As it appeared in the Cape Cod Times March 10, 2003
Doing It Right Instead of Rushed
It is not surprising that the public is confused about the decision of nurses and their medical colleagues to question specific aspects of the national smallpox vaccination program. This response is to address some very confusing information. Our medical community has chosen to move cautiously until certain questions have been answered, especially those around putting the public at risk. They should have been answered by the federal government before the smallpox program was started.
Here is the risk to the public. This vaccine temporarily causes a wound full of smallpox-like virus. The wound can shed the virus and can accidentally infect unvaccinated people – a disastrous possibility in a hospital full of very sick patients. Patients who should not be exposed are those who are immunocompromised or pregnant or have cancer, HIV positive, or asthma, sick children, patients on steroids or chemotherapy or those who have skin rashes and eczema, or any of the autoimmune syndromes such as lupus, diabetes, rheumatoid arthritis or fibromyalgia.
Ironically, the very nurses and physicians who would be getting the vaccination would be the same ones who would be in contact with high risk patients. Nursing is physical work and the chance of this flimsy dressing being disturbed is very likely. It is supposed to protect others from cross contamination but gives the public a false sense of security.
In the New England Journal of Medicine article “How Contagious is Vaccinia,” Dr. Kent Sepkowitz, states that “relatively little is known about the spread risk of secondary transmission of this virus in the hospital setting.” He raises questions whether vaccinated workers remaining on the job could start a “self-inflicted epidemic – not of the smallpox, but of the infection with the live, potentially fatal virus, vaccinia.” (January 30, 2003)
No worker who is injured or loses days worked from getting vaccinated will be compensated for wages lost because it is a “volunteer” program, not work-related. Sen. Edward Kennedy is working on legislation to provide appropriate funding to those injured by the smallpox vaccine. The legal firm of Jackson/Lewis has specifically addressed legal liability in their report “National Smallpox Vaccination Plan: Workplace Law Implication for Health Care Facilities.”
Should a vaccinated nurse or healthcare worker inadvertently cross-infect another co-worker or worse yet, an immuno-compromised patient with the vaccinia causing adverse affects, that healthcare worker can be sued.
The Jackson Lewis report concludes that “good intentions and the need for patriotic support are not defenses to the type of claims that may pursue.” Legal activity is much higher today than it was 30 years ago. In those days, everyone got vaccinated so the chances of cross-innoculation was not possible.
The U.S. Senate is holding hearings on the smallpox campaign, and both federal and state authorities are considering ways to cover liability. Actually, both of these problems would be greatly diminished if the vaccinated worker was simply given a paid furlough during the contamination time.
The Massachusetts Nurses Association is working with Dr. Alfred DeMaria, Director of Communicable Disease Control for the State Dept. of Public Health to resolve these issues. The MNA is also conducting a conference for nurses to help prepare them for the smallpox program.
Nurses agree with the report written by the Institute of Medicine who is the scientific body charged by the federal government to consult with the Center for Disease Control on the smallpox program. Published January 16, 2003, it urges us not to rush into it but proceed with caution and do it right.
Terri Arthur of Falmouth and Rosemary O’Brien of Harwich both registered nurses, are chairwoman and vice chairwoman, respectively of the Congress on Health & Safety, Massachusetts Nurses Association.
