Washington Post,
Unions Call for Changes in Smallpox Vaccine Program
By Ceci Connolly Washington Post Staff Writer
Two of the nation's largest unions called on President Bush yesterday
to suspend smallpox vaccination of health care workers until the
administration agrees to provide medical screening of volunteers and
compensation for anyone injured by the vaccine.
One of the organizations, the Service Employees International Union
(SEIU), said that unless the administration agrees, it will recommend
that its 750,000 members in the health sector not participate in the
vaccinations. Already, several prominent hospitals are refusing to
take part, citing safety concerns.
One week before the start of the extensive immunization campaign for
health care workers, the union and hospital defections threaten to
complicate Bush's goal of inoculating 500,000 hospital
and public
health staffers in the first phase of the program.
Jerome M. Hauer, acting assistant secretary for public health and
emergency preparedness, said he will continue to look for ways to
address safety and compensation issues but will not postpone the
program. "There are many people out there who have told us they want
to be vaccinated," he said. "We are going ahead with the
program."
On Dec. 13, Bush announced plans to inoculate as many as 10.5 million
health care workers and emergency responders most likely to come
in
contact with an initial case of smallpox. Mandatory immunization of
500,000 military personnel is underway.
The administration and Congress have provided liability protections
for makers of the vaccine as well as hospitals and medical personnel
administering it. If, for instance, a hospital patient is
accidentally
infected with the live vaccine, neither the hospital nor its staff
would be responsible for damages.
But federal officials have consistently rejected
entreaties to
compensate people harmed by the vaccine, which consists of a live
virus known for its serious side effects. Past experience
indicates
that between 14 and 52 of every 1 million people immunized will suffer
life-threatening complications, such as blindness and swelling of the
brain; one or two could die.
Under provisions of the Homeland Security Act, people injured by the
vaccine would have to sue the federal government and prove negligence
to be compensated.
The unions are also pressing Bush to pay for medical tests that could
screen out risk factors such as pregnancy, eczema and weakened immune
systems.
"Those asked to risk their health, livelihood and even their lives
must be protected from receiving a vaccine where contraindicated and
must be compensated for adverse effects resulting from vaccination,"
wrote Gerald W. McEntee, international president of the American
Federation of State, County and Municipal Employees (AFSCME), which
includes 350,000 health care and emergency workers.
SEIU President Andrew L. Stern said civilian volunteers should receive
the same screening and protections as the military, which has screened
out about 30 percent of its members because of contraindications. "The
problem still is: 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," he said.
At least a half-dozen hospitals, including
and Centura Health hospitals in
inoculate employees.
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According to an article in USA today, one of AFSCME's largest locals,
in Philadelphia, voted not to participate in the program until
issues of screening and compensation for people who are injured are
worked out.
http://www.usatoday.com/news/health/2003-01-16-union-smallpox_x.htm
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SEIU's press release on smallpox safety:
http://home.attbi.com/~mlyon01/articles/SEIUsmallpox.htm
SEIU's letter to Bush on smallpox safety:
http://home.attbi.com/~mlyon01/articles/SEIUBush.htm
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Meanwhile, the LA Times reports that the vaccination program, due to
begin on January 24, is stalling in confusion and resistance.
States Lag at Start of Smallpox Program
Officials see a drop in health-care workers willing to be
inoculated.
Confusion on vaccine delivery and safeguards is also cited.
By Vicki Kemper Times Staff Writer
January 17 2003
WASHINGTON -- Just days before President Bush's smallpox vaccination
program was originally set to begin, the number of front-line
health-care workers expected to volunteer to be inoculated has shrunk
dramatically and some states are still months away from launching
their campaigns. A telephone survey by The Times of public health
officials in 20 states also revealed several key misunderstandings
between state and federal officials on issues as basic as when vaccine
supplies will be delivered to the states.
Federal health officials acknowledged the "variability in
preparedness" among the states, but expressed confidence that the
program was the best way to prepare the nation for a bioterrorism
attack with the smallpox virus.
"All of the states have taken enormous steps ... in an incredibly
short period of time," said Dr. Julie L. Gerberding, director of the
Centers for Disease Control and Prevention. "Overall, we're very
pleased and impressed."
Yet many of the plans described by state health officials differ
markedly - in size and timing - from the program laid out last month
by the Bush administration.
State officials cite a variety of reasons: the lack of additional
liability protections for hospitals; the absence of guaranteed
compensation for vaccinated health-care workers who lose time on the
job; a growing sense that a smallpox attack is not imminent; and a
deeper understanding of the vaccine's risks.
Federal officials and advisory committees have been rushing this week
to conduct essential training, complete basic recommendations and
broaden their interpretation of liability provisions contained in the
Homeland Security Act.
