WASHINGTON - Despite President Bush's recommendation, hospitals and health care workers are turning down the smallpox vaccine, worried about the inoculation's side effects and unconvinced that the threat of a bioterror attack justifies the risk.

Federal officials had hoped to inoculate almost 450,000 health care workers in the program's first month. With the month up tomorrow, the figure is coming in at about 1 percent of that goal.

Some health care unions have urged members to refuse the vaccine until the government can guarantee compensation for anybody injured by the shot.

States are not close to beginning a second stage of vaccinations for as many as 10 million emergency responders and other health care workers.

Health and Human Services Secretary Tommy G. Thompson is disappointed by the response.

"It is absolutely imperative we get more people vaccinated against smallpox to get more prepared," he told a congressional panel this month.

Officials at the Centers for Disease Control and Prevention, which is running the program, say they never expected the total to reach 450,000 because some people have health conditions that make the vaccine too risky for them.

They also believe that the numbers are likely to grow as hospitals receive more information and as federal officials resolve outstanding problems.

Smallpox killed hundreds of millions of people around the world before it was declared eradicated in 1980.

But the vaccine is risky. It is made with a live virus that can infect the body. Experts estimate that 15 to 50 people out of every million vaccinated for the first time will face life-threatening complications, and that one or two will die.

The last smallpox case in the United States was in 1949, and routine vaccinations against the disease ended here in 1972.

All stocks of the virus were supposed to have been destroyed except for samples in labs in Moscow and Atlanta. Experts now fear that some of the Russian stock could be in the hands of hostile nations, including Iraq.

With the United States moving ahead with plans for war against Iraq, Bush started the new vaccination campaign in December.

He ordered inoculations for 500,000 members of the military, and the Pentagon is on its way toward reaching that goal. About a half-dozen soldiers have had serious reactions, but all have recovered.

Without an imminent threat, Bush said, the vaccine is not recommended for the public. But he urged health care workers and emergency responders to accept vaccinations.

The first round was for members of public health teams, who would investigate potential cases, and emergency room workers. They are the most likely to encounter contagious patients and would be needed to care for sick people in the event of an attack.

In plans submitted to the federal government, states estimated that the initial group would number about 450,000.

The first inoculations were delivered Jan. 24, and federal officials hoped that states would complete the first stage in about a month.

As of a few days ago, just 4,213 people in 27 states had been vaccinated, and many hospitals have said they will not participate.