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By Ceci Connolly
Washington Post Staff Writer
Wednesday, December 18, 2002; Page A02
Two prominent teaching hospitals are refusing to vaccinate their employees against smallpox, rejecting President Bush's call for mass inoculation of front-line medical workers who would be the first to confront a biological attack.
Officials at Grady Memorial Hospital in Atlanta and Virginia Commonwealth University in Richmond said yesterday that the risk of dangerous side effects of the vaccine and inadvertent transmission to patients outweigh the remote threat of an attack with a virus that has not been seen since the 1970s. Three other large medical centers, Children's Hospital of Philadelphia, Emory Medical Center in Atlanta and the University of Iowa Hospitals and Clinics are leaning against inoculating their staffs.
The hospitals' decisions mark the first high-profile opposition from the medical community to a plan Bush announced Friday to inoculate as many as 11 million Americans by late summer and underscores some health workers' reluctance to return to a decades-old vaccine known for its serious side effects. In rare instances, the vaccine has caused life-threatening cases of encephalitis and some deaths.
"I don't like to cause disease," said Carlos del Rio, Grady Memorial's chief of medicine, describing his fear that a hospital worker could accidentally spread live vaccinia to a patient with a weakened immune system. "If, say, a patient with AIDS became infected, that would be a disaster."
Julie Gerberding, director of the Centers for Disease Control and Prevention, said she was neither surprised nor disappointed that a handful of hospitals is opting out of the program.
"This is a voluntary program," she said. "We understand not all hospitals will choose to participate." She said she expects the vast majority of U.S. medical facilities to heed the call to vaccinate physicians, nurses and other staff.
Many physicians, noting that they are in the business of risk-benefit assessment, said the Bush administration has not made a compelling case for waging a high-stakes battle against a disease that was eradicated worldwide by 1980. The only known stocks of smallpox virus are kept in government labs in Moscow and Atlanta, although some security experts fear other nations, including Iraq, may have the virus.
"There is a lack of logic to the current proposal," said Richard Wenzel, chairman of the department of internal medicine at Virginia Commonwealth. "If our government in all its intelligence thinks smallpox exists in enemy hands, why would we creep up on that policy? We would rush to vaccinate everybody right now."
The decision by Grady, the largest emergency-care center in Georgia, is notable because of its close ties to the CDC, the federal agency that oversees the vaccination program.
In unveiling his sweeping plan Friday, Bush said there was "no information that a smallpox attack is imminent." But he said he decided to call for the vaccination of health care workers, emergency responders and military personnel as a precautionary move necessitated by new threats at home and abroad.
Mandatory vaccinations in the armed forces are already underway, and voluntary inoculations for as many as 500,000 hospital and local health department workers are scheduled to begin in late January.
Many state health commissioners, hospitals and individual physicians have said they are willing to assist with the program. "I'm confident we will have the support we need to have sufficient response capacity," Gerberding said.
In a second phase, scheduled to begin as early as March, states will encourage the remaining 10 million health care workers, police officers, firefighters and emergency medical technicians to receive the vaccine. That larger group could launch a mass vaccination campaign in the event of a smallpox attack and still handle other emergencies, she said.
Bush also promised that the vaccine would be made available to any adult American who "insists" on being inoculated, but he stressed that the government strongly discouraged average citizens from being vaccinated.
Broad inoculation has been opposed by many medical experts, including the CDC's own Advisory Committee on Immunization Practices. In October, that group endorsed vaccinating only the first 500,000 doctors and nurses. One committee member, Paul Offit, has objected to any program that extends beyond a core group of about 15,000 people who he said could respond to a smallpox outbreak without putting large numbers of people at risk.
"What worries me about offering this to the general public is that they do not understand the risks of the vaccine," said Offit, head of the Vaccine Education Center at the Children's Hospital of Philadelphia. He said the hospital has asked Pennsylvania officials for a supply of vaccine to be used only if an outbreak occurs.
"We will make a list of people who should be vaccinated, we will show 20 to 25 people how to vaccinate and then we will wait," he said.
Even a single case of smallpox would likely trigger mass inoculations nationwide, federal officials have said. The goal at that point would be to vaccinate all 286 million Americans in less than 10 days.
Like Offit, former CDC director Jeffrey Koplan said developing detailed mass vaccination plans in the event of an emergency is perhaps a higher priority than inoculating groups of emergency workers now. "Whether a hospital chooses to do none or a few or a lot doesn't remove the important responsibility of planning for something should it happen," said Koplan, now a vice president at Emory University.
© 2002 The Washington Post Company