Friday, January 31, 2003

BY KITTA MacPHERSON
Star-Ledger Staff

As the state gears up for a major public display today in the war against bioterrorism, public health officials are conceding behind the scenes that the effort to create an army of health workers vaccinated against smallpox has largely failed.

State health officials are set to inject about 100 physicians, nurses, law enforcement officers and disease investigators with the smallpox vaccine today at the War Memorial building in Trenton. First in line will be Eddy Bresnitz, the state epidemiologist and coordinator of the state's smallpox vaccination plan. He will be injected with a few jabs of the vaccine's bifurcated needle at an 11 a.m. news conference.

Bresnitz and the other volunteers are answering the call of President Bush who on Dec. 13 unveiled plans to inoculate a half-million health care volunteers, with another 10 million health care personnel, police, firefighters and emergency rescue workers to follow.

The second wave of vaccinations in New Jersey -- aimed at attaining 15,000 immunized health care workers -- was supposed to take place over the next few weeks. The idea was that, at the very least, all of the state's 85 acute care hospitals would be able to provide 50 to 150 immunized workers to handle a local outbreak

But they're nowhere near the target.

At Robert Wood Johnson University Hospital in New Brunswick, which employs about 3,600 full-time workers, one person has volunteered to be vaccinated. Doug Campbell, an associate vice president of operations at the hospital, said the facility staged eight informational sessions about the vaccine since the beginning of December at the request of state officials.

At University Hospital in Newark, part of the University of Medicine and Dentistry of New Jersey, 10 people have been medically cleared to be vaccinated out of more than 2,000 employees. Some 641 workers had signed up for one of 34 information sessions staged by the hospital over the past two months and held at all hours of the day and night to accommodate various shift work.

Officials at Saint Barnabas Health Care System, one of the state's largest health conglomerates with 23,000 employees, said yesterday that they would not participate in the state's smallpox vaccination program and would not be sending any volunteers.

"After extensive discussions, the decision has been made, based on currently available information, that our system cannot, in good conscience, participate in the national voluntary smallpox immunization program at this time," said Ronald Del Mauro, president and CEO of Saint Barnabas.

"The foot soldiers voted with their feet not to be immunized," said William Halperin, professor and chairman of the department of preventive medicine and community health at New Jersey Medical School in Newark. "The bottom line is that there isn't a lot of participation in this program."

Deciding what to do next is critical, as lack of participation does not take away from the fact that smallpox could very well be used as a bioterror weapon, he said.

"I think the challenge to the public health community is now to take its lumps about the lack of enthusiasm and ask itself how it can be flexible enough to deal with the possibility of bioterrorism," said Halperin, a career public health specialist. "These are very smart people all the way up. They are thinking, 'Okay, what is our contingency plan?' I guarantee it."

Nancy Connell, a bioterrorism expert at the Center for Emerging Pathogens at New Jersey Medical School, said that lack of evidence of a real threat meant that many volunteers failed to find a good reason to take on the risks of the vaccine.

She is hoping that public health officials will now develop a more generic vaccination plan that could include a response to other dangerous infectious diseases such as a flu pandemic.

The smallpox vaccine cannot cause smallpox. It contains a live virus, vaccinia. In rare cases, it can lead to severe rashes, lethal skin infections or fatal inflammation of the brain.

People with skin conditions or compromised immune systems, such as cancer and organ transplant patients, cannot receive the vaccine. Pregnant or nursing women and children under age 18 are also not recommended to receive the shot.

Many health care workers who would have been perfect candidates declined the vaccine because of concerns about family members who might contract infections.

Hospital officials also reported feeling uncomfortable about informing workers about the vaccination program, lest they be perceived as exerting some form of subtle pressure. Though all the federal and state health department information stressed the voluntary nature of the program, there was a fear that there was a subtle coercion at work.

"Hospitals were expected to participate," said Lawrence Budnick, a physician at New Jersey Medical School in Newark.

Many pointed to legal and insurance issues that remained unresolved today as reasons for not being vaccinated.

"Members of the state health department really can't be faulted for this -- they've worked night and day to get this done," said Howard Steinberg, the Morris County public health officer. Questions of whether people would be paid for time off or protected if they passed the infection to others have not been answered.