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http://www.nytimes.com/2002/12/19/health/19HOSP.html?tntemail0

Two Hospitals Refuse to Join Bush's Plan for Smallpox

By JEFFREY GETTLEMAN

TLANTA, Dec. 18 — As health experts continue to express doubts about President Bush's plan for smallpox vaccinations, two major hospitals have already refused to go along with the program, and several others say they have not yet decided.

The two hospitals are Grady Memorial in Atlanta and Virginia Commonwealth University in Richmond, Va. Both say the risks of the vaccine are too significant to allow them to inoculate their employees under the new federal guidelines.

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"No. 1, this is not a safe vaccine," said Dr. Carlos del Rio, chief of medical services at Grady Hospital and a professor of infectious disease. "This is a vaccine that has known complications and known side effects."

At Virginia Commonwealth University, officials said there was no imminent threat of smallpox. "Why put our employees, their families and our patients at risk of complications?" said Dr. Hermes A. Kontos, the chief executive of Virginia Commonwealth University's health system.

President Bush cited the possibility of biological warfare as a rationale for his announcement last Friday that all frontline military personnel and health care workers should be vaccinated. But administration officials have repeatedly acknowledged that there is no evidence that a smallpox attack is imminent or that any of the deadly virus is in enemy hands.

Even the health experts who support the president's smallpox plan, which is voluntary, agree that the vaccine can cause serious complications and even death, particularly among people with immune deficiencies and other disorders.

For every million recipients, 15 will have life-threatening reactions, including one or two deaths, and hundreds will have severe rashes or other illnesses.

The vaccine is made from a live virus, vaccinia, a relative of smallpox. It is administered with a special needle that creates an open sore. For three weeks the virus is highly contagious and can cause infection, either in the person who received the vaccine or other people in close contact.

Coast to coast, hospitals are grappling with how to deal with the president's plan, which calls for health and emergency workers to begin being vaccinated in January.

Emory Medical Center in Atlanta, which is affiliated with the federal Centers for Disease Control and Prevention, the agency responsible for the vaccination program, has not yet decided whether to participate.

"When push comes to shove, we are dealing with an eradicated disease that we haven't seen a case of since 1977," Dr. Jeffrey Koplan, Emory's vice president for academic health affairs, said today.

Dr. Koplan said reports that secret stocks of the smallpox virus were held by such countries as Iraq and North Korea were not enough to warrant putting patients at risk.

In California, Brian Johnston, a trustee of the California Medical Association and an emergency room doctor at the White Memorial Hospital in Los Angeles, said: "We're aware that there are risks, no question. There are risks associated with any vaccine, and this vaccine is probably more problem prone than other vaccines. However, we know it's effective."

Dr. Johnston said his hospital was participating in the program.

In Baltimore, Johns Hopkins Hospital is moving toward inoculating 250 first responders.

In New York, Presbyterian Hospital has not yet made a decision on how to proceed, said Dr. Michael A. Berman, executive vice president of the hospital. "We believe the solution should be to do this not on an individual hospital basis, but on a regional basis," Dr. Berman said.

If a single large hospital were to receive smallpox patients, for example, other patients might have to be moved out, creating an imbalance in the city's medical resources, Dr. Berman said.

Most New York hospitals, including Mount Sinai, the North Shore-Long Island Jewish Health System and Westchester Medical Center, indicated they would go along with the president's plan.

In San Francisco, the University of California Medical Center will vaccinate only a small group of physicians and nurses, and not those who live with children or who are H.I.V. positive, pregnant or lactating.

Some doctors said they were surprised there was any resistance to the smallpox plan.

"Maybe it's a generational thing, " said Dr. Joel Geiderman, co-chairman of the emergency department at Cedars Sinai Medical Center in Los Angeles, which will be vaccinating staff members. "I'm 51, and when I was growing up in the late 50's it was like an age of miracles. When vaccines came out, it was a wonderful thing. "

Rumsfeld to Be Vaccinated
WASHINGTON, Dec. 18 (AP) — Joining President Bush, Defense Secretary Donald H. Rumsfeld said today that he too would be vaccinated against smallpox, along with about a half-million troops.

"It's hard to ask people to do something that you're not willing to do yourself," Mr. Rumsfeld said on CNN.

Mr. Bush ordered on Friday that about 500,000 troops in "high-risk parts of the world" be vaccinated. Officials fear that countries like Iraq and North Korea are harboring secret reserves of smallpox and could use it as a weapon or pass it to terrorists.

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.