Guest columnist
Smallpox-vaccination plan carries unnecessary risks

By Diane Sosne
Special to The Times

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The Bush administration is calling on hospitals around the country to vaccinate hospital workers who would be on the front line in the event of a bioterrorist attack with the smallpox virus. Within a few months, about 7,000 Washingtonians will be asked to volunteer for vaccination.

But there is growing concern that the current vaccination plan could inadvertently cause unintended problems. Two major hospitals in Georgia and Virginia recently announced that they are opting out of the plan because they are not convinced it is safe. At least one hospital in Washington state has declined to vaccinate.

Many front-line health-care workers share these concerns and want to make sure that our patients, neighbors and families are not put at risk unnecessarily.

Health-care workers want to be ready to care for our community if there is ever an attempt to use smallpox as a weapon against us. To do so, we need to devise a safe plan that takes all known risks into account, protects patients and front-line caregivers, and adequately supports the hospitals and public-health agencies that have been asked to carry out the plan.

The medical reality is that the smallpox vaccine is the least-safe human vaccine. Public-health officials estimate that at least a third of vaccination participants will become ill as a result of the procedure. Some people will suffer severe, long-term health problems because of the vaccine, and a handful of people will be killed by their reaction to the vaccine.

People who are vaccinated can be contagious and need to be reminded to take precautions when around patients or family members who are vulnerable. That means hospitals need to work with nurses and other staff to make sure patients and employees' families are not inadvertently endangered by exposure to a contagious vaccination participant.

To minimize risks, hospital administrators need to make sure that anyone considering vaccination is aware of the factors that can endanger them — including an immune system weakened by HIV or chemotherapy, a skin condition such as eczema and pregnancy or the chance of pregnancy.

A truly voluntary program ensures that everyone asked to volunteer is given ample information about the risks, time to ask questions and the assurance that a decision not to participate will not be frowned upon.

But even with careful screening, the sad fact is that some people will be harmed by the smallpox vaccination. Unfortunately, President Bush's plan would leave patients and health-care workers who are injured out in the cold.

When Congress passed legislation to create the new Homeland Security Department, it was careful to exempt politically influential pharmaceutical companies that manufacture the vaccine from liability related to side effects. But the federal vaccination plan does nothing to provide treatment and compensation to patients, health-care workers or family members who will be permanently injured.

It is simply wrong to put the public and front-line health-care workers at risk and then walk away from them when things go wrong. The federal government needs to establish a simple and fair compensation system to care for people who are injured by the vaccine. A patient who is inadvertently infected and disabled should be compensated. A health-care worker whose career is cut short because of a reaction to the vaccine should not be punished because he or she wanted to help protect our community.

Also, there is the issue of resources. The federal government expects hospitals and state and local public-health bodies to launch a major health campaign but is providing few resources to help them implement its plan.

Our health-care system is already facing serious funding challenges. If a smallpox attack is a national threat, then the federal government should share national resources — in the form of federal funding — to help carry out its plan. Local hospitals and chronically underfunded public-health agencies should not be expected to shoulder the financial burden of implementing such a major campaign.

The Bush administration's plan has been conceived and announced hastily, without much discussion or input from the public. There is still time to add safeguards before we start vaccinating hundreds of thousands of people. Let's fix what is wrong with this plan.

Diane Sosne is a registered nurse and president of Service Employees International Union District 1199NW, which represents more than 10,000 nurses and health care workers in Washington.