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Smallpox: U.S. Immunization Plan Reformed in the Face of Dissent By David McGlinchey By Tuesday, 432 people in 11 states and Los Angeles County had received the inoculation, according to Joe Henderson, the Centers for Disease Control and Prevention associate director for terrorism preparedness, who spoke yesterday at a bioterrorism conference hosted by the National Governors Association. The first phase of the plan began Jan. 24 and was to be finished by the end of this month but that schedule has now been extended, Henderson said. “We know it’s more than 30 days and we hope it’s less than six months,” he said. In a sharp departure from earlier Bush administration statements that emphasized the importance of immunized first responders, Henderson said that CDC officials are not concerned about the number of medical personnel vaccinated in the first phase as long as the vaccine is widely offered and the public is well informed. “It would be a success if no one receives the vaccine, but we offered this opportunity to all the right people,” he said. In December, Bush called for 500,000 medical emergency workers to be inoculated in the first phase of the plan, but concerns about patient compensation, screening, vaccine costs and public education have hindered the effort, state and federal health officials said. Only one-third of U.S. states are slated to begin their immunizations by mid- to late February — when the first phase of the program was scheduled to be complete — and several health departments will delay much further. New York City might wait several months before beginning immunizations, according to a U.S. official. The “issues remaining as of this morning are considerable,” said William Raub, the deputy director of the Health and Human Services Department’s Office of Public Health Preparedness. Henderson said he expects another 400 people to receive immunizations by the end of the week. These numbers “don’t look like a raving success,” Henderson said. The effort should not be measured in numbers, however, but rather in readiness and in terms of “standing up a program that is safe,” he added. Henderson said the CDC smallpox education program had reached 800,000 U.S. medical care workers. Some U.S. hospitals and medical workers’ unions have refused to support the immunization campaign until compensation issues and other sticking points are resolved. Medical officials are concerned that people who are sickened by the vaccine will not be compensated because they took the vaccine voluntarily. While administration officials continue to investigate the concerns, there are no firm solutions on the table right now, according to Raub. Henderson said the problem is being addressed but Congress must deliver the solution to the compensation dilemma. “I think in the coming weeks we will see some remedy,” he said. Many state and local officials have urged the administration to slow the immunization campaign until those remedies are delivered. “Slow down, get it right. Understand what it is we are doing,” National Association of County and City Health Officials Executive Director Patrick Libbey said. The original plan called for the first phase of immunizations to be complete by the end of this month and a second phase to inoculate up to 10 million emergency workers. After the second phase is complete, officials had said they would look to offer the vaccine to the general public. The lines between those phases are blurring and the process is more of a continuum, Henderson told the conference. He maintained, however, that by mid- to late summer the United States would have a safe program in place to offer the vaccine to members of the public who insist upon immunization. Several state health officials told Henderson that many medical workers, health departments and hospitals were concerned about the plan. Officials said that unless the United States addresses a number of issues, turnout might remain low. “What if the federal government threw a vaccination party and nobody came?” asked David Engelthaler, bioterrorism coordinator for the Arizona Department of Health Services.
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