Vaccinations for smallpox not in budget
State officials seek funds for health workers
 

The Associated Press and Wausau Daily Herald
MADISON - Wisconsin health officials want to vaccinate several thousand medical workers against smallpox, but say they don't know how the state will pay for it because $19.3 million in federal bioterrorism money for the next year is already earmarked for other projects.

Wisconsin hospitals already are deciding who should receive the vaccine. But the state doesn't have the money for the manpower to give the shots and watch for potentially deadly side effects, said Dr. Jeffrey Davis, chief medical officer and state epidemiologist for communicable diseases.

 

"I honestly don't know how this ultimately will be resolved," Davis said. "We've committed our resources."
The Bush administration wants each state to inoculate medical workers against smallpox in case terrorists unleash the virus.

Marathon County Health Officer Julie Willems Van Dijk said the county has been working with the state to develop the vaccination plan. The specifics of the plan and its time frame have yet to be outlined, but Willems Van Dijk said it will include several safeguards for health care providers, including extensive screening of those receiving the vaccine.

To comply with federal and state plans, Community Health Care Wausau Hospital officials have identified a core group of caregivers who will be given the option of receiving the vaccination.

Wisconsin has received $19.3 million in federal bioterrorism grants through August 2003, but state health officials didn't allocate any of it for smallpox vaccinations, Davis said.

The money came with strict federal guidelines on uses, including laboratory readiness, communication upgrades and training, but none for smallpox inoculation, he said.

Tony Jewell, a spokesman for the U.S. Department of Health and Human Services, said the guidelines imply smallpox readiness.

"A simple reading of them shows they pertain to smallpox," Jewell said. "And we've made it perfectly clear smallpox is a disease we fear most."
Smallpox, one of the deadliest diseases known to man, was eradicated in 1980. Routine vaccinations in the United States ended in 1972.

But with war in Iraq looming, President Bush ordered about 500,000 members of the U.S. military be inoculated. The Bush administration also wants to inoculate as many as 10 million medical personnel nationally, including 200,000 in Wisconsin, to blunt a biological terrorist attack.

The first phase of the plan calls for inoculating about 450,000 medical workers, including about 4,700 in Wisconsin, who volunteer to take the vaccine. They would serve as smallpox first-response teams.

The federal government plans to provide the vaccine and special double-syringes to administer it.

"When a state like Wisconsin says they can't do it, they're not recognizing that it won't be as labor intensive as they anticipate," said Jerome Hauer, Office of Emergency Public Health Preparedness assistant secretary.

Davis said the cost of administering the vaccines wouldn't be known until Wisconsin hospitals determine how many staff members want it. He also didn't know if the state might divert some of its federal bioterrorism money for the inoculations.

Health officials also don't want to ask the state to cover the costs, Davis said. Wisconsin faces a $2.6 billion deficit in its next budget brought on by falling revenues.

Jim Malone, a spokesman for the state Department of Health and Family Services, said he expects more federal money to pay for vaccinations. He said 4,000 vaccinations in Wisconsin shouldn't be extremely expensive.

"Paying for that level is a problem, not a crisis," he said.

Jewell said HHS already has given the states $1.1 billion for bioterrorism readiness in fiscal year 2002. The department requested another $1.4 billion in bioterrorism money for the states in its 2003 budget, he said.

But he said the original $1.1 billion distributed in 2002 should be enough for states to begin the first phase of inoculations.

The guidelines that accompanied that money didn't mention smallpox specifically, but sections state the money should be used to develop plans for infectious disease outbreaks and mass distribution of antibiotics and vaccines.

Malone said states simply need more money for mass inoculations.

"Every state has told them that," he said. "It's interesting they chose to ignore that. This issue isn't going to go away."
Hospitals around Wisconsin are slowly identifying workers who would deal with initial smallpox cases. But the holidays, doubts about a disease not seen for decades and questions about the vaccine have hindered the process.

Experts estimate 15 out of every 1 million people vaccinated for the first time will face life-threatening complications and one or two will die.

Denny Thomas, risk management director at Marshfield's Saint Joseph's Hospital, said his medical center wants to inoculate people in as many as 200 positions.

The possibility of a smallpox outbreak in Wisconsin is real, he said. The disease can spread through the air and symptoms don't appear for days, making it deceptively contagious, he said.