Saturday, January 25, 2003

By KEVIN COUGHLIN AND ANGELA STEWART
Star-Ledger Staff

Volunteers across New Jersey are supposed to get smallpox vaccinations next week, forming the state's front line against bioterrorism.

But Janet Clausen won't be lining up anytime soon.

"I just think it's too questionable and too many things can go wrong," said Clausen, a longtime emergency room nurse at Newark's University Hospital.

She's got plenty of company. So many health care workers share Clausen's concerns about the vaccine that the state extended yesterday's deadline for volunteers to sign up. Inoculations are set to start next Friday.

Yesterday, Connecticut became the first state in 31 years to give smallpox vaccinations -- to three health care workers. A nurse's union there joined other groups urging no vaccinations without clearer protections for anyone harmed by the vaccine.

New Jersey aimed to inoculate up to 15,000 volunteers -- enough for smallpox teams at 85 hospitals -- as part of a national program to immunize 500,000 volunteers.

But state officials said they may have to rely on smaller, regional response teams to contain any suspected outbreaks of the deadly virus unless more volunteers come forward.

"We want volunteers," state Health Commissioner Clifton Lacy said yesterday.

Lacy expressed hope that federal officials will resolve most liability concerns. The state Attorney General's Office is reviewing how state workers compensation coverage would apply to volunteers made ill by the vaccine. Contract workers pose a special concern.

"We hope to resolve this relatively soon," said Paul Loriquet, a spokesman for Attorney General David Samson.

Federal Health and Human Services Secretary Tommy Thompson said yesterday he is devising plans to compensate persons injured by the vaccine.

"Make no mistake: We can and must make the smallpox vaccination plan a reality," Thompson told the U.S. Conference of Mayors.

Lacy said New Jersey will raise enough volunteers to contain any smallpox outbreak for seven days -- long enough for reinforcements to be vaccinated in a crisis. But first, he said, their concerns must be met.

"We're not going to vaccinate anybody in the state of New Jersey unless the issues that need to get addressed get addressed," said Lacy, who met with Samson this week.

Delivery of New Jersey's first 4,500 doses from the federal government is expected early next week.

Vaccinations of "the vaccinators" will occur under tight security at sites in Newark, Dover, Teaneck, Sayreville, Flemington, Mt. Laurel and Egg Harbor, Lacy said.

They in turn will vaccinate other health care volunteers over the next few weeks. Lacy said another wave of volunteers -- he estimated as many as 200,000 police, firefighters and emergency medical personnel -- may be immunized this spring.

Echoing complaints from around the country, many New Jersey health care workers and hospital officials questioned immunizing against a scourge not seen in the U.S. since 1949, and officially stamped out globally in 1980.

History suggests the smallpox vaccine will kill one or two persons from every million who receive it, while making dozens gravely ill.

Better, critics contend, to administer the vaccine soon after suspected exposure to smallpox, when experts say the antidote still works.

Julie Gerberding , director for the federal Centers for Disease Control and Prevention, contends the threat is too real and the danger too great -- smallpox typically kills one third of its victims -- to delay vaccinating health workers.

Many in the military -- including the commander-in-chief -- already have been vaccinated.

On Dec. 13, President Bush unveiled plans to inoculate a half-million health care volunteers, with another 10 million health care personnel, police, firefighters and emergency rescue workers to follow.

The federal government has assumed limited liability for negligence claims arising from the program, under the Homeland Security Act.

But Senate Democrats, including New Jersey's Jon Corzine and Frank Lautenberg, urged Bush last week to help create a compensation fund for persons harmed by the vaccine.

Smallpox vaccine contains a live virus, vaccinia. It cannot cause smallpox, but in rare cases leads to severe rashes, lethal skin infections or fatal inflammations of the brain.

Infants and persons with skin conditions or weakened immune systems should not be inoculated. Women who are pregnant or nursing also should avoid the vaccination, a series of jabs to the arm with a two-pronged needle.

The inoculation produces a scab that can infect others. The CDC says immunized health care workers may return safely to their hospitals, but Lacy said anyone who works with immune-depressed patients should transfer to other units until their scab heals.

Michael Gerardi, director of pediatric emergency services at Morristown Memorial Hospital, said he will be vaccinated -- despite nagging fears of transmitting vaccinia to patients and being sued.

New Jersey hospitals have been showing staffers CDC videos about the smallpox vaccine.

"It was pretty graphic and just kind of cemented my feeling I don't really want that vaccine in me," said Clausen, of University Hospital.

Hospital administrators say state officials have told them they anticipate only 150 or so volunteers statewide.

Edward Brooks, a 40-year-old emergency medical technician at University Hospital in Newark, said he won't be volunteering.

"I personally don't want to be a statistic," Brooks said.