Smallpox: agreement and action

     After a longer-than-necessary debate, Congress and the administration have reached an agreement on compensation for the few individuals who will suffer side-effects as a result of a smallpox vaccination. While the plan may not placate every critic, the nation's unpreparedness for a smallpox crisis calls for swift action.
     The final agreement, reached between White House Chief of Staff Andrew Card and Sen. Edward Kennedy, is more generous than what the White House originally called for, but not unreasonably so. Under the original plan, those killed or permanently incapacitated would have received up to $262,100, while those less severely injured would have received up to $50,000 in lost wages. Under the new plan, the families of those who suffer fatal side-effects will have the choice between a lump sum of $262,100 or payments of up to $50,000 per annum from the deceased's lost wages until the youngest child is 18 years old, with no cap. Those permanently disabled will be eligible for $50,000 each year until age 65 with no cap. The agreement also removed the administration's original requirement that individuals be vaccinated within 180 days to qualify for benefits.
     The elimination of the 180-day provision is likely the most problematic, since it works against the need for speedy inoculations. Moreover, vaccines only last about 60 days after their vials have been opened. Since the Centers for Disease Control and Prevention (CDC) have shipped over 285,000 doses of the vaccine, tens of thousands could spoil if they are not used.
     Now, there's some hope that they will be. With vaccinations now coupled with a compensation package, the Service Employees International Union — the nation's largest for health-care workers — has endorsed the program, contrary to its previous stance. The American Public Health Association has also given the plan its support.
     The endorsements couldn't come at a better time, since the administration's plan to inoculate the citizenry has stalled badly. According to The Washington Post, only 32,000 of the 450,000 health-care workers that states hoped would get immunized have actually done so.
     Concerns about compensation have been one reason for the recalcitrance of the medical community. So have worries about side-effects of the shot, which now include myocarditis (heart inflammation). However, the chances of complications from a smallpox shot are minuscule, and the odds of lethal side effects are even smaller. Pre-vaccination screening will continue to reduce the danger to high-risk groups, and reasonable precautions must not become paralysis.
     Critics also fear that the focus on smallpox has taken resources away from preparing for other threats or treatment of emerging diseases, such as SARS. However, those threats must be prioritized, and the administration has properly put primacy on smallpox preparedness, given its infectivity, its lethality and its plausible availability to terrorists.
     Health-care workers refusing the inoculation are not merely gambling with their patients' lives, but also their own. They should learn a lesson from the ongoing outbreak of SARS, which has hit health-care workers particularly hard, seemingly a consequence of their close proximity to patients. A smallpox outbreak could wreak havoc among those unvaccinated health-care workers given charge of casualties.
     Health-care workers will be on the front lines during a smallpox attack, but so will civilians. Thanks to the stubbornness of the health-care community, the public remains unprepared for a smallpox crisis. All the more reason for the administration to open up smallpox vaccinations to all the citizens who want them without the necessity of a clinical trial.