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Plans to start vaccinating half a million US healthcare workers against smallpox as early as this week are facing growing resistance, as some hospitals, unions, and professional bodies question the rushed nature of the implementation.
The US federal government, unlike authorities in the United Kingdom, has
recommended the immunisation of millions of health and emergency
workers against the threat of a potential bioterrorist attack, with
phase 1 expected to start on 24 January. The plans have sparked
ongoing public debate (BMJ 2002;325: 794)
Across the United States a small but growing number of hospitals have decided to opt out of the plans, refusing to allow their staff to be vaccinated. In Colorado, Joseph Swedish, the chief executive officer of the state's biggest hospital chain, Centura Health, said earlier this month, "At this time, it is not clear that the benefits of immunising against smallpox outweigh the risks to associates, their families, and our patients." The not-for-profit Centura runs 10 hospitals, is one of the biggest private employers in Colorado, and has over 10000 associates.
Last week, the giant American Federation of State, County, and Municipal Employees (AFSCME), which represents 350000 nurses, physicians, and other healthcare workers, called for a postponement of the start date for phase 1, until concerns about vaccine safety and compensation had been met.
Healthcare lobbyist Ms Barbara Coufal said the union was calling for more
education about the vaccine's dangers, a screening programme to
prevent high risk groups from being immunised, better surveillance of
side effects, and a fund for those hurt by the vaccine. "We're asking
people to serve their country, but if they get hurt the country's not
going to stand behind them
that's
idiotic."
A report from the Institute of Medicine, part of the US National Academy of Sciences, has also recently urged more caution with the implementation of the smallpox plan, emphasising safety concerns and the need for more time to evaluate side effects of those initially immunised.
Dr Brian Strom, chairman of the report committee, told the BMJ that
healthcare workers who opted to receive the vaccine would be taking a
risk with absolutely no benefit. "From a public health point of view
it makes no sense to give a vaccine that kills people against a
disease that doesn't exist. This is not a public health campaign,
it's a bio-defence campaign," said Dr Strom, who is professor of
biostatistics and epidemiology at the University of Pennsylvania.
Asked about the decision by hospitals to opt out, Dr Strom said:
"It's absolutely acceptable for hospitals to opt out
I
think it's rational."
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© 2003 BMJ
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© 2003 BMJ Publishing
Group Ltd
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.