and the possibility of smallpox being released to the world is greater than zero, we'd better be prepared. For us to have done nothing, I think is unconscionable.

SPENCER MICHELS:

San Francisco's health department has been less enthusiastic about inoculating health workers.

DR. SUSAN FERNYAK, San Francisco Health Official:

Frankly, at least in this part of the country, there isn't a lot of interest in the vaccination.

SPENCER MICHELS:

Dr. Susan Fernyak, who heads up San Francisco's efforts to comply with the federal plans, says that of nine hospitals in the city, only four have chosen to participate. And of those, far fewer health workers decided to get inoculated than Fernyak first thought.

DR. SUSAN FERNYAK:

We determined that we would need about 2,200 doses of vaccine. Over the last several months, that number has slowly drifted down. It was under 1,000 and then under 500, under 200, under 100, and now we're at about 50 doses of vaccine.

SPENCER MICHELS:

Although San Francisco's health department has followed federal plans and prepared to vaccinate the entire population, it has resented the impact the program has had on other essential services.

DR. SUSAN FERNYAK:

It's been a very difficult program to implement. We've had to divert many staff from other programs that are just as important or probably more important than the smallpox vaccination program.

SPENCER MICHELS:

Dr. Fernyak and nearly all health officials worry about infection from the vaccine. Mary Magee is a nurse, at San Francisco General Hospital's birth center, who will not get inoculated. She administers to babies under a year old whose immune systems are still developing and who could be infected by a recently vaccinated health worker.

MARY MAGEE, Nurse:

We know that there's a whole list of conditions that renders a person vulnerable to the serious side effects from the vaccine, anything from eczema to being a pregnant or breast-feeding mom to being a newborn or a recipient of chemotherapy. And once you're vaccinated, your vaccination site will shed live virus for three weeks.

SPENCER MICHELS:

Those infected by the vaccine don't get smallpox, but a skin infection called vaccinia. Health officials say that cancer patients on chemotherapy and HIV/AIDS patients, whose immune systems are weakened, are especially vulnerable to infection. In San Francisco, where the HIV rate is elevated, the concern is heightened.

DR. SUSAN FERNYAK:

We really want to make sure that none of these individuals are inadvertently exposed to the vaccine virus.

DOCTOR:

How are you doing right now?

SPENCER MICHELS:

Despite those concerns, the hospital's Dr. Erwin Tan, who often deals with cancer and AIDS patients, has decided to get vaccinated. A former Army reservist with biological warfare training, he serves on the city's bioterrorism working group.

DR. ERWIN TAN, San Francisco General Hospital:

God forbid there's a smallpox case somewhere in this world, I want to be able to turn to a scared parent and say, you know, "I understand that this vaccine has a lot of risks, but let me tell you my experience with it." And that very human experience, that interaction at the bedside, is very much what medicine is about.

SPENCER MICHELS:

And Tan says there's another reason that health workers should be vaccinated.

DR. ERWIN TAN:

We feel that our most important mission is to be able to vaccinate the entire city within five days. Anything that helps us prepare for this is helpful, and vaccinating a small group of people– whether it be five, 30 or 50 people– would help us with experience with this vaccine and experience in treating the normal complications of this vaccine.

SPENCER MICHELS:

Some health officials worry that they would have to replace vaccinated workers until they are no longer infectious, or keep them away from vulnerable patients at a time of shrinking hospital budgets.

DR. SUSAN FERNYAK:

It's very difficult for people to take three weeks off if they… you know, from the work if they're full-time clinical staff. That is difficult for them.

UNIDENTIFIED:

We use a special needle.

SPENCER MICHELS:

While various public officials, including California's health director, were promoting the vaccination program by getting vaccinated, the federal government tried another tactic: It announced it would try to get Congress to approve a plan to provide compensation, up to a quarter of a million dollars, for those workers who become ill or die from vaccinations.

RICHARD CARMONA:

Well, I think it will help because I think some of the concerns that were expressed by the public had to do with compensation and "if I lose time from work" and so on. I don't think it's the sole answer.

DR. SUSAN FERNYAK:

I'm not sure it'll make a lot of difference. It seems that people's concerns are really about safety of the vaccine. Even if their… even if their family is compensated if they die, I don't think they're interested in dying from this vaccine.

SPENCER MICHELS:

But nurse Mary Magee and others have a concern about the vaccination program outside the medical and financial: Politics.

MARY MAGEE:

This came down as a mandate from the federal government. One could argue that this is politically driven.

SPENCER MICHELS:

Why? Why is that?

MARY MAGEE:

The smallpox vaccination program is part of getting the people of the United States into the mindset that there's going to be a war, and a lot of people are very concerned about counterterrorist attacks if there's a war. And this is a way to try to allay fears by saying, "Look, we're doing something to protect you from a possible bioterrorist attack."

SPENCER MICHELS:

Federal health officials say they expected it would take a while to get the smallpox vaccination program rolling. Should an actual case appear, they say, public attitudes will change fast.