President Bush's plan to inoculate 500,000 health care and emergency workers against smallpox by the end of February is far behind schedule, delayed by state worries about adequate funding and compensation for the vaccine's potentially dangerous side effects.
As of Feb. 27, only 7,300 health workers had volunteered for vaccination, less than two percent of the administration's goal, which was meant to lay the groundwork for the second phase of the program - the rapid inoculation of 10.5 million emergency workers.
Bush's inoculation plan is driven by fears of a terrorist attack employing the highly contagious smallpox virus as a biological weapon. While vaccination is an effective prophylactic against the disease, it is known to cause severe side effects in a small number of recipients.
Experts estimate that for every million people vaccinated, as many as 1,000 will have significant reactions to the vaccine, 14 to 52 will suffer life-threatening illness and one or two could die. Pregnant women, cancer patients, HIV positive people and victims of skin conditions like eczema are at greater risk of serious illness because of their weakened immune system. Candidates for inoculation are prescreened for such conditions, but health professionals have been more concerned that the contagious scab the vaccine creates could infect patients under the care of vaccinated health care workers.
The Centers for Disease Control and Prevention (CDC) Thursday (2/27) reported the first known case of a "moderate to severe" adverse reaction, underscoring concerns about the safety of the vaccine. It affected a Florida nurse inoculated earlier this month.
Bush's unprecedented plan to vaccinate against a disease that has not occurred in the United States in five decades and was eradicated worldwide in 1978 has met fierce resistance among medical professionals and state health officials. Many health experts doubt that the benefits of immunization outweigh the risk of side-effects, which include blindness, encephalitis and death.
The case in Florida involved a 39-year-old female nurse who developed a significant rash nine days after inoculation. The rash developed into scattered fluid-filled lesions that healed about 15 days after the inoculation.
"This was a minor illness and the patient is recovering at home," said Dr. Steven Wiersma, Florida's state epidemiologist. Wiersma said that the CDC is examining virologic samples from the woman to determine the exact cause of the infection.
Florida officials also reported two other inoculated health workers have experienced ailments that have not been associated with the smallpox vaccine, but were reported to the CDC as possible adverse reactions.
CDC and Florida health officials did not say whether or not the woman, whose name they withheld, had health insurance or lost wages from missing work. Under current law in some states, worker's compensation does not cover health care costs incurred through a voluntary vaccination.
"This event reaffirms the need for a compensation program to support health care workers and their contacts injured by the smallpox vaccine," said U.S. Rep. Henry A. Waxman, a California Democrat who has been pushing a bill that would create a no-fault compensation fund for any person sickened by the vaccine.
Initially, the Bush administration refused to create a compensation fund for people sickened by the vaccine and said that anyone who suffered serious complications could apply for workers compensation or sue the federal government for negligence.
That policy is one of the roadblocks keeping states from fully implementing the smallpox program.
In Arizona, health official had balked at beginning vaccinations without a federal compensation fund, but the state's worker's compensation provider said on Monday it would cover potential side effects. The state has since vaccinated five health workers, but officials said that only half of the 7,700 volunteers originally projected for the program now plan to participate.
"Compensation is key- we can't put our workers at risk and not provide any coverage in case they get sick," said Michael Murphy, spokesperson for the Arizona Department of Health.
Joseph Henderson, the CDC's director of Terrorism Preparedness and Response, said in early February that federal officials were "working feverishly" to solve the compensation problem and would soon introduce legislation to create a compensation fund. Three weeks later, Henderson said that the administration was still working on a compensation plan.
"The administration is hopefully going to be delivering something to Congress this week to discuss compensation," Henderson told the National Governors' Association last Monday.
States have ordered 274,000 doses of vaccine from the federal government since Bush announced the smallpox plan last December, but hundreds of hospitals, several major unions and some state health departments have refused to participate in the program, due largely to unresolved questions over compensation.
"Most states won't start vaccinating until after the time they were supposed to have finished," Henderson said.
States have also opposed Bush's proposal to eventually offer the smallpox vaccine to the general public. Officials in Washington, Michigan and Arizona have said they will not open vaccination clinics to the public.
"Given what we don't know about the threat level of this disease, we absolutely will not offer it to the general public," said Mary Selecky, Washington secretary of health.