Smallpox Vaccine Plan Hits a Snag: Compensation

The federal effort to prepare the nation for a potential smallpox attack has run into “a significant barrier,” with many health workers and some state and local agencies refusing to participate in the vaccination program until they are guaranteed compensation for medical costs and lost wages, officials acknowledged Wednesday.

Just 432 front-line health-care workers, including a small number in Los Angeles County, had been inoculated by Tuesday, and only one-third of the states were on track to begin offering vaccinations by mid- to late February -- when the first phase of the program was originally scheduled for completion.

Undeterred by the slow start, federal authorities are gearing up to begin offering the vaccine to insistent members of the public as soon as midsummer, said Joseph Henderson of the Centers for Disease Control and Prevention.

Henderson, the CDC’s associate director for terrorism preparedness and response, was confronted publicly Wednesday with what federal officials have been dealing with privately for weeks: state officials demanding the creation of a compensation fund for health-care workers who volunteer to be vaccinated and then suffer side effects.

Compensation is “the thing,” said Idaho emergency response coordinator Bill Bishop, one of scores of state officials attending a bioterrorism summit convened by the National Governors Assn.

“We just need it fixed -- bad,” Bishop told Henderson, adding that efforts to vaccinate emergency personnel would otherwise be “unmanageable.”

In the meantime, some labor groups, including the Service Employees International Union and the California Nurses Assn., have recommended that their members not volunteer for the vaccine.

“What if the federal government threw a vaccination party and nobody came?” asked David Engelthaler, chief of the Arizona Department of Health Service’s Office of Bioterrorism.

Henderson acknowledged that the program “doesn’t look like a raving success” but said it should be judged not by the number of people inoculated but by how prepared the nation is to respond to a potential attack.

Add to the persons vaccinated the more than 800,000 nurses and doctors who have learned how to recognize smallpox symptoms and report a possible case, as well as a public health system now ready to respond to an attack, Henderson said, and the program is proceeding well.

Henderson said federal officials were “working feverishly” to solve the compensation problem. He predicted that legislation would soon be introduced to set up a compensation fund.

Michigan will not begin vaccinating health-care workers until the issue is resolved, said George E. Hardy, executive director of the Assn. of State and Territorial Health Officials.

Henderson said New York City would not begin inoculations until late May. Reached by telephone, a representative of the city’s health department disputed that, insisting that vaccinations would begin in the next two weeks.

The vaccination can cause serious side effects in some people and may even kill one or two people for every 1 million inoculated. Henderson said the CDC had not received any reports of adverse effects among health workers vaccinated so far.

Of the “tens of thousands” of servicemen and women the military says it has vaccinated, there have been two reports of serious reactions.

One man developed generalized vaccinia, a skin reaction, and another was hospitalized with encephalitis, a serious inflammation of the brain.

Both men are believed to be recovering, Henderson said.

When President Bush unveiled the smallpox program in December, Health and Human Services Secretary Tommy G. Thompson said the first stage -- immunizing medical workers -- would be completed by the end of February.

Henderson said that schedule has changed. “We know it’s more than 30 days and we hope it’s less than six months,” he said.

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Times staff writer Aparna Kumar contributed to this report.