Smallpox vaccine: Easing fears on inoculations

A bill offers needed protections for physicians and other health care "first responders" who receive the vaccine.

Editorial. May 12, 2003.

When President Bush announced his smallpox vaccination plan last December, the public expected to hear a collective "Ouch!" as hundreds of thousands of health care workers rolled up sleeves and got pricked in the interest of national security.

Instead, the program began with a whimper. As of early April, just 32,644 people designated as first responders in the event of a bioterrorist attack had received the vaccine -- only about 7% of the 450,000 health care workers that federal officials had hoped would get inoculated, according to the Centers for Disease Control and Prevention.

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Fortunately, congressional lawmakers have passed legislation they hope will convince more health professionals to join the effort.

Why have so few health care workers volunteered to date? Many, including some physicians, are concerned about the small, but real, risks of injury or death associated with the smallpox shot.

In the past, out of every million people vaccinated for the first time, about 1,000 experienced serious reactions, and between 14 and 52 people experienced potentially life-threatening reactions. The CDC estimates that one or two people out of every million who receive the vaccine might die from it.

The recent fatal heart attacks of at least two health care workers who had just been vaccinated exacerbated fears about the shot even though a direct link was not made.

But on top of the concerns about the vaccine itself are other anxieties. Physicians and other health care workers worry that the medical bills and lost work resulting from a voluntary smallpox vaccination wouldn't be covered by their health or disability insurance.

They also fear that once they began inoculating others, they could be held liable for some injuries. Last year's Homeland Security Act protects physicians and others from lawsuits by those they vaccinate, but what about legal action from people -- friends, colleagues -- they might accidentally infect with the vaccinia virus? Organizations representing health care professionals worried that the Homeland Security Act contained loopholes leaving them vulnerable.

Several groups supportive of the Bush administration's plan, including the AMA, urged Congress to address these issues before the inoculation effort began.

And last month, lawmakers complied.

The bill, which Bush is expected to sign, deals with both the compensation and liability concerns. Last-minute negotiations between Republicans and Democrats made the final measure more generous than earlier versions.

Health care workers would get unlimited reimbursement for medical expenses if they are injured by the vaccine. That same protection would apply if they accidentally infected a family member who then experienced a bad reaction.

As for lost time, those injured by the vaccine would receive two-thirds of their income (three-quarters if they have children), up to $50,000 a year, with a lifetime benefit of $262,100. Those permanently disabled would receive up to $50,000 a year with no lifetime limit. The families of workers who died would receive $262,100.

The bill's liability provisions make it clear that vaccinated health care workers who accidentally transmit the vaccinia virus to others would not be held legally responsible for any resulting injuries, and it extends the liability protections to anyone participating in the voluntary program.

That clears the way for the AMA to begin in earnest efforts to inform doctors about the vaccination plan, the risks the vaccine poses and the compensation program.

The bill will not resolve physicians' fears about the smallpox vaccine. The CDC has taken steps to prevent doctors and health care workers at the highest risk of adverse reactions from getting the shot. Agency guidelines now warn against people with heart problems receiving it.

The vaccine will never be 100% safe. So the decision about whether to step forward is a personal one that every physician first-responder will have to make.

But Congress' passage of the measure on compensation and liability offers at least some essential protections for those who are willing to answer their country's call, so that they will be able to help others.