The Bush administration, seeking to rescue its foundering smallpox immunization campaign, has agreed to a limited compensation package for medical personnel and emergency responders who are made ill by the vaccine, health officials said yesterday.
After months of pressure, the administration acquiesced to demands from unions, hospitals and public health departments in the hope that providing financial protection for the nation's front line against bioterrorism would entice skeptical health care workers to be immunized.
The decision to provide disability and death benefits comes when just 12,404 health care workers have answered President Bush's call for 500,000 volunteers to be vaccinated. Hundreds of hospitals have refused to participate.
"This removes the concern that a lot of people had, and we would expect that the numbers of people that would be vaccinated would increase," said Jerome Hauer, acting assistant secretary for public health emergency preparedness at the Department of Health and Human Services. "This would provide them the level of comfort they need in the very small likelihood of an adverse event."
The proposal, drafted by HHS and the White House, follows a 1968 law that compensates police officers injured in the line of duty. Individuals who die or suffer a permanent disability would be eligible for $262,100 in benefits. Lost wages as a result of temporary or minor illness would be capped at $50,000 and would be paid only after an individual had missed five days of work. The same benefits would be available to a hospital patient or family member who becomes ill after contact with an inoculated health care worker.
If approved by Congress, the payment plan would apply to the 500,000 medical personnel in the first phase of the vaccine program and as many as 10 million rescue workers who would be inoculated in the second phase. One administration official estimated that the compensation program could cost $20 million to $30 million.
"We are asking these health professionals to perform a vital public duty, so we are proposing to provide them the same sort of benefits that we provide our public safety officers when they are injured on the job," said Julie Gerberding, director of the Centers for Disease Control and Prevention.
For months, the White House has resisted pleas for a compensation fund, arguing that anyone who suffered severe reactions could sue the federal government for negligence. But health and legal experts said that approach failed to take into account that most complications from smallpox vaccinations are normal and expected -- not the result of negligence.
When smallpox vaccination was routine, about 1,000 of every 1 million people inoculated experienced minor reactions, such as a rash, fever or malaise. An additional 14 to 52 people suffered severe complications such as blindness and encephalitis, and one or two of them died, according to the CDC.
There is no treatment for smallpox, but inoculation was successful in eradicating the disease worldwide in the 1970s. Bush ordered smallpox vaccinations resumed out of concern that terrorists or other enemies might use the germ as a weapon.
Many of the unions that have opposed the vaccination program voiced half-hearted support for what they called a partial solution.
"We appreciate they recognize it's a problem, but there's a long way to go from what we're looking for," said Chris Donnellan, associate director of government affairs for the 150,000-member American Nurses Association. The caps on compensation and requirement that workers cover the first five days of lost wages are particularly troubling to the union, he said.
The AFL-CIO and the Service Employees International Union said the effort fell short.
"President Bush refused to listen to patients, physicians, nurses and health workers when he launched the smallpox program," said Rob McGarrah, coordinator for workers' compensation at the AFL-CIO. "Now, more than two months later, with the program in shambles, the administration has finally taken a step in the right direction."
Health officials who have spent nearly a year developing their smallpox plan issued their request for volunteers yesterday with a fresh sense of urgency and gloomier warnings about the risk of attack.
"The issue at this point in time is we have to move forward with getting our public health and medical response teams vaccinated and then move quickly into the first responder community to get them vaccinated," Hauer said.
HHS Secretary Tommy G. Thompson warned in a statement last night: "A smallpox release is possible and we therefore must prepare by offering vaccine to those most likely to respond."
Sen. Judd Gregg (R-N.H.), the new chairman of the Senate Committee on Health, Education, Labor and Pensions, intends to sponsor the administration bill, which may compete with a more generous package drafted by Rep. Henry A. Waxman (D-Calif.).
"Compensation gives people the degree of comfort they need to proceed with vaccinations, allowing the program to move forward," said Gregg, who noted that many in his home state have been reluctant to be immunized. "This is a vital national security issue."