2.19.03

Small effort

A Boston Globe Editorial

BY THE END of this month, the Bush administration had planned to have 450,000 doctors, nurses, and other health-care workers vaccinated against smallpox and prepared to treat and vaccinate fellow citizens if terrorists or Saddam Hussein should unleash the deadly virus on the United States. But as of last week, the government's tally of those inoculated stood at just 1,043. The administration bears much of the blame for two crucial failures that have hobbled the vaccination effort. When Health and Human Services Secretary Tommy Thompson unveiled the smallpox preparation strategy last December, it seemed to be a sensible compromise between those who wanted to begin mass vaccination of the general public immediately and those who just wanted the problem to go away. The plan was to vaccinate the health-care workers first and then move to 10 million first responders. If at any point there were a smallpox attack, mass vaccination would begin.

But with a possible invasion of Iraq just weeks away, the country is woefully unprepared if, as the Central Intelligence Agency has warned, Saddam Hussein responds with a smallpox attack on this country. Vaccination, which is voluntary, has been stalled by the administration's failure to have the federal government accept full liability for any adverse reactions to the vaccine or to any secondary infections of unvaccinated persons, especially patients with weakened immune systems, by nurses or doctors who have been inoculated.

Understandably, many nurses' unions and hospitals have refused to take part in vaccination programs. To get broader participation, the government should not only have guaranteed compensation but also agree to pay employers to furlough health-care workers for the days after vaccination when it is most likely their inoculation wound would infect others.

An even more basic flaw has been the failure to educate the public about what is at stake. Instead of just being vaccinated himself, President Bush should have asked for network TV time to spell out the CIA's assessment that Saddam probably has smallpox and might try to use it against the United States, either in an unprovoked attack or, more likely, in the event of a US assault.

The administration might have shrunk from such a public-education campaign for fear it would undermine domestic support for a war. But by not drawing more attention to the threat, the administration has encouraged the skeptical reaction of many health professionals who say the danger of smallpox is not imminent enough to justify the vaccine's adverse reactions and secondary infections. In Israel, the threat is well understood, and the country has prepared itself by inoculating health workers and preparing vaccine supplies for the population at large. A US failure to do likewise could be catastrophic.

This story ran on page A18 of the Boston Globe on 2/19/2003.
C Copyright 2003 Globe Newspaper Company.