- The Washington Times - Friday, December 20, 2002

A public campaign of vaccination against smallpox is unsafe and unnecessary, according to new reports released yesterday, and many U.S. health care workers and some hospitals say they will not participate in voluntary immunization programs because of the risks.
"We cannot endorse a public vaccination campaign at this time because the certainty of harm outweighs the small chance of net benefit," a team headed by Sam Bozzette of the Rand Corp. wrote in a New England Journal of Medicine report made available yesterday. It was one of two reports released by the journal that reached that conclusion.
The articles were distributed a week after President Bush announced an initiative of mandatory smallpox inoculation for 500,000 U.S. troops and voluntary vaccinations for at least that many emergency health care workers and members of smallpox-response teams. The plan attempts to help protect them, in the event that the smallpox virus is used as a bioterror weapon.
Mr. Bush said last week that the federal government will make the vaccine available to the public on a voluntary basis. But he stressed that the government will not be recommending that the public receive pre-attack immunization because vaccination can cause death and severe illness in some cases.
Studies from the 1960s show that of every 1 million first-time vaccine users, 15 will suffer life-threatening complications and that one or two will die. A Heritage Foundation policy paper noted that about 300 people would die if the whole country were inoculated.
In the other report released yesterday by the journal, Thomas Mack, a smallpox specialist at the University of Southern California, said smallpox transmission can be stopped by isolating the victim and quickly vaccinating caregivers.
Mr. Mack estimates that no more than 15,000 people would need to be vaccinated if the United States sets up National Guard field hospitals for smallpox patients and those who have come in direct contact with them.
"A terrorist introduction of smallpox could produce a short outbreak of cases of death, but the current vaccine policy will provide little protection. The cost in deaths from vaccine complications will outweigh any benefits," he wrote.
The U.S. military inoculated more than 150 people against smallpox during the past week, but about 100 were exempted for medical reasons, the Pentagon told the Associated Press yesterday.
In the first five days of the military program, 276 persons were screened for the vaccine, with 102 exempted for medical reasons, said Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs.
Meanwhile, emergency health care workers say they want answers to "unanswered questions" about the president's recommendation that they undergo voluntary vaccination against smallpox.
Among those asking questions are the American College of Emergency Physicians, the American Nurses Association (ANA), members of some hospital associations, and, in some cases, hospitals themselves.
"Smallpox is a highly contagious disease, and many hospital workers are concerned about [accidentally infecting] their patients" after being vaccinated with the live virus, said Jim Lott, executive director of the Los Angeles-based Hospital Association of Southern California.
"We're getting a large number of anecdotal reports from hospitals in this area that employees are not reacting warmly to the offer of voluntary smallpox vaccinations. Hospitals are hotbeds for contagion, and this is one more contagion we do not need," Mr. Lott said.
Many doctors and nurses, who would be among the first to treat smallpox patients in an attack, also are wary of receiving the vaccine. "There are still many unanswered questions. For example, there needs to be a risk-benefit analysis to compare the risks of a mass [smallpox] vaccination program and the potential of a terrorist attack" using smallpox, said Dr. Brian Hancock, president-elect of the American College of Emergency Physicians.
But Dr. Hancock said doctors need to know the risks of the vaccine to those who receive it and to "immunosuppressed patients" they treat, such as patients infected with HIV and those who have undergone organ transplants.
"If there is ever a smallpox attack, those patients will be in our laps," Dr. Hancock said, referring to emergency physicians. "But until we get answers to the questions we're asking, we have stopped short of recommending mandatory [smallpox] vaccinations" for those in emergency medicine, he said.
Jim Bentley, a senior vice president of the American Hospital Association, says he knows of two hospitals that don't plan to offer staff vaccinations Grady Memorial Hospital in Atlanta and Virginia Commonwealth University's medical center in Richmond.
"It is difficult to support the decision to vaccinate hospital personnel when there has been no case of smallpox for 30 years and when there's a large probability" that vaccinated workers could transmit disease to patients, Dr. Richard Wenzel, chairman of the Richmond hospital's infectious disease department, told the Associated Press.
Mary Jean Schumann, director of nursing practice and policies for the ANA, said she raised questions about vaccine risks and liability in a letter she sent last month to Health and Human Services Secretary Tommy G. Thompson. "We haven't heard anything" from him, she said.
Ms. Schumann said there is a big concern about liability, should a hospital employee become sick from the vaccine. "The only recourse an employee would have for an adverse reaction would be to file workmen's compensation, which, of course, affects the hospital."

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