BACKGROUND:

On December 13, 2002, President Bush announced a plan to better protect the American people against the threat of a smallpox attack by terrorists or a hostile nation.  Under this plan, the Department of Health and Human Services is charged to work with state and local governments to form volunteer Smallpox Response Teams (Teams) who can provide critical services in the event of such a catastrophe.  To ensure adequate mobilization, these Teams must be inoculated with the smallpox vaccine.  Given that this program calls for volunteers, certain issues must be resolved before we get adequate workforce participation.  Although the  state ofConnecticutand theCountyofLos Angelesare rolling out these plans, few health care and emergency workers are participating.

These issues have to deal with funding, but primarily liability and workers’ compensation.  The Bush administration and Congress have provided liability protections for makers of the vaccine as well as hospitals and medical personnel.  Further, on January 24, 2003 Secretary Thompson signed the “Declaration Regarding Administration of Smallpox Countermeasures” provided limited liability for certain covered health care workers.  However, the liability protections contained in the Homeland Security Act do not provide adequate coverage.  Many of the individuals who would volunteer to receive the smallpox vaccine are not direct employees of hospitals, or other health care organizations that would not qualify for federal liability protection. 

There are significant costs and liability concerns associated with workers’ compensation, including lost wages and medical costs associated with vaccine complications and side effects.  The smallpox vaccine is unlike any other inoculation people normally receive.  The inoculation is a live virus called “vaccinia” and has be known to cause death in 1 or 2 people per million who take the vaccine.  Additionally, out of every million people receiving the smallpox shot, 40 may suffer complications that could be life threatening.  This is a risk not everyone is willing to accept.  Some workers’ compensation carriers may not provide coverage for workers who voluntarily participate in the program.  However, the health care workers and emergency responders that bravely step up to accept this risk ought to be compensated if complications  arise.  These issues need  to be resolved by both the federal and state governments.

Funding is also an issue that needs to be addressed.  The Centers for Disease Control (CDC) notified the state that bioterrorism preparedness funds cannot be used to pay for smallpox vaccination implementation costs; the funds could only be used for planning purposes.  As a direct result of CDC’s directive, Counties and local hospitals will incur costs that are not covered by federal or state reimbursement.  Some of these costs include county staffing for the vaccination clinics and follow-up, release time for workers getting vaccinated, and monitoring the vaccine site by hospital staff.  Costs to the County range from $50,000-$60,000 and the costs to hospitals vary depending on participation.  Although this program is voluntary, it borders very close to an unfunded mandate. 

The Smallpox Vaccination Plan is needed.  However, many issues have to be resolved before this plan is effective.  I am glad to see that the debate is going on in Washington to resolve these issues.  In fact, many Senators have expressed support for legislation to provide compensation to health care workers who experience adverse reactions to smallpox vaccinations.  Nevertheless, San Diego County needs to lend their voice to the debate and come down on the side of the brave men and women who are called upon in a time of tragedy.

I urge your support for the recommendations.

Respectfully submitted,

RON ROBERTS

Supervisor, Fourth District