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Hospitals Refuse Call To Vaccinate Workers
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By Ceci Connolly
Washington Post Staff Writer
Wednesday, December 18, 2002; Page A02
Two prominent teaching hospitals are refusing to vaccinate their
employees against smallpox, rejecting President Bush's call for mass
inoculation of front-line medical workers who would be the first to confront
a biological attack.
Officials at Grady Memorial Hospital in Atlanta and Virginia Commonwealth
University in Richmond said yesterday that the risk of dangerous side
effects of the vaccine and inadvertent transmission to patients outweigh the
remote threat of an attack with a virus that has not been seen since the
1970s. Three other large medical centers, Children's Hospital of
Philadelphia, Emory Medical Center in Atlanta and the University of Iowa
Hospitals and Clinics are leaning against inoculating their staffs.
The hospitals' decisions mark the first high-profile opposition from the
medical community to a plan Bush announced Friday to inoculate as many as 11
million Americans by late summer and underscores some health workers'
reluctance to return to a decades-old vaccine known for its serious side
effects. In rare instances, the vaccine has caused life-threatening cases of
encephalitis and some deaths.
"I don't like to cause disease," said Carlos del Rio, Grady Memorial's
chief of medicine, describing his fear that a hospital worker could
accidentally spread live vaccinia to a patient with a weakened immune
system. "If, say, a patient with AIDS became infected, that would be a
disaster."
Julie Gerberding, director of the Centers for Disease Control and
Prevention, said she was neither surprised nor disappointed that a handful
of hospitals is opting out of the program.
"This is a voluntary program," she said. "We understand not all hospitals
will choose to participate." She said she expects the vast majority of U.S.
medical facilities to heed the call to vaccinate physicians, nurses and
other staff.
Many physicians, noting that they are in the business of risk-benefit
assessment, said the Bush administration has not made a compelling case for
waging a high-stakes battle against a disease that was eradicated worldwide
by 1980. The only known stocks of smallpox virus are kept in government labs
in Moscow and Atlanta, although some security experts fear other nations,
including Iraq, may have the virus.
"There is a lack of logic to the current proposal," said Richard Wenzel,
chairman of the department of internal medicine at Virginia Commonwealth.
"If our government in all its intelligence thinks smallpox exists in enemy
hands, why would we creep up on that policy? We would rush to vaccinate
everybody right now."
The decision by Grady, the largest emergency-care center in Georgia, is
notable because of its close ties to the CDC, the federal agency that
oversees the vaccination program.
In unveiling his sweeping plan Friday, Bush said there was "no
information that a smallpox attack is imminent." But he said he decided to
call for the vaccination of health care workers, emergency responders and
military personnel as a precautionary move necessitated by new threats at
home and abroad.
Mandatory vaccinations in the armed forces are already underway, and
voluntary inoculations for as many as 500,000 hospital and local health
department workers are scheduled to begin in late January.
Many state health commissioners, hospitals and individual physicians have
said they are willing to assist with the program. "I'm confident we will
have the support we need to have sufficient response capacity," Gerberding
said.
In a second phase, scheduled to begin as early as March, states will
encourage the remaining 10 million health care workers, police officers,
firefighters and emergency medical technicians to receive the vaccine. That
larger group could launch a mass vaccination campaign in the event of a
smallpox attack and still handle other emergencies, she said.
Bush also promised that the vaccine would be made available to any adult
American who "insists" on being inoculated, but he stressed that the
government strongly discouraged average citizens from being vaccinated.
Broad inoculation has been opposed by many medical experts, including the
CDC's own Advisory Committee on Immunization Practices. In October, that
group endorsed vaccinating only the first 500,000 doctors and nurses. One
committee member, Paul Offit, has objected to any program that extends
beyond a core group of about 15,000 people who he said could respond to a
smallpox outbreak without putting large numbers of people at risk.
"What worries me about offering this to the general public is that they
do not understand the risks of the vaccine," said Offit, head of the Vaccine
Education Center at the Children's Hospital of Philadelphia. He said the
hospital has asked Pennsylvania officials for a supply of vaccine to be used
only if an outbreak occurs.
"We will make a list of people who should be vaccinated, we will show 20
to 25 people how to vaccinate and then we will wait," he said.
Even a single case of smallpox would likely trigger mass inoculations
nationwide, federal officials have said. The goal at that point would be to
vaccinate all 286 million Americans in less than 10 days.
Like Offit, former CDC director Jeffrey Koplan said developing detailed
mass vaccination plans in the event of an emergency is perhaps a higher
priority than inoculating groups of emergency workers now. "Whether a
hospital chooses to do none or a few or a lot doesn't remove the important
responsibility of planning for something should it happen," said Koplan, now
a vice president at Emory University.
© 2002 The Washington Post Company
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