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The next step against smallpox House Editorial
Most researchers, policy analysts and public observers disapproved of last month's recommendation by the Advisory Committee on Immunization Practices to vaccinate only about 20,000 U.S. health-care workers against smallpox. Now, officials at the Department of Health and Human Services say they want to vaccinate even more workers, perhaps upwards of a half-million, beginning as early as the fall.
Vaccinating roughly 40 percent of the nation's emergency health-care cadre would certainly be a great step forward. Ultimately, however, Americans must be able to choose for themselves whether to receive the vaccine. While making the smallpox vaccine available to everyone presents technical and bureaucratic challenges, U.S. health officials should not let these stand in the way of the public's right to choose if they should receive the vaccine.
Health and Human Services Secretary Tommy Thompson is expected to announce his department's smallpox strategy within the next few weeks. Critics of the public-choice mold often say the smallpox vaccine is not safe for everyone and, therefore, should not be widely distributed. As the editors of this page have written previously, this is not a valid argument. More important logistical concerns, however, present major obstacles to implementing a voluntary vaccination program.
The foremost of these concerns relate to liability. We know from mass vaccinations during the late 1960s and early 1970s that modest numbers of people receiving the smallpox vaccine develop health complications, and some of them die as a result. The potential for litigation is high. At minimum, legal mechanisms must be in place to protect pharmaceutical companies from paying out crippling damages. Although the National Vaccine Injury Compensation Program has existed since 1986, its provisions weren't designed with voluntary mass vaccination in mind. A new federal compensation fund, which adequately protects both vaccine manufacturers and vaccine recipients, should be in place before doctors begin doling out smallpox shots.
Public-health officials must also consider a multitude of other logistical issues. Would potential vaccine recipients be required to submit to an HIV test, since HIV-positive individuals risk injury from the vaccine? Administering hundreds of millions HIV tests would drive up the cost of a vaccination program.
States already are calling for their own stockpiles of vaccine. Health officials have yet to determine the best method of distribution. Further complicating the issue is the nature of the vaccines themselves, many of which are stored in 100-dose vials. If each vial is not used all at once, the vaccine remaining in the vial must be discarded.
Although these important complications might discourage the implementation of a public vaccination program, the Department of Health and Human Services must make the vaccine available to all. The protection of the personal health and freedom of Americans is well worth the time and effort.
These procedural and legal complications — though valid — must not be used as justification for bureaucratic inertia. They are problems to be solved with some dispatch by the secretary.
-- Martin (Martin@aol.com), July 22, 2002