January 23, 2003 -- More Hospitals Refuse Smallpox Vaccinations Before an Outbreak

 

 
USA Today reported Monday that more than 80 US hospitals are refusing
pre-outbreak smallpox vaccinations.


The Atlanta Journal-Constitution: 01/23/03]

Most metro hospitals buck smallpox plan

By M.A.J. McKENNA  The Atlanta Journal-Constitution

Five of seven Atlanta trauma centers will not ask their staff to
receive smallpox vaccinations scheduled for next week, potentially
reducing the number of local health care workers being vaccinated to
fewer than 100.

Atlanta Medical Center, DeKalb Medical Center, Gwinnett Medical Center
and Grady Memorial Hospital have told the state they will not ask
their emergency department staffs to volunteer for vaccination, said
Dr. Kathleen Toomey, Georgia's public health director.

North Fulton Medical Center is not announcing a hospital policy, but
is allowing workers to make their own decision, Toomey said. Only
Children's Healthcare of Atlanta, which operates the former Egleston
and Scottish Rite hospitals, has agreed to ask staff to volunteer for
the vaccinations, currently scheduled for Jan. 30 at health clinics in
DeKalb County.

The withdrawals are the latest development in an apparent backlash
against President Bush's vaccination plan -- a movement that began
Dec. 16 when Grady became the first hospital nationwide to opt out of
vaccination and that now takes in major urban and university hospitals
in California, Colorado, Minnesota, North Carolina, Tennessee, Texas
and Virginia.

Personnel at the institutions have given the same reason for declining
to vaccinate: Absent the clear threat of an attack, they cannot ask
their staff to risk taking a vaccine with severe side effects. The
30-year-old smallpox vaccine is the most dangerous one in use: Studies
done in the 1960s found 1-2 deaths and 15-50 serious reactions for
every 1 million vaccinations.

The decisions come one day before the unofficial start date for
vaccination campaigns -- a new law protecting vaccinators from
liability becomes effective Friday. The announcements also come five
days after the Institute of Medicine, a nonprofit organization that
advises Congress on health policy, urged the federal government to
slow down the vaccination process.

The vaccination campaign, announced by Bush on Dec. 13, calls for
vaccinating up to 510,000 military members and 450,000 emergency
department staff to protect against a possible bioterrorist attack, as
well as expanding vaccination to 10 million hospital employees,
police, fire and emergency workers.

Vaccine shipped

The Atlanta-based Centers for Disease Control and Prevention, which
supervises the smallpox plan, dispatched the first shipments of
smallpox vaccine Tuesday to Connecticut, Nebraska, Vermont and Los
Angeles
, but declined to say when those jurisdictions would begin
vaccinating. So far, 20 states have requested more than 100,000 doses
of vaccine, the CDC said.

Georgia's smallpox plan, already one of the most conservative in the
country, originally called for vaccinating approximately 400 emergency
department staff and public health workers.
By contrast, 15,000
vaccinations are planned in New York City. The state government
intended to spread vaccination slowly across Georgia, beginning in
January with metro Atlanta: The plan called for a 15-person smallpox
response team from each of the five public health districts in the
area, and up to 15 emergency and intensive care staff from each of the
seven local trauma centers. In February, March and April, vaccinations
would be offered to similar teams in North and South Georgia, then to
additional staff at trauma centers, and then to staff at other state
hospitals.

Bioterror planning

The smallpox response teams will still be vaccinated. Given the local
trauma centers' decision, most of those being vaccinated Jan. 30 will
be employees of the Georgia Division of Public Health or of county and
district health departments. Children's Healthcare is expected to send
no more than 15 personnel from both hospitals, said Public Health
spokesman Richard Quartarone.

Toomey, the public health director, said the hospitals that decline to
vaccinate their staff are still participating in the state's bioterror
planning.

"You could vaccinate everyone in Georgia and still not mount an
effective response if you haven't thought through how you would
investigate a case and mobilize the medical community," she said.
"We've gotten the full cooperation of all the hospitals, and we'll
have more than enough [of our] staff ready to respond in the event of
a smallpox case."

Wednesday, an influential national medical group reported that nurses
who would be likely to treat a smallpox case have not been adequately
prepared to recognize and treat the disease. The survey of 2,661
nurses by the National Network for Immunization Information, a
nonprofit group sponsored by seven doctors' and nurses' professional
organizations, found that almost two-thirds believe smallpox is more
contagious than it actually is, while almost four-fifths do not know
that smallpox vaccination can protect them several days after
exposure. See Washington Post 1-22-03, "Many nurses lack understanding
of smallpox, poll says":



At the same time, A New York Times Op-Ed piece suggests changes in the
program, but still endorses a pre-outbreak vaccination program, saying
"Nobody knows whether any terrorist group possesses a smallpox weapon,
but if there is any danger it is most likely to erupt when the United
States is threatening to invade Iraq."
 

An ABC News story quotes a NY City nurse practitioner as saying she
believes the Bush administration is urging the vaccine simply to
"build up a little hysteria" ahead of an attack on Iraq. She does not
want to put herself in danger in the absence of an actual smallpox
attack. And more important, she says, are the patients at her hospital
who might be accidentally infected.
http://abcnews.go.com/wire/US/ap20030123_188.html


The 20,000-member Massachusetts Nurses Association yesterday urged the
state's nurses not to volunteer for smallpox shots until the state
resolves important safety and legal liability issues, representing the
largest group so far to rebel against President Bush's campaign to
prepare for a possible bioterrorism attack.

The Pawtucket (RI) Times reports that the state's largest union of
health-care workers (United Nurses and Allied Professionals) is urging
its members to refrain from participating in the state's smallpox
immunization program unless changes are made.
http://www.zwire.com/site/news.cfm?newsid=6789254&BRD=1713&PAG=461&dept_id=24491&rfi=6