With the Bush administration's smallpox program getting off to a slow start, Congress and HHS last week were weighing proposals to address safety and compensation concerns that have discouraged providers from being vaccinated.
More than 300 hospitals and health systems have declined to make the voluntary smallpox vaccine available to their healthcare workers under phase one of the campaign, announced Dec. 13, 2002.
The plan initially called for inoculating up to 500,000 workers within 30 to 60 days of the start of the program, which launched Jan. 24 when the Homeland Security Act took effect (Jan. 6, p. 6). As of the middle of last week, 1,043 people in 19 states, primarily public health officials, had received the shots, according to the Atlanta-based Centers for Disease Control and Prevention, which is administering the effort.
An Institute of Medicine subcommittee charged with examining implementation of the vaccination plan said the absence of a compensation plan "could seriously impact" its goals of increasing terrorism preparedness.
But CDC Director Julie Gerberding downplayed the relatively small number of vaccinations. She said the agency was "not surprised to see this rate of immunization," and has not specifically set a target number of people to vaccinate.
"It's tempting to concentrate on the 500,000 number, but I urge you to understand that our goal is not achievement of a number," she said on a recent conference call with reporters. "Our goal is achievement of a preparedness capacity."
Gerberding said it is the responsibility of local and state public health departments to identify the minimum number of health workers necessary to be vaccinated in their jurisdictions to carry out a mass vaccination program.
Since inoculations began late last month, 45 states and four counties have requested 267,100 doses of smallpox vaccine from the CDC, which has shipped roughly 265,100 doses. Few of those doses have been administered so far.
The program is off to a slow start in Connecticut, which became the first state to vaccinate health workers when three individuals received the shot Jan. 24. Christopher Cannon, director of Yale-New Haven (Conn.) Health System's Office of Emergency Preparedness, told Modern Healthcare last week that about 100 hospital workers had been vaccinated in the state. He said 6,300 doses were ordered by the state, and 1,000 workers have volunteered to be vaccinated so far, and that number is expected to grow.
Cannon said he is not discouraged because all of the state's 32 hospitals will have vaccinated workers. "We probably won't hit the 6,300 number as far as vaccinations, but that's OK," he said.
Safety concerns continued to loom last week with news that a Florida woman suffered a minor allergic reaction to the shot. John Agwunobi, secretary of Florida's state health department, said the woman is "doing fine and is ready for a rapid return to normal activities."
The complication was believed to be the first in a health worker; on Feb. 7, Pentagon officials confirmed that two U.S. military personnel became seriously ill after receiving the smallpox vaccine but said the men now are in good condition.
Although HHS has said it is working with the White House and Congress to devise a compensation plan for workers who may be injured by the vaccine, many healthcare officials contend it would put them at ease to have a public statement from the White House supporting such a program.
"The White House's silence on the issue is deafening," Andrew Stern, president of the Service Employees International Union, told Modern Healthcare. "I think the more they deal with the screening, monitoring and compensation issues, the more people will volunteer to do this."
The 1.5 million-member SEIU, the nation's largest union of healthcare workers, additionally has called for increased screening and monitoring safeguards for civilians receiving the shot.
"We can't count on anything more than a get-well card from Washington," Martha Baker, a nurse at Jackson Memorial Hospital in Miami and co-chairwoman of the SEIU's Nurse Alliance, said in a written statement.
During congressional hearings Jan. 29, Sens. Bill Frist (R-Tenn.), Judd Gregg (R-N.H.) and Edward Kennedy (D-Mass.) agreed to work together to establish safeguards for vaccinated workers, including compensation for harm.
Eight members of Congress, including Rep. Henry Waxman (D-Calif.), also wrote a letter to President Bush late last month asking him to support the creation of a compensation fund. A Waxman aide told Modern Healthcare last week that the congressman plans to introduce legislation in the House that would create such a fund.
Curtis Rooney, senior associate director and counsel for federal relations at the American Hospital Association, said he believed the White House will step forward to support a compensation program.
He said the AHA was working with the Bush administration, as well as Frist and Gregg, to address the safety concerns.
Gerberding said last week she was not at liberty to discuss details of a compensation framework HHS is working on, but she was optimistic that the administration "will be able to close these gaps."