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Smallpox I: Congress Attempts to Solve Smallpox Compensation Dilemma By David McGlinchey Medical workers have stayed away from the program in droves over fears of the well-advertised and potentially dangerous side effects of the vaccine. Over a month into the immunization campaign, fewer than 7,500 emergency workers nationwide have received the vaccine (see related GSN story, today). On Feb. 13, Representative Henry Waxman (D-Calif.) introduced the Smallpox Vaccine Compensation and Safety Act and staffers are negotiating a bill in the Senate to provide compensation for those who suffer adverse vaccine side effects. “I have heard from public health officials and vaccination experts that many health care workers are understandably reluctant to accept a vaccine to protect the public while being forced to face the consequences of an adverse reaction alone. These consequences can include large medical bills, lost income, pain and suffering, and death. There can be no doubt that a compensation plan is urgently needed,” Waxman said. Senator Judd Gregg (R-N.H.), chairman of the Health, Education, Labor and Pensions Committee, and Senator Edward Kennedy (D-Mass.), the committee’s senior Democrat, are drafting legislation to address obstacles to the smallpox immunization plan, according to their staff. “We need to reassure people that need to receive the vaccine that they will be protected,” said Christine Iverson, a spokeswoman for the Gregg’s committee. Legislation will be brought to the Senate “hopefully in the next month,” Iverson said. Gregg, Kennedy, Senate Majority Leader Bill Frist (R-Tenn.) and other lawmakers are negotiating to produce a bill that resolves the vaccine compensation issue, according to Kennedy aide Jim Manley. “Everyone, in the end, would prefer to have a bipartisan proposal,” Iverson said. Although it is not yet clear what the final product will look like, she said that Gregg and Kennedy have been “working closely” on the issue. The U.S. health care community’s reluctance to accept the vaccine surprised experts, some of whom complained about exaggerated reports of the possible side effects. “People have wildly overstated the risks of the vaccine. Wildly,” said Ed Kaplan, a Yale University professor who has criticized the CDC’s smallpox vaccine plans. He said that sensationalized reports are keeping volunteers away. “In part it’s because there were a lot of scare tactics being used,” according to Kaplan. While some experts said the chances of suffering vaccine side effects are remote, they also said that public concerns must be addressed. “All of us, I certainly did, underestimated the impact of the compensation issue,” said Georges Benjamin, executive director of the American Public Health Association. Benjamin said that issues of compensation and liability protection are “showstoppers,” and Congress still has “a huge way to go.” Waxman’s Bill Waxman’s bill proposes a “no-fault compensation program modeled on the existing childhood Vaccine Injury Compensation Program. The purpose of this bill is to compensate people … for their unreimbursed medical expenses and lost wages,” according to a summary of the bill released by Waxman’s office. The bill would also provide up to four days of medical leave for emergency and medical workers who “suffer transient but significant reactions.” The bill calls for Washington to reimburse employers for the missed days. Waxman also proposes federal grants for the smallpox immunization program, which has been a large and unfunded mandate, according to some state and local officials. Waxman’s proposal would send federal grants to states that “provide adequate education and screening for potential vaccines,” as well as testing and post-immunization monitoring. Senate Legislation Kennedy’s proposal provides federal grants to help fund state immunization efforts and establishes a compensation program, according to Kennedy aide Manley. The bill also “ensures that people receive medical treatment … free medical care” if they suffer side effects, he said. “There are indications that the White House is willing to support it, we have to wait and see,” according to Manley. Gregg is pushing legislation to provide compensation for smallpox vaccine patients as well as liability protection for those who develop and administer other vaccines, according to Iverson, the committee spokeswoman. The Homeland Security Act, which became law in November, does not provide sufficient liability protection for makers of vaccines other than smallpox, Iverson said (see GSN, Nov. 25, 2002). This is an issue that needs to be addressed to encourage companies to develop other vaccines without fear of lawsuits, Iverson said, because the United States might need to “vaccinate people down the road” against anthrax or botulinum toxin.
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