WASHINGTON — If the federal government wants a successful smallpox inoculation program, it must provide money to the states and compensation to people injured by the vaccine, the Institute of Medicine said Thursday.
Congress is working toward plugging the compensation hole. On Thursday, the House was considering legislation that would aid people injured by the vaccine, which carries rare but serious side effects. But Democrats and Republicans were at odds over how generous the package should be.
Worried about a bioterror attack with smallpox, the administration is encouraging staff in public health departments, hospital workers and emergency responders to get the vaccination. In the program's first two months, response has been tepid.
So far, just over 25,000 people have been vaccinated. Initial estimates were that some 450,000 would get the shot within 30 days or so during the first stage, with another 10 million emergency responders offered the vaccine in stage two.
The Institute of Medicine panel, a group of experts advising the federal government on the program, suggested a variety of reasons why people are declining the vaccine: They do not consider themselves at high risk of a smallpox attack; they are confident that vaccinations could take place quickly if there were an attack; and concerns about transferring the live virus from health workers to patients and therefore sickening vulnerable people.
The panel singled out the issue of compensation, saying that without action, the program may never be fully implemented.
"State health departments, hospitals and individual vaccines have expressed concern over the past two months about the lack of a national compensation program to cover medical expenses for adverse reactions, time lost from work and (in the worst possible outcomes) permanent disability or death," the panel said in its report, the second in a series about the smallpox vaccination program.
Without a program, it said, "the nation's preparedness to respond to a smallpox attack could be hindered."
The Bush administration put forth a plan that would pay $262,500 for people who are killed or permanently injured. The individual would also get two-thirds of lost wages, up to a maximum of $50,000.
The House was set to consider a similar, GOP-sponsored package on Thursday. Democrats are promoting a more generous package. They want a higher cap for lost wages and guaranteed funding for the program; the Republican plan would force this program to compete with others during the appropriations process.
Republicans tried to negotiate a compromise but promised to push the bill ahead even without Democratic support.
"One way or another it's imperative that we jump-start the stalled inoculation program," said Ken Johnson, the House Commerce Committee spokesman.
There is similar division in the Senate.
The Institute of Medicine also said lack of federal dollars to run the vaccination program is producing "significant financial worries" among states, local health departments and hospitals. Local departments appear to have shifted money from other important tasks, including areas related to bioterrorism and to other disease prevention, to focus on this one, the report said.
The panel recommended that the CDC conduct a wide-ranging inquiry to find out just how much the smallpox program is costing states.
The committee also expressed concern that the CDC was moving too quickly from the first stage of vaccinations into the second phase, saying it could inhibit efforts to evaluate and improve the program.
Further, it recommended the CDC find a better way to measure how well a community is prepared for a smallpox attack, beyond numbers of people vaccinated.
"Having more vaccinated individuals is only as effective as the plans for deploying these individuals in a potential smallpox bioterrorist event," it said.
The report praised other aspects of the CDC program. It said federal officials have done a good job of creating a system to track people who suffer complications.
On the Net: Institute of Medicine: www.iom.edu/