Health Workers Balk at Smallpox Vaccinations

Cite medical, financial, political reasons for not lining up

FRIDAY, Feb. 7, 2003 (HealthDayNews) -- 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."

More information

For the case against vaccines, visit this University of Florida site. Here is the CDC's smallpox information site.

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