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[IP] An article Re: Smallpox vaccinations

Excerpted from the New York Times Feb.7, 2003

Many Balking at Vaccination for Smallpox

President Bush's plan to vaccinate 500,000 health care workers against
smallpox is getting off to an unexpectedly slow start as hundreds of
hospitals and thousands of nurses across the country say that they
will not participate.

The Centers for Disease Control and Prevention said today that only
687 volunteers in 16 states had been vaccinated since the program
began two weeks ago, though it has shipped 250,000 doses of vaccine to
41 states.

A nationwide survey of state health officials by The New York Times
this week found about 350 hospitals that declined to participate.
Hundreds more have not yet decided.

The vaccination plan is part of the Bush administration's preparation
against a terrorist attack or a war on Iraq, but the White House
seemed unfazed by the slow start.

Scott McClellan, a White House spokesman, said the program was "still
very much in the early stages."

"We are confident that more than enough health care workers will
answer the call so that we are prepared to respond to protect our
fellow Americans in the event of any attack," Mr. McClellan said.

Smallpox experts said they were surprised at the low turnout.

"Given the media attention, I thought people would be much more
eager," said Elizabeth Fenn, a history professor at Duke University
who has traced the disease's history. However, she said, health
professionals might be more wary of the vaccine. When it was last used
in the 1960s, it caused up to 52 life-threatening complications and
two deaths for every million vaccinations.

No serious reactions have occurred among those vaccinated in the past
two weeks, the disease centers said. Dr. William J. Bicknell, a
smallpox expert at the Boston University School of Public Health who
favors vaccinating 10 million people as quickly as possible, blamed
the centers, saying the agency had let potential volunteers develop
exaggerated fears, failed to assure them that they would be protected
in case of bad reactions, and did not publicize the Israeli and United
States military vaccination campaigns, which have had few problems.

On the other hand, Dr. Paul Offit, chief of infectious diseases at
Children's Hospital of Philadelphia and a member of the president's
advisory panel on smallpox vaccination, said he was "surprised,"
adding, "People are voting with their arms."

Dr. Offit was the only member of the panel to vote against nationwide
vaccination, and his hospital was quick to back out because it had so
many children with immune systems weakened by cancer treatment or
organ transplants.

Public-health and hospital officials concede that they are struggling
to find volunteers. Many health workers say they are skeptical that an
attack is imminent and fear having a bad reaction to the vaccine or
infecting a patient or relative with it.

Many also fear they will not be compensated, whether they lose a day's
work to fever or end up near death from encephalitis.

A number of local health officers, charged with overseeing the
vaccinations, said the vaccinations would sap already tight health
budgets. They said the federal government had seriously understated
the real cost of smallpox vaccinations, which require extensive
training, screening and follow-up. "It's not like lining people up for
flu shots at the mall," said Patrick M. Libbey, director of the
National Association of City and County Health Officials, which has
argued that the vaccinations cost $200 to $400 per person, while the
disease centers have estimated it at as little as $13.

Sounding defensive in a telephone news conference yesterday, the
centers director, Dr. Julie Gerberding, urged reporters not to
concentrate on the low participation.

"Our goal is achievement of a preparedness capacity, not achievement
of a number," Dr. Gerberding said. "We recognize that concerns about
compensation are causing people to be slow to volunteer because
they're afraid they'll fall through the cracks."

She declined to say how the issue would be addressed, and some said
that could fuel the frustration of nurses associations that have
called for the plan to be delayed. 

"We have nurses calling us from all over the state with questions that
we still don't have answers for," said Clair Jordan, executive
director of the Texas Nurses Association, which has advised its 5,000
members not to volunteer.

Nurses unions in California, Massachusetts, Rhode Island and parts of
Pennsylvania have also advised members not to volunteer.

"There's problems with protecting my family," said Linda
Condon-McMahon, 43, an emergency-room nurse at Brockton Hospital in
Massachusetts, "and protecting the patients till the site scabs over.
Slapping a little bandage on it isn't going to protect them - somebody
trips and falls, grabs your arm, and there goes your bandage."

Of the roughly 350 noncooperating hospitals found by The Times, 175
are in Texas, which, unlike most other states, last month pressed all
of its 550 acute-care hospitals to make a decision.

The high refusal rate "is not surprising at all, nor is it important,
as long as all of our communities will be adequately protected," said
Dennis Perrotta, the Texas epidemiologist.

One of the first hospitals to balk was St. Vincent Infirmary Medical
Center in Little Rock, Ark.

Margaret Preston, a spokeswoman for Catholic Health Initiatives of
Erlanger, Ky., which owns St. Vincent's, said vaccinating workers
"puts the patients at risk, and the risk outweighs the benefits."

Hospital chains have followed suit. The five-hospital Providence
Health Systems in Washington State said it would not want vaccinated
employees at work during the three weeks they could shed virus, and
could not afford the resulting staff shortage.

In Richmond, Va., the Virginia Commonwealth University Health System
said it would not vaccinate until one confirmed case of smallpox
appeared in the world.

Dr. Richard Wenzel, the system's head of internal medicine, who
treated smallpox decades ago in Bangladesh, called the decision
"purely a medical risk-benefit assessment." 

New Jersey has vaccinated the most so far 97 health workers and police
officers on Jan. 31.

The state's relative success is due to "very robust" communication
with health workers, said Dr. Clifton R. Lacy, the state health
commissioner. Also, he said, "New Jerseyans see themselves as somewhat
vulnerable to bioterrorism. We were the epicenter for the anthrax
event, and we still have post office buildings closed down."

Colorado vaccinated 19 people on Jan. 31 and planned to vaccinate
1,100 soon, said Dr. Ned Calogne, the state's chief medical officer.

Dr. Calogne was having his third smallpox vaccination, having had one
as a child and one as a teenager going abroad.

Asked about the many volunteers backing out, he said with a laugh:
"Maybe some are just waiting to see if the rest of us survive. I'm
kidding, kidding."
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