Bush Announces National Smallpox Vaccination Plan
As expected, President Bush on Friday announced a national smallpox vaccination plan under which about 500,000 military personnel and as many as 10 million emergency and health care workers will receive the vaccine, the Washington Post reports. The plan marks the first time that public health officials will provide vaccinations for a disease that has not appeared in more than 20 years (Connolly/Milbank, Washington Post, 12/14). Bush called the plan a protective step in response to the Sept. 11 attacks, not to "real or perceived threats," the Los Angeles Times reports (Kemper, Los Angeles Times, 12/14). As part of the plan, the federal government has sent the smallpox vaccine to several military bases abroad, where about 500,000 military personnel will receive the inoculation. In late January, the government will begin to vaccinate about 439,000 civilian emergency workers not at high risk for side effects as part of a 30-day voluntary program. In the second phase of the vaccination plan, which will take between 45 and 90 days, federal and state governments will move to vaccinate about 10 million health care workers; government officials estimate that about half of the workers will decide to receive the vaccine. U.S. diplomats in the Middle East also could receive the vaccine, and the State Department will consider requests from U.S. allies for the vaccine. In late spring or early summer of 2003, the federal government will offer the vaccine to U.S. adults in the general population not at high risk for side effects (Washington Post, 12/14).
Individuals with eczema, atopic dermatitis, HIV and cancer, as well as pregnant women and organ transplant patients, should not receive the vaccine (Los Angeles Times, 12/14). The government does not recommend the vaccine for the general population, and individuals who request the vaccine will have to complete questionnaires and consent forms (Washington Post, 12/15). Some individuals may qualify to enroll in clinical trials of the smallpox vaccine, and the government may establish a program to allow others to receive the vaccine as an experimental treatment (Altman/Grady, New York Times, 12/15). Bush said that he would receive the vaccine but that his family and staff would not "because our health and national security experts do not believe a vaccination is necessary for the general public" (Sammon, Washington Times, 12/15). HHS has launched a Web site at www.smallpox.gov that provides information on the smallpox vaccination plan (HHS release, 12/13). The Bush administration also plans to offer a program to educate the public and health care workers about the risks of the vaccine (Hitt, Wall Street Journal, 12/16).
On CNN's "Late Edition" Sunday, HHS Secretary Tommy Thompson said that he will not receive the smallpox vaccine and that other Cabinet and government officials should not receive the inoculation. Thompson said, "The president is doing it because he is the commander in chief, and he believes that if he is ordering his troops ... to get this vaccination, he should do it as well." He said Bush recommends that "elected officials be considered just like the general public" and should not receive the vaccine. "I have also made the same kind of recommendation to the governors and to health officials who are not going to be in the first line," Thompson said (AP/New York Times, 12/15).
Health care workers, first responders and hospitals nationwide have raised a number of concerns about the smallpox vaccination plan, the Washington Post reports (Sanchez, Washington Post, 12/15). Health care workers will likely not begin to receive the vaccine until after Jan. 24, when a provision in the Homeland Security bill passed last month that protects vaccine manufacturers and those who administer the vaccine from liability takes effect (California Healthline, 12/12). Although some health care workers said that they will receive the vaccine "for the good of the country and their own well-being," others raised concerns about side effects and whether the federal government will compensate their families for injuries caused by the vaccine (Washington Post, 12/15). Hospitals will determine if vaccinated employees receive leave or reassignment to prevent exposure to patients at high risk for side effects of the vaccine (O'Brien, Baltimore Sun, 12/14). "Because of our duties to respond, we need to be prepared, and the best available evidence is that the vaccine is how we get prepared," Thomas Terndrup, head of emergency medicine at the University of Alabama at Birmingham, said. "That is how we are convincing ourselves to sort of accept the vaccine," he added (Brown, Washington Post, 12/14).
Meanwhile, legal experts said that "it will be difficult" for individuals to win compensation from the federal government for injuries caused by the smallpox vaccine, the New York Times reports. Individuals would have to prove that the government was negligent in the provision of the vaccine to win compensation, they said. Professor Edward Richards, director of the law, medicine, and public health program at Louisiana State University, said, "It would be very hard to recover from the government for the risks the government knew it was exposing people to. The government is not liable if it makes a policy choice to expose citizens to a risk. It might be a bad policy choice, but it's not negligence" (Pear, New York Times, 12/14). Thompson said that most health insurance plans would cover the cost of medical care required as a result of the smallpox vaccine, but he did not provide details on who would cover the cost of care for individuals without health insurance. In addition, many states have raised concerns that workers' compensation would not cover the cost of care for health care workers who became ill as a result of the smallpox vaccine. However, Michael Osterholm, a former Minnesota state epidemiologist who advises Thompson, said that no state has "refused to cover this program under the workmen's compensation program" (Altman, New York Times, 12/16). Opponents of the smallpox vaccination plan, such as the Service Employees International Union, have said that that the plan does not provide adequate protection for health care workers. Martha Baker, an intensive-care nurse in Miami, said, "We need to know if we do step up and take the vaccination that we have protection" (Wall Street Journal, 12/16).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.