- The Washington Times - Thursday, January 23, 2003

U.S. hospitals are preparing to start vaccinating about 440,000 volunteering health professionals against smallpox over the next six weeks, a consequence of the president's decision to better protect America against a smallpox attack. Most hospitals are cooperating with this critical national security measure. However, according to a recent story in USA Today, some are being recalcitrant.

More than 80 hospitals, including the hospitals of the Medical College of Virginia and the Vanderbilt University Medical Center in Nashville, have chosen not to participate in smallpox vaccinations. Federal and state authorities have few tools in their armamentarium to persuade them otherwise. The homeland security bill is silent on mandatory smallpox vaccines (other than in regard to liability protection), and government officials from President Bush on down continue to insist that, aside from those in the military, the vaccine be given on a voluntary basis only.

This raises the important question of whether the president should have the authority to insist that institutions cooperate in this critical public-health measure. Given the nature of the threat, it is extraordinary that the commander in chief appears to have no power of compulsion over the nation's hospitals to carry out the federal anti-terrorism public-health policy. Note that we are not referring to a private citizen's right to refuse treatment, only to hospitals' obligations to offer services deemed essential.

Still, such refusals may not have as big an impact on homeland safety as might be feared. For one thing, the refuseniks number only "a tiny fraction" of hospitals involved, according to USA Today. Moreover, this first tier of vaccinations has two prongs hospital employees and state public-health officials. So, for instance, while it's not clear how many Virginia health professionals will refuse to participate, the state will assemble vaccinated public-heath response teams regardless. Hospitals in the nation's capital have been cooperating, and preparations are underway in Maryland, where the only hospital that has refused to participate is Frederick Memorial.

Smallpox refuseniks are concerned that the incalculable risks of a smallpox attack are outweighed by the small, but known risks of tragic side-effects from smallpox vaccinations. Dr. William Schaffner, head of Vanderbilt's Medical Center, complained to USA Today that the smallpox vaccine was not safe, and suggested Mr. Bush instead support a flu vaccination campaign.

However, the federal government continues to encourage flu vaccinations, despite the chance that a tiny percentage of those that partake will develop Guillain-Barre Syndrome. And a healthy individual free of vaccination risk factors (such as being HIV-positive or having a skin infection like eczema) has a much greater chance of being hit by lightning than being killed by a smallpox vaccination. The risk of accidental transmission is not large either, especially since those who partake of the vaccine will receive instructions on the basic hygienic steps and those following them are health professionals.

While the health professional undoubtedly realize that there's a war on, they fail to appreciate how grave the smallpox threat is, and will remain, regardless of what happens in Iraq. While their patriotism may be unimpeachable, their judgment is questionable.

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