Hospital groups are commending HHS' proposed plan to offer more frontline healthcare workers smallpox vaccine but contend a number of complicated administrative, logistical and social issues must be dealt with before launching the bioterrorism-preparedness measure.
Officials at HHS have not completed their policy for a national smallpox vaccination strategy, but stressed recently that plans to approve vaccinations for health professionals during peacetime are under way and awaiting HHS Secretary Tommy Thompson's approval. Exactly how many healthcare workers will be offered the vaccination in advance of a confirmed smallpox case or confirmed bioterrorism attack is still undecided.
"No policy decisions have been reached, and no number has been determined," HHS spokesman Bill Pierce told Modern Healthcare. "It will be a matter of weeks until a final decision is to be made and any vaccination program would start."
A special advisory committee for the Centers for Disease Control and Prevention released June 20 draft recommendations for HHS outlining a national smallpox strategy calling for the vaccination of roughly 10,000 to 20,000 frontline healthcare and emergency workers. But some officials acknowledge the federal government is considering voluntary smallpox vaccinations for up to 500,000 healthcare professionals on the front lines.
"If this is the case, we believe that officials at the Department of Health and Human Services are heading in the right direction," Chip Kahn, president of the Federation of American Hospitals, said in a written statement. "Last month, we indicated our strong support for voluntary vaccinations for all frontline healthcare workers."
James Bentley, senior vice president of strategic policy planning at the American Hospital Association, said the AHA also advocates providing the vaccine on a voluntary basis to a broader number of workers in the hospital community.
"Strategically, (HHS) needs to decide how we balance risks of not having more people vaccinated and the risks of vaccination, and we're supporting them during the process," he said. "We have tried not to be strident about this, have opened dialogue and the department is responding. This is not an easy set of issues here."
Citing potential serious if not grave side effects, Bentley said the AHA believes the vaccine must be voluntary for health workers and not compulsory. The issue is one among many unresolved administrative and logistical questions facing HHS officials, he said.
The CDC's Advisory Committee on Immunization Practices recommended against vaccinating the general public in advance of a smallpox outbreak. Vaccination was recommended, however, in advance for special Smallpox Response Teams, one per state or territory, composed of selected public health professionals including medical team leaders, epidemiologists, disease investigators and laboratory scientists. The committee further recommended advance vaccination for selected healthcare personnel in facilities predesignated to serve as referral centers to provide care for initial cases.
"The prospect of terrorists deliberately exposing Americans to smallpox means `first responders' must be protected before an attack so they can provide immediate and continual care to people in their communities," Kahn said.
In required bioterrorism-preparedness plans due April 15 to HHS, states were asked to outline specific response plans for biological attacks including devising plans for "a potential epidemic" in each state or region. During this mandated preparedness planning, some state health departments, in cooperation with local or metropolitan hospital associations, also may have designated certain hospitals to serve as referral centers for smallpox victims, Bentley said. But other states are still undecided regarding a final local policy for responding to an outbreak.
Jan Emerson, spokeswoman for the California Healthcare Association, said the state's emergency medical systems trauma committee will be talking over the next several weeks with California hospitals to evaluate provider roles in the event of a smallpox outbreak.
"One of the questions we have and don't yet know the answer to is whether hospitals are even the right places for smallpox victims," she said. "If it gets into the ventilation system, it can contaminate the entire hospital."