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Health care workers balk at Bush's vaccine plan
Safety issues cloud smallpox inoculations
Sabin Russell, Chronicle Medical Writer
Saturday, December 14, 2002
©2002 San Francisco Chronicle.
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URL: http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2002/12/14/MN183071.DTL
President Bush revealed his plan Friday to vaccinate troops and medical personnel
against
smallpox, but opposition is building among the civilian health care workers who will be
among the first asked to take the 30- year-old vaccine.
An estimated 500,000 troops will be required to take the vaccine, which carries a
small risk
of serious complications -- statistically, one of those soldiers can be expected to
die from
them. Vaccination of a small number of military personnel is already under way.
Bush told reporters at a Washington, D.C., briefing that he felt obliged as commander-
in-
chief to be vaccinated himself. "I do not believe that I can ask others to accept this
risk
unless I am willing to do the same," he said.
By summer, administration officials said, the vaccine will be available to any healthy
adult
American who demands it, but because of the its dangerous side effects, they strongly
discouraged average citizens from being inoculated.
Health care workers who would be most likely to treat smallpox victims are being asked
to
take the vaccine voluntarily. But some doctors, nurses and other hospital workers are
balking.
UNIONS URGE CAUTION
Health care worker union members staged press conferences throughout the nation Friday
-- including one at San Francisco General Hospital -- to voice concerns over the
safety of
the vaccine and the practical problems of giving it to so many medical staffers at one
time.
"We're going to discourage people from participating until a plan is put forward that
adequately protects both health care workers and their patients," said Lorraine
Thiebaud, a
San Francisco General Hospital nurse and vice president for Local 790, of the Service
Employees International Union.
"We are so stretched here, with budget cuts coming down on us, and now we are asked to
run out and get vaccinated against an imaginary threat," Thiebaud said.
Among her concerns is whether vaccinated health care workers will be permitted to stay
home from work during a period when they could infect their patients with the live
virus
found in scabs formed by their vaccination.
Smallpox vaccine is made from a live cowpox virus, a weaker germ that is closely
related to
smallpox but not nearly as dangerous to human beings. But it can be dangerous to people
whose immune systems are weakened by HIV, cancer chemotherapy or
immunosuppressive drugs for organ transplants. The vaccine is not recommended for
pregnant women or people with a history of the skin condition eczema.
RISK OF ACCIDENTAL STICK
Thiebaud also noted that the vaccine would be administered with a nonretractable
lancet,
resembling a miniature two-pronged fork, designed to scratch the skin at the
inoculation
site. It is a 50-year-old technology and poses a small risk of nicking a nurse or
doctor with a
blood-contaminated point.
Thiebaud's local union was instrumental in pushing for laws that banned use of unsafe
needles in hospitals across the nation.
The SEIU, which represents 750,000 health care workers in 22 states, has been
campaigning for a variety of safeguards before the vaccine campaign is rolled out.
"Let's slow down and do it right," said Sal Rosselli, president of Local 250, which
represents
nursing home workers and hospital orderlies in Northern California.
Rosselli said the union has been talking with Northern California hospital operators,
but he
is concerned the workers' concerns will be ignored in other locales.
NOT ON FEAR ALONE
Robert Golomb of Lafayette, an emergency room doctor, had reservations.
"I must assume that the president is aware of clear evidence that smallpox can be used
as
a bio-weapon and is not making a decision based on fear alone," he told The Chronicle.
"Only on this basis can I support his policy and have myself revaccinated."
Anticipating the federal plan to inoculate health care workers, California has ordered
40,000
doses of smallpox vaccine from the federal Centers for Disease Control and Prevention,
which controls the national supply of it. According to Health and Human Services
Secretary
Tommy Thompson, the nation now has enough vaccine on hand to protect the entire
country in the event of a terrorist attack.
An international vaccination campaign wiped out naturally occurring smallpox in 1980.
While
the United States kept cultures of the virus under tight security, there are lingering
fears
that stocks of the virus were maintained in Russia, and possibly Iraq and North Korea
-- and
that terrorist organizations have been actively seeking it.
The risk that terrorists would gain access to the long-silenced smallpox virus is
theoretical,
but the danger posed by the vaccine is real. For every 1 million Americans vaccinated
against smallpox for the first time, an estimated 15 will suffer life-threatening
complications, and one or two will die.
With that risk in mind, federal health officials have decided against a mass
immunization
campaign -- which many of Bush's more conservative backers were demanding. Instead,
the president said his administration "will work to accommodate" members of the general
public who want to be vaccinated, but will not recommend that they seek it.
Bush told reporters that neither his staff nor his family would be vaccinated,
"because our
health and national security experts do not believe vaccination is necessary for the
general
public."
The smallpox vaccine is considered more dangerous than other modern vaccines because it
consists of a live virus. The vaccine actually causes a mild case of cowpox, a disease
closely
related to smallpox but not remotely as lethal. Antibodies raised against cowpox will
protect
against smallpox for an unknown period -- experts estimate between five and 30 years.
But
almost no one has received a smallpox vaccination in the United States since 1972, when
routine vaccinations were halted.
Dispensing the vaccine
The smallpox vaccine is administered to the skin over the deltoid muscle using a cool
and sterile bifurcated needle.
A very small volume of vaccine is held between the fork of the needle and then released
onto the skin.
Needle is held perpendicular to the arm.
Then 15 strokes are rapidly made within an area about 5 mm in diameter. The strokes are
vigorous enough for a trace of blood to appear on the skin. .
GROUPS BEING OFFERED THE SMALLPOX VACCINE
MILITARY
Who: About 500,000 personnel in "high-threat areas."
When: Vaccinations began Friday at Walter Reed Army Medical Center in Washington.
How: Mandatory.
STATE DEPARTMENT
Who: About 20,000 people working in U.S. embassies in the Middle East.
When: Not specified.
How: Recommended, but not mandatory.
CIVILIAN SMALLPOX RESPONSE TEAMS
Who: About 450,000 people most likely to come in contact with a contagious smallpox
patient, including people who work in hospital emergency rooms and people on public
health teams who would investigate suspicious cases of smallpox. States already
submitted
plans identifying people in this group and plans for vaccinating them.
When: Beginning in late January, or when states are ready. Program expected to take 30
days, although health officials said some states may take longer. How: Recommended, but
not mandatory.
HEALTH CARE WORKERS AND EMERGENCY RESPONDERS
Who: About 10 million total. People who work in hospital intensive care units,
infectious
disease doctors, dermatologists and other health care workers who might deal with
smallpox. First responders including police and fire.
When: States must develop plans; timetable uncertain.
How: Recommended, but not mandatory.
GENERAL PUBLIC
Who: Adults who insist on getting the vaccine.
When: People can enroll in clinical trials now under way at various sites across the
country.
The Department of Health and Human Services will create a new program available in
every state for people who want to sign up, expected by late spring or early summer.
Under
both measures, complicated paperwork would be involved, because people would be
enrolling in experiments to see if the vaccine works. People also could wait until
2004, after
enough vaccine is licensed.
How: Not recommended, but available.
Source: World Health Organization
The Washington Post contributed to this report. / E-mail Sabin Russell at
[EMAIL PROTECTED]
©2002 San Francisco Chronicle.
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