Disappointing or deadly?

"Disappointing." That was how Health and Human Services Secretary Tommy Thompson this week characterized the fact that approximately one-third of eligible hospitals across the nation are not participating in the first phase of the president's smallpox vaccination plan. It's a rate of refusal far higher than expected, and considering the magnitude of the potential consequences for such recalcitrance, "disappointing" is a substantial understatement. A more apt word is "deadly," since few doubt that rogues or terrorists will attempt to attack Americans with smallpox. In his speech yesterday before the U.N. Security Council, Secretary of State Colin Powell noted that Saddam Hussein "has the wherewithal to develop smallpox." He also has the means to deploy it.

The hospitals refusing to participate fall into two categories: those that believe that the smallpox vaccine is too risky to give out; and those that believe the threat of a smallpox attack is very unlikely. The threat may not be imminent, but the uncertainties inherent in intelligence-gathering make calculating the likelihood of such an event problematic. Given the ambiguities, prudence would seem to dictate that reasonable precautions be taken — even though inoculations do carry a small risk of adverse effects, and even if some questions about liability and compensation still need to be resolved.

Which suggests another reason that some states seem reluctant and some hospitals are not participating — money. Many states are faced with record deficits, and the inoculation program will be both inconvenient and expensive. Several authorities suggested that federal fiscal sweeteners could speed state compliance.

According to the Centers for Disease Control and Prevention's (CDC) latest numbers, more than 256,000 doses of the vaccine have been requested from 42 states and four counties, including Maryland, Virginia and the District of Columbia. Eight states have not even asked for the smallpox vaccine, although representatives from most of those states claimed technical or logistical reasons for their delayed requests. Oregon is in the midst of a school vaccination program, and so plans to begin inoculations next month, when more trained individuals are free. Montana is still in the middle of blizzard season, making timely delivery of vaccinations problematic.

However, the bottom line is that America's health professionals — especially its first responders — are failing in their duty to be fully prepared to respond to a smallpox attack. There's a mere three-day window, after contacting smallpox, in which the vaccine can be successfully applied, and unforeseen difficulties will undoubtedly delay vaccine deliveries during an attack. Those who have taken the Hippocratic Oath and yet refused the smallpox vaccine will be fortunate indeed if their stubbornness does not turn deadly.

EDITORIAL • February 6, 2003
TheWashington Times