W ith only a fraction of the nation's healthcare workers having been voluntarily vaccinated against smallpox and concerns still pouring in about risks from the shot and liability issues, future participation in the federal vaccination program is uncertain.
Federal health officials, state health departments and hospitals initially identified some 450,000 healthcare and public health workers eligible to receive the vaccine. Officials assumed a large percentage would receive inoculations within 60 days of the program's Jan. 24 launch, but a lack of volunteers has brought the initiative to an unanticipated standstill. About 36,000 healthcare workers and public health officials have stepped forward to receive the shot.
"One of the problems was the expedited fashion in which this program was carried out; there wasn't enough time for states to buy into it," said physician Jose Romero, director of the combined division of pediatric infectious diseases at the University of Nebraska Medical Center and Creighton University in Omaha. "There certainly was not as large a turnout as was hoped."
Romero, who is chief medical adviser to Nebraska's Douglas County Health Department in Omaha, coordinated vaccinations for the county. More people were inoculated per capita in Nebraska than any other state in the program, and Douglas County vaccinated one-third of the state's 1,388 volunteers, he said.
According to a recent General Accounting Office report, the Centers for Disease Control and Prevention, Atlanta, has reconsidered the White House's initial vaccination targets and now says as few as 50,000 healthcare and public health workers may provide sufficient response capacity in the event of a smallpox attack. HHS spokesman Bill Pierce told Modern Healthcare the White House never intended to achieve a specific number of vaccinated workers.
"We've continually said that the more people we have vaccinated, the better off we'll be, and we're getting close to what we think we need at a minimum," Pierce said. "We never said we wanted 450,000."
With a lack of clear federal guidance, states are mapping out their own approach. Some, such as Nebraska, are halting vaccinations altogether because of low turnout or sufficient preparedness capacity. Others, led by Florida, already have begun vaccinating a second round of workers.
As of May 9, the government received reports of 55 serious adverse reactions to the vaccine, according to the CDC, which also is investigating the deaths of three civilians who suffered heart attacks after receiving their inoculations. The CDC is reporting 413 additional cases of mild complications from the vaccine, including rashes, headaches and fevers.
Federal legislation signed earlier this month by President Bush would provide those permanently disabled by the vaccine up to $50,000 per year with no cap on lifetime compensation. Those with less serious injuries will qualify for up to $50,000 per year with a $262,100 lifetime cap.
According to the GAO report, the government initially estimated the cost at $13 per shot when it has cost $204 to $265 per shot. HHS Secretary Tommy Thompson announced earlier this month the department would provide $100 million in federal funds to states to continue the program.