Smallpox vaccination program covered by questions

Wednesday, April 2, 2003

The Bush administration says the threat of an attack with the smallpox virus has never been higher. Yet far fewer health-care workers have been vaccinated than officials envisioned, and at least a dozen states have suspended their programs because of concerns the shots are linked to cardiac disease.

Congress, meanwhile, is stalemated on a plan to compensate those harmed by the vaccine, and state health officials are asking the federal government to help pay for vaccination costs -- estimated at $249 per vaccination.

Some questions and answers about the vaccination program and what officials are doing to try to keep the program going:

Q: How many people have been vaccinated so far?

A: Just over 25,000 people during the program's first two months, far short of initial projections. Federal officials anticipated that close to a half-million public health and hospital workers would get the vaccine during a first stage of vaccination, expected to last about a month. In stage 2, which is beginning slowly in some places, they planned to offer the vaccine to another 10 million emergency responders.

The idea was to vaccinate enough people to respond if there was a smallpox attack anywhere in the nation.

Health and Human Services Secretary Tommy Thompson said the program needs to do a better job of making people comfortable with the vaccine.

"We are trying to allay their fears. We're concerned about everybody's fears," he told reporters in Atlanta.

In the military, where vaccinations are mandatory, some 350,000 have been inoculated.

Q: Why haven't more hospitals participated and more people volunteered?

A: The vaccine carries rare but serious and sometimes deadly side effects. Hospitals are concerned that vaccinated workers could infect vulnerable patients since the vaccine uses a live virus that can escape the inoculation site.

On top of all that, the government so far has failed to establish a way to compensate people injured or killed by the vaccine. Congress has barred most lawsuits that might be filed, leaving victims with few avenues to recoup medical costs, lost time from work and other expenses. A childhood vaccine compensation program provides payments to people hurt by vaccines, but it does not include smallpox.

Still, establishing a compensation program isn't a "silver bullet" that will get people to volunteer for the shot, said Michael Osterholm, a bioterrorism expert at the University of Minnesota who helped federal officials develop the smallpox program. A "substantial number" of health workers are simply not convinced that a smallpox attack will ever happen, he said.

"If you don't really believe smallpox is a real possibility, any risk of an adverse event with the vaccine is going to be too high," Osterholm said.

Q: Still, a compensation program would allay some concerns. Why doesn't the government establish one?

A: After months of delay, the Bush administration proposed a compensation program, but Democrats and others immediately complained that it wasn't generous enough. Republicans in Congress are trying to move the Bush package anyway, but it's unclear whether they will succeed. On Monday, the GOP was embarrassed when their package was voted down on the House floor.

Thompson suggested Tuesday that he would like to see the administration compromise. "We're going to go back and hopefully make concessions," he said.

The discord on Capitol Hill is particularly unsettling given that it took the administration months to come up with its own compensation package. Many believe the program should have been in place before shots began.

Q: Has anyone been seriously injured by the vaccine?

A: Three people have died of heart attacks, but they were at risk for heart problems before they received the shot. Similarly, two people have reported cases of angina, or chest pain. It's possible that the vaccine is triggering heart problems in people who are already prone to difficulty; it's also possible the vaccine is unrelated.

To be safe, the Centers for Disease Control and Prevention is advising anyone with heart disease or at serious risk for heart disease not to get vaccinated.

Several people are reporting heart inflammation, and officials believe the vaccine may be to blame. But there is no way to screen out those at risk for this condition.

Existing screening rules already eliminate a number of other people who face particular risks, including people with compromised immune systems -- such as organ transplant recipients and people with HIV, pregnant women and people with a history of skin disorders.

Q: Why are states suspending their programs?

A: Most say they are waiting CDC guidance on how to handle the questions about heart problems. CDC says it is sending that information out now.

States with temporary suspensions are Alabama, Arizona, California, Illinois, Kansas, Maine, Michigan, Nevada, New York, Vermont and Washington state. In addition, Connecticut ordered a two-day suspension that was ending Tuesday. In Idaho, state officials recommended that local health districts temporarily suspend vaccinations. In Montana, Yellowstone County -- home to Billings, the state's largest city -- suspended vaccinations that were to have begun Tuesday, in part because of the cardiac disease issue.

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