Smallpox vaccination plan faces obstacles

States unclear on details, volunteers pulling out

January 17, 2003|By LOS ANGELES TIMES

WASHINGTON - Just days before President Bush's smallpox vaccination program is set to begin, the number of front-line health-care workers expected to volunteer to be inoculated has shrunk sharply and some states are months away from launching their campaigns.

A phone survey by the Los Angeles Times of public health officials in 20 states also revealed key misunderstandings between state and federal officials on issues as basic as when vaccines will be delivered.

"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. "We're very pleased and impressed."

Yet many of the plans described by state health officials differ markedly from the program laid out last month by the Bush administration.

"Because the ... threat [of an attack with smallpox virus] is not imminent," Gerberding said, "we can put safety as our highest priority." Last month, however, when Bush 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 shots "as soon as they possibly" could, preferably within 30 days.

Then, they said, state and local health departments would begin inoculating as many as 7 million additional health-care workers and 3 million police, fire and other emergency personnel.

Yet several state health officials said 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.

Centers for Disease Control officials said they were waiting to hear from the states.

Kansas and Pennsylvania expect to take as long as two months to complete the process. Massachusetts officials said they might need 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.

Because the vaccine carries risks - studies conducted in the 1960s indicate that one or two out 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 time from work 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 smallpox.

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