American Nurses Association Says HHS Proposal On Smallpox Falls Short

Washington, DC -- After months of silence from the administration regarding its concerns about the smallpox vaccination program, the American Nurses Association (ANA) welcomed a legislative proposal released by the Dept. of Health & Human Services (HHS) yesterday regarding compensation for health care workers who suffer side effects after volunteering for the smallpox vaccination, but said the proposal falls far short of addressing many concerns about the program.

"The HHS proposal demonstrates that the administration recognizes a problem exists; however, it falls short of addressing the range of issues that ANA is concerned about," said Barbara A. Blakeney, MS, APRN,BC, ANP. "This compensation plan is solely focused on worst-case scenarios and does nothing to address the more common scenarios where individuals experience side effects that would cause them to lose less than five days of work," she said. "Furthermore, the plan fails to address the other issues we have raised regarding both patients' and nurses' health and safety."

ANA is particularly concerned about the risks of nurse-to-patient transmission of the vaccinia virus. Recent reports of cases of secondary transmission underscore the need for clear safety guidelines. "It's easy to understand why nurses who work with high-risk groups, such as cancer and AIDS patients, are reluctant to receive the vaccine," Blakeney said. "Given the lack of information on the risk of a smallpox outbreak and the well-documented risks associated with the vaccine, many nurses are making the professional judgment not to be vaccinated," she added.

The proposed HHS plan focuses solely on compensation and is modeled after the Public Safety Officers Benefit program, a benefits package currently available to police officers and firefighters. Under the HHS plan, individuals who die or suffer permanent disability from the vaccination would be eligible for $262,100 in benefits. Individuals with temporary or partial disability would receive two-thirds of lost wages, but only after losing five days of work, and benefits would be capped at $50,000.

To date, the federal Centers for Disease Control and Prevention (CDC) reports only 12,690 health care workers have been vaccinated since the program began on Jan. 24, despite the administration's plan to vaccinate 500,000 volunteers. Registered nurses are included in the first phase of the plan, as well as the second phase of 10 million first responders who are scheduled to receive this vaccination.

In letters to HHS Secretary Thompson on Nov. 7 and to President Bush on Jan. 16, ANA identified the following issues that must be addressed before the program moves forward:

• the potential transmission of the vaccinia virus to patients and family members;
• the right to coverage of medical costs associated with receiving the vaccine;
• the utilization of safer bifurcated needles;
• the critical need to establish an adequate prescreening and education program;
• maintaining sufficient staffing during the voluntary, pre-event vaccination program;
• compensation for lost time at work due to adverse effects of the vaccination program; and
• protection from job discrimination or retaliation for refusing to be vaccinated.

"Many of the critical safety issues questions are not addressed in the HHS plan," Blakeney said.

ANA praised a bill introduced by members of the U.S. House of Representatives in February, calling it a more comprehensive approach to addressing the shortcomings of the vaccination program. The bill, the Smallpox Vaccine and Compensation and Safety Act (H.R. 865), introduced by Rep. Henry Waxman (D-CA) with original co-sponsors Reps. Sherrod Brown (D-OH), Lois Capps (D-CA) and Edward Markey (D-MA), would offer education, medical screening and surveillance to health care workers who volunteer for the smallpox vaccine. In addition, the legislation would provide medical care and a no-fault compensation fund for anyone harmed by the vaccine, including patients. Assistance would be administered through state grants.

"We heartily applaud Congressman Waxman and his colleagues in the U.S. House of Representatives for their courage and initiative in addressing the tough safety and liability questions associated with smallpox vaccination," said ANA President Blakeney.

Smallpox Information and Resources

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The American Nurses Association is the only full-service professional organization representing the nation's 2.7 million Registered Nurses through its constituent member nurses associations. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

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