Health professionals challenge US smallpox vaccination plan
Ray Moynihan, Washington, DC
Plans to start vaccinating half a million US healthcare workers against
smallpox as early as this week are facing growingresistance, as some
hospitals, unions, and professional bodiesquestion the rushed nature
of theimplementation.
The US federal government, unlike authorities in the United Kingdom, has
recommended the immunisation of millions of healthand emergency
workers against the threat of a potential bioterroristattack, with
phase 1 expected to start on 24 January. The planshave sparked
ongoing public debate (BMJ 2002;325: 794)[Free
Full Text],largely because of the
dangers associated with the smallpox vaccine,estimated to cause up
to 50 life threatening complications permillion people vaccinated
(see www.cdc.gov).
Across the United States a small but growing number of hospitals have decided
to opt out of the plans, refusing to allow theirstaff to be
vaccinated. In Colorado, Joseph Swedish, the chiefexecutive officer
of the state's biggest hospital chain, CenturaHealth, said earlier
this month, "At this time, it is not clearthat the benefits of
immunising against smallpox outweigh therisks to associates, their
families, and our patients." The not-for-profitCentura runs
10 hospitals, is one of the biggest private employersin Colorado,
and has over 10000associates.
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 postponementof the start date
for phase 1, until concerns about vaccine safetyand compensation had
beenmet.
Healthcare lobbyist Ms Barbara Coufal said the union was calling for more
education about the vaccine's dangers, a screeningprogramme to
prevent high risk groups from being immunised, bettersurveillance of
side effects, and a fund for those hurt by thevaccine. "We're asking
people to serve their country, but if theyget hurt the country's not
going to stand behind themthat'sidiotic."
A report from the Institute of Medicine, part of the US National Academy of
Sciences, has also recently urged more cautionwith the
implementation of the smallpox plan, emphasising safetyconcerns and
the need for more time to evaluate side effects ofthose initiallyimmunised.
Dr Brian Strom, chairman of the report committee, told the BMJ that
healthcare workers who opted to receive the vaccine wouldbe taking a
risk with absolutely no benefit. "From a public healthpoint of view
it makes no sense to give a vaccine that kills peopleagainst a
disease that doesn't exist. This is not a public healthcampaign,
it's a bio-defence campaign," said Dr Strom, who isprofessor of
biostatistics and epidemiology at the Universityof Pennsylvania.
Asked about the decision by hospitals to optout, Dr Strom said:
"It's absolutely acceptable for hospitalsto opt outI
think it's rational."
(Credit: AP PHOTO/PABLO MARTINEZ MONSIVAIS)
President Bush announcing his vaccination
plan last month
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