SCATTER SHOTS FEW ACCEPT POX VACCINE.

Byline: Carol Rock Staff Writer

VALENCIA - An effort to prepare thousands of Americans against a possible terrorist-wrought smallpox epidemic seems to be infected with liability concerns that have brought the program to a crawl.

Of the 9,000 doses of live vaccine shipped to the Los Angeles County Health Department, fewer than 100 public health workers have volunteered to be immunized - and just 10 employees at Santa Clarita's only hospital.

The workers, all considered part of the public health/first responders group outlined in the Bush administration's plan, are scattered throughout the county.

Despite the small number of doses given, county public health officials are confident that the public is protected.

``We are making progress,'' said Dr. Alvin Nelson, medical director of the county's immunization program. ``We do have enough public health members vaccinated to initiate containment were there a smallpox event at this time.''

According to a report from Dr. Thomas Gannwaite, director and chief medical officer of the county Department of Health Services to the Board of Supervisors, a number of potential volunteers have declined the vaccine because of potential health risks. The Centers for Disease Control have issued several contraindications for receiving the vaccine, including a wide range of skin conditions and immune disorders that resulted in 30 percent to 50 percent of those willing to be vaccinated to be screened out.

What seems to have stalled the program's momentum is a question of who will pay for health care and lost compensation if a person receiving the vaccine suffers debilitating side effects. It is expected that for every 1 million people inoculated, 1,000 will experience serious reactions and as many as 50 people may experience life-threatening reactions. One or two of those people are expected to die.

Because the program is voluntary, many workers' compensation and insurance programs do not cover adverse reactions. There is no program in place to compensate for time lost from work.

At Henry Mayo Newhall Memorial Hospital the vaccinations have been offered to everyone involved with patient care, according to spokeswoman Bhavna Mistry.

``It includes several hundred people,'' she said. ``Everyone from housekeeping to our emergency department staff. We are still taking names of volunteers.''

Of those offered the inoculation, just 10 have signed up.

David Campbell, spokesman for the Office of the Coroner, said that his staff was contacted by public health officials and offered the voluntary vaccinations. Remembering his youthful experience with the immunization, he has volunteered to participate. First responders in his office include field investigators and transportation workers.

Only members of the Sheriff's Department Special Enforcement Bureau, Emergency Services Detail, Emergency Operations Bureau and canine units have been offered the vaccine during this first phase of the program. All other sheriff's personnel - including those at the Santa Clarita station and working at the Pitchess Detention Center in Castaic - will be included in the second phase.

While prevention is the focus of this program, there is time for anyone exposed to smallpox to be inoculated if the disease breaks out.

``The good news is that you have three to four days after exposure to get the vaccine,'' said public health nurse Joanna Levinson.

Vaccination within three days of exposure will prevent or significantly lessen the severity of smallpox symptoms in the vast majority of people. Receiving the vaccination four to seven days after exposure offers some protection from the disease and may lessen the severity of symptoms.

Beverly Kemmerling, director of the Student Health and Wellness Center at College of the Canyons, said the college would be a vaccination site only if a large-scale inoculation program were put into effect.

``If we had an outbreak, there is enough vaccine in the county to ship a batch to COC,'' Kemmerling said. ``But if someone walked in with a rash, high fever and the pox, we would send them right to the emergency room. Considering that you might be contagious before you have the rash, this could be a public health nightmare.''

Union opposition

The California Nurses Association, which represent nurses at Newhall Memorial, has come out against participation unless nurses have been exposed to the virus. In a position paper posted on its Web site, the union claims that the vaccine is probably the riskiest human vaccine and is contraindicated by the CDC for an estimated 50 million people.

Also at issue is the union's belief that the smallpox program diverts important resources away from other critical health care programs and is being used to inflame public fears and build support for the impending war. The CNA is supported in its opposition by the American Nurses and the Service Employees International Union, which represents many employees in the local health care industry.

The crux of the unions' concern seems to be the lack of adequate protection for caregivers in case of adverse reactions.

Competing proposals are being considered to address the problem. U.S. Rep. Henry Waxman, D-Los Angeles, has authored the Smallpox Vaccine Compensation and Safety Act of 2003 (HR 865), which would provide some security for health care workers modeled after the National Vaccine Injury Compensation Program. That program is a federal no-fault system designed to compensate victims injured by childhood vaccines. Since smallpox vaccines have not been administered since 1972, it is not included.

Waxman's proposal would set aside funding from the federal Health and Human Services Department in the form of grants to states; ensure privacy of test results; and protect employees from discrimination by employers or insurance companies. It also comes with unlimited medical and lost wages reimbursement and a maximum death benefit of $850,000.

The Bush administration recently proposed a compensation fund based on the Public Safety Officers Benefit program. The PSOB is designed primarily for police officers and firefighters injured on the job and works in tandem with other benefit programs already in place.

The administration's compensation plan offers a permanent disability or death benefit of $262,100 and pays up to $50,000 in lost wages after a victim is off work for five days. This is in addition to any workers' compensation or disability insurance benefits received.

The second phase of the vaccination program cannot begin until all volunteers in the first-responder group are inoculated. After that is completed, then the vaccine would be offered to the any other health care and public safety officials. The third phase of the plan includes vaccination of the general public.

'Very prepared'

Dr. Raymond Aller, director of bioterrorism preparedness and response with the Acute Communicable Disease Unit of the county health department, said the vaccination program started slowly but is picking up. Hospital workers are next on the schedule to receive the inoculations.

``As a lot of people have observed, there have been small numbers of volunteer participants,'' he said. ``There is concern about the lack of a compensation program for some private health care providers. If the compensation plan is adopted by Congress, the picture will change dramatically.''

There have been no adverse reactions in Los Angeles County, except for one secondary exposure to a military vaccine.

``We have an obligation as public health professionals to care for the ill,'' Aller said. ``We need to have a group of people prepared to respond. There may be people who choose not to be vaccinated, but in the history of nursing care, we have done many things which have had a far, far greater risk than what we're being asked to do with the smallpox vaccination.''

Aller said that health officials are prepared for a myriad of bioterrorism scenarios.

``We are involved with the whole range of how to detect outbreaks of agents,'' he said. ``We also have a sufficient national pharmaceutical stockpile. We're actually very prepared to deal with smallpox.''