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By Jeremy Manier
Tribune staff reporter
Published December 19, 2002

Two Illinois hospitals have joined a growing group of medical centers nationwide that are opting out of a federal plan to vaccinate emergency workers against smallpox, reflecting concerns that the known risks of the vaccine may outweigh the uncertain threat of a terrorist attack with the virus.

Carle Foundation Hospital in Champaign and Decatur Memorial Hospital in Decatur notified the Illinois Department of Public Health in the last week that their workers will not be vaccinated, public health officials said Wednesday.

At least two other hospitals in Atlanta and Virginia also have said they will not take part in the voluntary plan, citing the small but real risk that vaccinated workers could suffer serious side effects or accidentally transmit the vaccine's virus--which is different from smallpox--to patients.

Such opposition could pose an obstacle to President Bush's plan, announced last Friday, to vaccinate up to 11 million people against smallpox, including a first round of 500,000 hospital and health agency workers. Bush has stressed that participation is voluntary, and Illinois health officials said they will not try to persuade hospitals to take part.

Dr. James Leonard, chief executive officer of Carle Foundation Hospital, said he struggled for more than a week over whether any of the 2,400 workers at his hospital would get inoculations.

Leonard said that after consulting with experts around the country, he was struck by the consensus that while the risk of a smallpox attack is unknown, the vaccine's risks are clear: Up to 52 people out of every million vaccinated could experience life-threatening side effects, with one to three dying. The vaccinia virus used for immunizations also can pose a risk to people with weakened immune systems, including patients with AIDS or cancer.

"I thought to myself, `What are we missing?'" Leonard said. "I came to the conclusion that we were not missing anything--[the plan] had taken on a life of its own, and I just couldn't justify the risk to the folks that work here and to our organization."

Dr. Gary Noskin, chief of infection control at Northwestern Memorial Hospital in Chicago, said the hospital has not yet decided whether to take part in the smallpox plan. He said some experts fear that news of adverse reactions to smallpox vaccines could sour the public on shots for diseases with a more immediate threat, such as measles.

Another concern is legal liability for vaccine side effects. Although the recently passed Homeland Security Act would protect municipal health agencies, experts say it's unclear whether hospitals could be held liable for complications that their employees or patients experience.

"I suspect that will be tested in the courts," Noskin said.

Illinois officials asked 152 hospitals outside Chicago to submit their plans for smallpox vaccination by Dec. 13. About 75 percent of hospitals had returned their plans as of Wednesday, public health spokesman Tom Schafer said. The Carle Foundation Hospital and Decatur Memorial are the only two that have said they will not take part.

Chicago public health officials said their preparations will take another few weeks, but so far no city hospitals have told authorities that they will not participate.

Schafer said health officials will not try to persuade hospitals to take part. In the event of an actual smallpox attack, he said even hospitals that do not participate could be protected. The smallpox vaccine can provide protection up to 72 hours after someone has been exposed to the virus, and federal plans call for the ability to vaccinate every person in the U.S. within 10 days in case of an outbreak.

"In the event of a localized outbreak, the vaccine would be offered in those areas first," Schafer said.

As for the current vaccination plan, Schafer said, "We've stressed that it's strictly a voluntary program."

Copyright © 2002, Chicago Tribune