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http://www.cnn.com/2003/HEALTH/01/29/smallpox.concerns.reut/index.html

Smallpox vaccine rollout questioned

Officials: Program leaves public vulnerable to other risks

Wednesday, January 29, 2003 Posted: 3:59 PM EST (2059 GMT)

Smallpox vaccinations for health workers began Friday in Connecticut.

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VIDEO CNN's Sanjay Gupta looks at the potential risks associated with smallpox shots. (January 23) PLAY VIDEO RELATED Interactive: The vaccine -- what are the risks?    • Volunteers get smallpox vaccinations  • Behind the Scenes: Medical field split on smallpox vaccine  • Interactive: What is smallpox and how does it spread?  • Smallpox FAQs

WASHINGTON (Reuters) -- The U.S. plan to start vaccinating health care workers against smallpox is draining other public health efforts, perhaps leaving people vulnerable to other diseases, public health officials said on Wednesday.

The plan to inoculate 450,000 nurses, doctors and technicians in case of a biological attack is already under fire from unions and other groups worried about who will take care of workers made sick by the vaccine.

Local health officials and some senators said they were worried about the cost of the plan and whether it was hurting more immediate efforts -- such as vaccinating people against influenza, which kills 36,000 Americans every year.

"There is a lot of concern amongst us here and in my state that funds that we are providing for upgrading our public health facilities are now going to be siphoned off to meet this broad project for vaccinating for smallpox," Iowa Democratic Senator Tom Harkin told the hearing of a Senate Appropriations subcommittee.

"We are in fact diverting our bioterrorism resources and leaving ourselves unprepared," Patrick Libbey, chair of the National Association of County and City Health Officials, told the hearing. "We need to stay small, go slow and assure that we have the resources to do it properly."

Libbey said a 718 NACCHO agencies showed that 58 percent felt smallpox preparations were hurting other efforts to prepare for a biological attack, as well as general public health efforts.

"Public health clinics that provide such services as childhood and influenza immunizations have been deferred, delayed or canceled in 182 jurisdictions due to the demands of smallpox vaccination," Libbey said.

"We will compromise our ability to prevent and respond to influenza, childhood diseases, West Nile virus, contaminated drinking water, foodborne illness and chronic diseases."

Worth the risk?

Smallpox was eradicated in 1979, but experts believe groups and governments such as Iraq may have developed the virus for use as a weapon. President Bush decided the risk was big enough to make it worth vaccinating 450,000 workers so they will be ready to vaccinate others in case of an attack.

In addition, 500,000 troops are being vaccinated.

Vaccination started last week, but just four workers volunteered at a Connecticut hospital that was the first to immunize.

THE VACCINE:   The last natural smallpox case was in Somalia in 1977   Vaccine effective if given within 4 days of exposure   Vaccine does not contain the smallpox virus   Vaccine is made from a virus called vaccinia   15 per million vaccinated experience serious complications   1-2 people per million will die from vaccine   Most Americans under 30 haven't been vaccinated   1 case is considered a public health emergency Source: CDC

Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, said she is not concerned about the pace. She has said the CDC and states want to move slowly and take care of any problems as they arise.

The vaccine being used comes from 30-year-old stocks. It uses a live virus called vaccinia that is related to smallpox and can have severe side-effects. When used in the past the vaccine made up to 52 per million people vaccinated ill and killed 1 or 2 per million.

Vaccinia can also kill people who come into contact with a recently vaccinated person. Dr. Louis Bell of the Children's Hospital of Philadelphia told the hearing that, when the vaccine was used in hospitals, as many as 10 percent of hospital patients were infected by health care workers, and 11 percent of them died from complications.

Gerberding said workers are being educated about the risks and will wear gauze pads over the vaccination site to reduce the risk of this happening.

But it is still unclear who will pay if someone becomes infected by a healthcare worker and gets very ill, misses work or worse. Gerberding told reporters this was a "big gap" that needed to be examined.

Workers also balk at getting the vaccine because it is not clear what happens if they or family members get sick. No fund has been set up to compensate them and it is not always clear whether private insurers or worker's compensation will pay.

"We have issues with compensation -- if you receive this and become ill, what happens?" said Wendy Laprade, a registered nurse at Womens and Infants Hospital in Providence, Rhode Island. "They are trying to roll it out with us tomorrow. We told them we won't participate," she said in an interview.

Laprade is also concerned about patients, who include small babies and very ill women. "You work hard and would a dressing put on your arm for a 12-hour shift ... could it become inadvertently displaced?"

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