Taken together, the actions indicate that, even as the Bush
administration continues to prepare for war against Iraq - which it
says may possess stocks of the smallpox virus - much of the urgency
that had been driving the smallpox plan has dissipated.
"Because the smallpox threat is not imminent," Gerberding said,
"we
can put safety as our highest priority." Last month, however, when the
president somberly unveiled the vaccination program, top federal
health officials said timeliness was critical. The inoculation of
500,000 military personnel began immediately.
Officials said then that they expected the states to start vaccinating
about 450,000 public health workers and hospital emergency-room
personnel late this month and to complete the process "as soon as they
possibly" could, preferably within 30 days. At that point, they said,
state and local health departments would begin inoculating up to 7
million additional health-care workers and 3 million police, fire and
other emergency personnel.
Yet several state health officials told The Times this week that they
would not begin vaccinating emergency-response team members until
mid-February or later. Many others said they did not know when their
programs would begin because they were awaiting direction - and
notification of when they would receive supplies of the vaccine - from
the CDC. Officials in
President Bush.
CDC officials said they were waiting to hear from the states.
"We are prepared to send vaccine as early as next week to states that
are ready to receive it," Gerberding said, adding that the program had
no official start date. "We want states to begin the program as soon
as they can safely do it."
Some states still believe they must complete the first phase of the
program within 30 days.
"We submitted a plan for 30-day implementation, and we're sticking
with it," said Ken August, spokesman for the
California Department of
Health Services, which requested 49,200 doses of vaccine.
But Gerberding called the 30-day deadline
"another complete
misunderstanding. The bottom line ... is that there is no end date for
this program."
In fact,
complete the process.
three months.
Of greater concern to some state officials are the large number of
health-care workers dropping out of the voluntary program and the
impact of the vaccination plan on routine public health services.
In
is "declining as we approach the giving of the vaccine," said Dr.
Donald E. Williamson, the state's top health officer.
Though
"it's possible that I may get only one-third or
one-half that
response."
In
the 500 vaccine doses requested for a five-county region would
be used
to inoculate health workers, a top health official laughed.
"It will be considerably less than that," said Sherri McDonald,
director of the Thurston County Public Health and Social Services
Department.
Behind the drop-off in the number of volunteers, said
Williamson, is a complex set of factors.
Because the vaccine itself carries risks - studies conducted
in the
1960s indicate that one or two of every 1 million people vaccinated
will die and many more will suffer serious complications - health-care
workers want to make sure they will be compensated if their reaction
to the vaccine causes them to miss work for a time or leaves them with
large medical bills.
Vaccinated workers and the hospitals they work in also seek assurances
that they will not be sued if they unintentionally
infect vulnerable
hospital patients with the smallpox virus.
Health and Human Services Secretary Tommy G. Thompson allayed some
concerns in a letter to hospitals last week, hospital and state
officials said.
But many health-care workers and some hospitals will
refrain from
participating unless the government offers additional protections.
Both state officials and union representatives have called for a
federally financed compensation fund.
"A number of hospitals are waiting at the trough but not drinking
yet," said Jim Lott, executive vice president of the Health Care Assn.
of
Potential vaccine volunteers are also trying to balance the threat of
a smallpox attack against the risks of the vaccine, Williamson said.
Because the president said there was no imminent threat, "people are
less willing to accept the vaccine" if compensation and liability
issues are not resolved, Williamson said. If the federal government
addressed those concerns, he added, "the fact
that the threat is not
imminent becomes less of a deterrent to getting vaccinated."
As with later start dates and longer completion times, the CDC's
Gerberding said she was not concerned about reports of fewer
vaccination volunteers.
"We need to get away from this notion of a number," she said,
referring to the government's original estimate of 450,000 front-line
health-care workers to be vaccinated in the first phase of the
program.
"We knew full well that we did not need to vaccinate that many
people," she said. Federal officials simply overestimated to ensure
there would be enough of the licensed smallpox vaccine, she said.
Aside from the uncertainties about timing and numbers, most states and
counties appear well prepared to implement the program. Many have
already taught nurses to administer the vaccine, which requires about
15 jabs with a two-pronged needle, and they have planned several
vaccination clinics over a period of weeks to avoid taking too many
health-care workers away from their normal jobs at any one time.
Gary Cox, director of Tulsa City/County Health Department in
said his agency was ready to begin as soon as it received the vaccine.
One of six already-trained vaccination teams will go to each hospital
in the region and complete the job in a few days, he said.
"The president has called on us to do this job to protect national
security, and we just look at it as, 'That's our job,' " Cox said.
"It will be an extra burden, but not a burden we can't handle," he
said.
Keeping a balance between vaccinating as many as 9,200 health-care
workers against smallpox and providing normal health services in
Angeles
director of public health for the Department of Health Services.
"Outbreaks don't stop," he said. "Sexually transmitted diseases,
childhood immunizations and the like still go on."