The administration has been sharply criticized by health care unions and others for failing to provide compensation for people who get vaccinated as part of a national bioterrorism preparation effort and then get sick or die from the shot. Based on historical information, as many as 40 people out of every million being vaccinated for the first time will face life-threatening reactions, and one or two will die.

Health and Human Services ( news - web sites) Secretary Tommy Thompson said Tuesday he is working with the White House and key senators to compensate such people for the time they lose from work, their medical expenses and other costs.

"I'm in favor of some compensation," Thompson said in an interview with reporters. "There's some anxiety out there. We want this (vaccination program) to be successful."

He said this type of lingering question gives people a reason to reject vaccination, so he'd like to see the issue settled. Creating a fund will not cost as much as he first suspected, he said, but he would not say what his initial or current estimates are.

Administration officials, speaking on condition of anonymity, said Tuesday that Thompson would like to model a fund after the existing Vaccine Injury Compensation Fund, which aids ( news - web sites) people injured by other vaccines. That fund does not cover smallpox.

Over coming weeks, federal officials hope to vaccinate up to a half-million emergency room workers and those on special smallpox response teams. During the program's next phase, the vaccine will be offered to 10 million other health care workers and emergency responders.

The military has a mandatory smallpox vaccination program under way.

For civilians, vaccination is voluntary. With smallpox not seen for more than two decades and no imminent threat of the disease's return, vaccinations are not recommended for the general public.

Despite concerns over smallpox liability, the Centers for Disease Control and Prevention ( news - web sites) said the program is moving ahead. The CDC shipped vaccine to four states Tuesday, and officials plan to ship to three more Wednesday. Another eight states have requested vaccine, and officials expect shipments to at least six of them will move within the next week. States have requested a total of more than 66,000 doses, said CDC spokesman Tom Skinner, who would not identify the states.

The vaccine was being shipped by commercial carrier through CDC's National Pharmaceutical Stockpile.

A variety of questions have been raised recently about the inoculation program, including whether states have enough time and money to implement it safely. People with a variety of conditions — including history of skin problems, cancer patients, organ transplant recipients and others — are particularly susceptible to the vaccine's side effects and should not be vaccinated. Each state will have to screen people carefully to be sure they do not have these conditions.

Those living with people who have these conditions also should not be vaccinated because the live virus in the vaccine can be transferred to close contacts and sicken them.

Significant questions have also arisen about the compensation issue. Congress acted to protect people and institutions delivering the vaccine from lawsuits by people injured by the shot, but it did nothing to aid those who are hurt.

On Capitol Hill, Sen. Edward Kennedy, D-Mass., planned to offer an amendment to a huge spending package now being debated that would set aside $750 million for a smallpox vaccine compensation fund. His amendment also would provide $850 million to help states, facing severe budget crunches, run their programs.

"The Bush administration's plan on smallpox has glaring deficiencies," Kennedy said in a statement, but it was unclear whether he will succeed.

Senate Majority Leader Bill Frist, R-Tenn., a leader on bioterrorism issues, was not ready to support the amendment, said spokesman Nick Smith. Frist is worried the bill will become "a spending free-for-all," Smith said.

Yet Frist will work on the issue in the coming weeks, Smith said, adding, "Addressing the need for smallpox protections is clearly a priority."

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On the Net:

Government smallpox information: http://www.smallpox.gov