February 08, 2003 -- Health Workers Balk at Smallpox Vaccinations


Health Workers Balk at Smallpox Vaccinations
Cite medical, financial, political reasons for not lining up

By Amanda Gardner HealthScoutNews Reporter

FRIDAY, Feb. 7 (HealthScoutNews) -- Health-care professionals are
citing medical, political and financial reasons for not towing the
U.S. government line and getting smallpox vaccinations.

The Centers for Disease Control and Prevention has shipped 204,600
doses of vaccine to 40 states, as part of its stated effort to
inoculate 500,000 health-care workers who would likely be caring for
smallpox patients. But the CDC reports that those workers aren't
rolling up their sleeves en masse: Only 687 people in 16 states had
volunteered since the program was inaugurated two weeks ago.

This apparent slow start seems to reflect a deep ambivalence among
doctors, nurses and other health-care professionals not only about the
vaccine, but also about the war against terrorism.

At issue is the safety of the vaccine (the CDC says about 1,000 out of
every 1 million people have experienced "serious" reactions, up to 52
people had potentially life-threatening reactions, and one to two in a
million may die), compensation for anyone who suffers complications,
the question of leave after receiving the vaccine, and whether
smallpox really is a credible threat.

"Over the last year on the national level, there has been a big debate
about smallpox, to vaccinate or not to vaccinate. Now that debate has
got to occur at every level in the medical system," says Dr. Georges
Benjamin, executive director of the American Public Health Association
(APHA) in Washington, D.C. "As more people do it and as we get a
better understanding of the risk-benefit, more people will be
comfortable vaccinating unless something happens."

The form of the roll-out may also be playing a role. Rather than one
federal plan to be implemented the same way in each state, various
metropolitan and other regions are determining how they want to do it,
says Jim Bentley, senior vice president with the American Hospital
Association (AHA) in Washington, D.C.

Both the AHA and the APHA generally support the administration's
program to vaccinate the vaccinators or those health-care workers who
are likely to be in the front line of a terrorist attack. Both have
also asked for additions to the program, including provisions for
liability and compensation for anyone who suffers consequences from
the vaccine.

"It was our sense that to make volunteering broadly successful, you
needed to take issues of liability and compensation off the table,"
Bentley says. That has not happened, he adds.

The National Association of Children's Hospitals echoes that concern.
"Children's hospitals have a disproportionately large impact on the
population of children most vulnerable to secondary vaccinia
infection," they write in a letter to the CDC. "Remaining faithful to
their missions of meeting children's unique needs will require these
hospitals to take extra caution in how they participate in the
national smallpox preparedness program."

Those who get a smallpox vaccination could be contagious for three
weeks, and there is a shortage of specialists in the pediatric field,
the letter says. These hospitals need more flexibility and a way to
compensate those who suffer bad reactions, the letter adds.

The CDC has acknowledged the issue. "We recognize that the concerns
about compensation are resulting in people being slow to accept the
vaccination program, particularly institutions where they don't have
confidence that they won't fall through the cracks," CDC director Dr.
Julie Gerberding said in a telebriefing Thursday.

Taking leave after receiving the vaccine has also been an issue. "It's
up to the particular institution, and part of what makes it so hard to
deal with in my opinion," Bentley says. Hospitals don't want to
deplete their staff but, at the same time, medical professionals don't
want to inadvertently expose any patients to a live vaccine.

"There clearly are a significant number of hospitals that are
concerned about exposing cancer patients or transplant or HIV patients
to a vaccine they shouldn't be exposed to," Bentley says.

Physicians for Social Responsibility is calling for more controls over
spreading the virus to the population at large. "There's a risk which
is way beyond what the original studies were in terms of
immune-compromised individuals," says Dr. Robert Gould, president of
the group and a pathologist at Kaiser Hospital in San Jose, Calif.
"We're supporting the decision of health professionals and hospitals
to opt out of the first round of vaccination."

Six staff members from Staten Island University Hospital in New York
City reported for vaccination training with health department
officials. Dr. Jordan Glaser, the hospital's director of infectious
diseases, doesn't know how many of the hospital's personnel will
eventually be vaccinated, but the institution has requested more than
150 doses. Even without active recruitment, Glaser says 30 volunteers
have already come forward.

"My sense is that the further you get from ground zero and 9/11/01,
the less people want to get vaccinated," he says. One person from the
hospital's infectious diseases department will be vaccinated, but
Glaser would not say whether he or another staffer will be that
person.

Meg Brizzolara, a registered nurse at San Francisco General Hospital,
has staunchly refused to either receive a vaccine or to administer
one. Her main concerns seem political.

"There's nothing to convince me that this threat is credible," she
says. "It looks more and more like this is fear-mongering on the part
of the White House to get support on this war, and that's not enough
reason for me."

"There's just not a doubt in my mind. I'm not going to do it," she
adds.

So the debate rages on.

"I've talked to a number of hospital CEOs about this," Bentley says.
"The places that have decided not to do it or have yet to make a
decision are in a position where the medical staff is not persuaded
this is the right thing to do. In that sense, the federal government
has not persuaded the physician community and the nurses that this is
the right, safe thing to do."



SOURCES:
Jordan Glaser, M.D., director, infectious diseases, Staten Island University Hospital, New York
City;
Robert Gould, M.D., president, Physicians for Social Responsibility, San Francisco and
pathologist, Kaiser Hospital, San Jose, Calif.;
Jim Bentley, Ph.D., senior vice president, American Hospital Association, Washington,
D.C.;
Meg Brizzolara, R.N., San Francisco General Hospital;
Georges Benjamin, M.D., executive director, American Public Health
Association, Washington, D.C.; Feb. 6, 2003, CDC telebriefing; Jan.
30, 2003, APHA legislative testimony