Smallpox vaccine compensation plan gets mixed reviews

Mar 7, 2003 (CIDRAP News) – The Bush administration's proposal to compensate health workers harmed by the smallpox vaccine has drawn mixed reviews from public health groups and unions, with some groups calling it a major step forward and others labeling it inadequate.

While numerous groups weighed in on the proposal, Sen. Judd Gregg, R-N.H., promised to introduce the plan in the Senate and work for quick enactment. Gregg, chairman of the Health, Education, Labor, and Pensions Committee, said in a statement, "This isn't a health issue or a legal issue. It's a vital national security issue."

The administration plan, announced this week, would pay $262,100 for workers who die or suffer permanent and total disability as a result of a smallpox shot. It would also pay people two-thirds of their lost wages after their fifth missed day of work, up to $50,000, and it would cover medical expenses for major reactions to the vaccine, to the extent that those aren't covered by health insurance.

The plan would cover all the health and emergency response workers to be vaccinated in the first and second stages of the voluntary civilian vaccination program, plus anyone exposed to vaccinia through contact with vaccinees, according to administration officials. The first stage includes an estimated 450,000 public health and medical workers on smallpox response teams, and the second will include up to 10 million additional health workers and first responders. About 12,700 people have been vaccinated since the program started Jan 24.

The National Association of City and County Health Officials (NACCHO) commended the administration plan but said it should also include funds to help state and local governments pay for the vaccination program, a position that was echoed by several other organizations.

A compensation program for vaccine-related adverse events is "necessary, but not sufficient" for improving the nation's bioterrorism preparedness, NACCHO said in a statement. "Many local public health agencies are diverting most if not all their existing resources for bioterrorism preparedness exclusively to smallpox vaccination. . . . Federal funding is imperative to enable localities to do their part in implementing the president's smallpox vaccination program without forgoing other activities essential to protect their communities."

Mary C. Selecky, president of the Association of State and Territorial Health Officials (ASTHO), called the administration proposal "an important step" toward solving problems that have slowed the vaccination program. But she also hailed Rep. Henry Waxman's recently introduced proposal, which includes a compensation program and several related measures, including funds to help states pay for their vaccination programs.

"This [administration] proposal and H.R. 865, recently introduced by Congressman Henry Waxman (D-CA), reflect major progress toward a critical bipartisan resolution of some of the important issues that have been an impediment to vaccination efforts," said Selecky, who is secretary of the Washington State Department of Health.

The head of the Service Employees International Union (SEIU) said the administration proposal is a "big step forward" but leaves some key issues unresolved. "By proposing some compensation for vaccine victims, the administration has taken a big step forward and given the smallpox program a much-needed shot in the arm," said SEIU President Andy Stern in a prepared statement. The statement said Health and Human Services Secretary Tommy Thompson has been sensitive to workers' safety concerns about smallpox vaccination and "spearheaded efforts within the administration" to solve problems with the program.

However, the union echoed the concern of NACCHO and ASTHO about funding for the overall vaccination program, saying Congress should provide money so that other public health programs won't be sacrificed. In addition, "health care workers and first responders nationwide need the same kind of aggressive medical screening, monitoring, and surveillance as military personnel being vaccinated," the SEIU said.

The American Federation of State, County, and Municipal Employees (AFSCME) was more critical of the administration proposal, calling it "woefully inadequate." The union, which includes 360,000 healthcare workers, said the proposed compensation payments are too low and the plan does nothing to ensure proper prevaccination screening.

AFSCME President Gerald McEntee said, "This plan still does not include basic education and screening requirements that would reduce injuries by making sure only thoroughly screened candidates receive the vaccination." Further, the plan doesn't help local agencies with the cost of screening, he said.

McEntee also said the proposed death and disability benefits are not enough to protect families from financial ruin. "For most workers, the maximum benefit represents only a few years of income," he said.

The American Nurses Association said the administration plan "falls far short" of addressing many of its concerns about the program. ANA President Barbara Blakeney said the plan focuses on the worst scenarios and wouldn't help workers who miss fewer than 5 days of work because of vaccine side effects. The ANA also said the plan fails to address several concerns the group raised in January, including safer needles, adequate screening and education, and protecting those who refuse the vaccine from discrimination.

The ANA praised Waxman's proposal as "a more comprehensive approach to addressing the shortcomings of the vaccination program." The legislation would provide medical care and a no-fault compensation fund for anyone, including patients, harmed by the vaccine, the group said.

Sen. Edward Kennedy, D-Mass., the senior Democrat on Sen. Gregg's committee, also criticized the administration plan, according to a Reuters report. A Kennedy spokesperson attacked the plan for not including funds to help state and local agencies pay for the vaccination program and for not compensating workers for their first five days of lost wages. The spokesperson said Kennedy will try to raise the $50,000 limit on wage compensation and the total compensation limit of $262,100.

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