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Collections under which this article appears: Drugs: immunological products and vaccines Organization of health care Governments - non UK

BMJ 2003;326:179 ( 25 January )

News

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 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)[Free Full Text], largely because of the dangers associated with the smallpox vaccine, estimated to cause up to 50 life threatening complications per million 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 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 themthat'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 outI think it's rational."

(Credit: AP PHOTO/PABLO MARTINEZ MONSIVAIS)   President Bush announcing his vaccination plan last month

© 2003 BMJ Publishing Group Ltd

Rapid responses:

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Smallpox Planned Vaccination for Early responders

dorothy m minucci

bmj.com, 2 Feb 2003 [Full text]

PDF of this article Email this article to a friend Respond to this article Read responses to this article PubMed citation Related articles in PubMed Download to Citation Manager Search Medline for articles by: Moynihan, R. Alert me when: New articles cite this article

Collections under which this article appears: Drugs: immunological products and vaccines Organization of health care Governments - non UK

© 2003 BMJ Publishing Group Ltd

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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.