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http://www.nytimes.com/2003/01/30/politics/30SMAL.html?tntemail0

Health Care Leaders Voice Doubts on Smallpox Inoculations

By DONALD G. McNEIL Jr.

ASHINGTON, Jan. 29 — Serious doubts about the president's smallpox vaccination plan emerged today at a Senate hearing from the very health care professionals who have been asked to get or administer the vaccine.

The chief of pediatrics at Children's Hospital of Philadelphia, the nation's largest children's hospital, said his institution would not immunize its staff.

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The health and safety director of a union representing 350,000 health care workers asked for a delay and said several of his chapters had advised their nurses not to cooperate.

Two public health officials said the Bush administration was seriously underestimating the costs of the plan and how much money it would take from public health programs for things like childhood vaccines and tuberculosis control.

Dr. Julie Geberding, chief of the Centers for Disease Control and Prevention, defended the administration's plan, but said, "We appreciate the concerns and are going to take steps to make the program successful."

The president's program, announced on Dec. 13, calls for up to 500,000 health workers to be vaccinated in the coming weeks. The second phase is to include 10 million more health workers, firefighters, police and ambulance personnel.

All are to be volunteers. Four doctors were vaccinated in Connecticut on Friday, the first day the plan went into effect, but Connecticut health administrators were embarrassed when the nurses on their vaccination team backed out at the last minute, citing concerns like those expressed at today's hearing before the subcommittee on labor, health and human services of the Senate Appropriations Committee.

The critics' chief worries were that vaccinated health workers could suffer side effects themselves or accidentally infect their own family members or patients with the vaccinia virus. If they or a family member suffered a bad reaction — whether resulting in a day off work because of fever or a rare but life-threatening case of encephalitis or generalized vaccinia — they might not be covered by workers' compensation, they said.

When the vaccine was last in routine use, in the 1960's, it caused up to 52 life threatening complications and two deaths for every million people vaccinated. Some experts expect higher rates of complications today because more people have compromised immune systems and skin problems. On the other hand, the 1960's figures were mostly for the first-time vaccination of children, while many health care workers today were vaccinated as children, and, of course, are adults and presumably know something about the risks of side effects.

Dr. Louis M. Bell, chief of pediatrics at Children's Hospital of Philadelphia, in explaining his hospital's decision not to join the plan, said, "The virus might spread from the arm of a health care worker to a hospitalized child."

From 1907 to 1975, Dr. Bell said, citing a study that he said would soon appear in The New England Journal of Medicine, 85 children and adults were infected by health care workers shedding virus, and 9 of them died. The risk was greatest to hospitalized children. Hospitals like his now contain many children on cancer chemotherapy or undergoing organ transplants, so the risks are greater, and there are more immuno-compromised health workers.

Senator Arlen Specter, Republican of Pennsylvania, who was chairman of the hearing, called it "rather startling that an institution of your prestige should decide not to inoculate." Mr. Specter later said a newspaper survey of 50 state health officials found that more than 80 of the country's 3,000 hospitals, including some leading ones, had made the same decision.

Dr. Geberding of the disease control agency said the administration's plan did not require every hospital to participate.

"We knew that not every one would choose to," she added. "We planned for it."

During her brief testimony, Dr. Geberding calculated that it would cost about $13 for each person vaccinated. An earlier estimate by the centers had been $85 a person.

Two witnesses disagreed. Patrick Libbey, director of the National Association of County and City Health Officials, said four of his members estimated their costs at $155 to $220 per person vaccinated, and Jane Colacecchi, the public health director of Iowa, estimated her costs at $400 a person. Both said their figures included training vaccination teams and paying their salary and travel costs, screening out people at risk, giving the vaccinations and bandages, following up on bad reactions and managing the data.

Dr. Geberding later said her estimate was only "the extra cost of putting vaccine in someone's arm," not what she called "infrastructure costs."

James August, health and safety director for the American Federation of State, County and Municipal Employees, representing 350,000 health care workers, called for a delay in the program until workers could be taught more about the risks, and until all the worries about compensation for those suffering side effects were worked out.

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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.