President Bush Signs Smallpox Compensation Bill and Releases $100 Million to Help Jumpstart Smallpox Immunization Program

 


Related Links:

 

CDC Smallpox Information

DHHS Press Release

Tracker Article on Smallpox Program

 

The initial response from healthcare and emergency workers to the smallpox immunization program has been lackluster. As of April 25, 2003, 285,700 doses of smallpox vaccine had been shipped and only 34,541 had been administered. As a result, Congress and the Bush administration have taken two steps to jumpstart the program: On Wednesday, April 30, 2003, President Bush signed into law a system to compensate people injured by the smallpox vaccine. On May 5, the Bush administration released $100 million to help the states run their programs.

Congress passed the new compensation law to reassure healthcare workers and emergency responders that the financial impact of adverse effects of the smallpox immunization would be covered by the government. Features of the new law include:

• Families of people killed by the vaccine and die without dependents are entitled to a lump sum payment of $262,100. 

• Estates of those who are killed and have dependents could choose the lump sum payment or up to $50,000 per year to make up for the deceased's lost wages. The payments would continue until the victim's youngest child reached age 18.

• Those who are totally and permanently disabled would get up to $50,000 per year for lost wages until age 65, with no cap.

• Those who are permanently but not totally disabled, and those with temporary disability, would get lost wages up to a maximum of $262,100.

On May 5, 2003, Tommy G. Thompson announced that the Department of Health and Human Services would release $100 million to the states to help the states "better prepare our nation for a possible smallpox attack and strengthen the public health infrastructure."

"Because a smallpox attack is possible, we must prepare our public health workers to quickly respond to protect the American public," Secretary Thompson said. "This additional money is part of our overall commitment to our state and local partners to build a stronger public health system to care for Americans in the event of any emergency, including a smallpox attack."

Concern from healthcare and emergency providers results from the fact that there as of April 25th there had been 53 adverse effects from the vaccine in 34,541 vaccinations. (see Table 1).   

 

Table 1: Adverse Events Associated with
Smallpox Vaccination Among Civilians

Adverse Event Total number of cases (January 24 - April 25)
Generalized vaccinia - Widespread vaccinia rash (ranging in severity from moderate to serious) involving sores on parts of the body away from the vaccination site resulting from vaccinia virus traveling through the blood stream 8
Inadvertent inoculation, nonocular - Spread of the vaccinia virus to another part of the body, except the eyes, caused by touching the vaccination site and then touching another part of the body, usually mild in severity 28
Myocarditis/pericarditis – Inflammation of the heart/membrane around the heart ranging from mild to life-threatening in severity 15
Ocular vaccinia - Eye infection that can be mild to severe (leading to loss of vision) usually resulting from touching the eye when vaccinia virus on your hand 2

 

Table 2: State by State Breakdown
 of Smallpox Vaccine Dose Shipments

State/Program # of Vaccine Doses Released, COB 4/25/03   State/Program # of Vaccine Doses Released, COB 4/25/03
Alabama 10,000   Alaska 300
American Samoa 0   Arizona 500
Arkansas 11,000   California 10,100
Chicago 4,200   Colorado 1,800
Connecticut 6,500   Delaware 700
District of Columbia 5,000   Florida 20,000
Georgia 900   Guam 0
Hawaii 4,500   Idaho 500
Illinois 10,000   Indiana 2,900
Iowa 1,000   Kansas 3,000
Kentucky 4,200   Los Angeles 9,200
Louisiana 10,000   Maine 3,000
Marshall Islands 0   Maryland 6,000
Massachusetts 1,500   Michigan 6,700
Micronesia 0   Minnesota 4,500
Mississippi 5,600   Missouri 5,000
Montana 1,000   Nebraska 4,000
Nevada 1,500   New Hampshire 3,000
New Jersey 5,500   New Mexico 5,000
New York 8,000   New York City 3,500
North Carolina 7,500   North Dakota 2,000
No. Mariana Islands 0   Ohio 6,500
Oklahoma 700   Oregon 400
Palau 0   Pennsylvania 10,000
Puerto Rico 100   Rhode Island 1,200
South Carolina 7,800   South Dakota 4,300
Tennessee 10,000   Texas 30,000
Utah 1,500   Vermont 2,000
Virgin Islands 0   Virginia 10,000
Washington 4,000   West Virginia 2,500
Wisconsin 2,500   Wyoming 2,600
Total # of Vaccine Doses  285,700


Table 3: State by State Breakdown 
of Number of Individuals Vaccinated 

State/Program # of Individuals Vaccinated, COB 4/25/03 TOTAL   State/Program # of Individuals Vaccinated, COB 4/25/03 TOTAL
Alabama 451   Alaska 94
American Samoa 0   Arizona 39
Arkansas 976   California 1,425
Chicago 50   Colorado 224
Connecticut 598   Delaware 107
District of Columbia 75   Florida 3,555
Georgia 134   Guam 0
Hawaii 173   Idaho 197
Illinois 148   Indiana 765
Iowa 475   Kansas 447
Kentucky 741   Los Angeles 212
Louisiana 1,106   Maine 39
Marshall Islands 0   Maryland 693
Massachusetts 77   Michigan 625
Micronesia 0   Minnesota 1,471
Mississippi 404   Missouri 1,253
Montana 89   Nebraska 1,388
Nevada 0   New Hampshire 275
New Jersey 657   New Mexico 130
New York 528   New York City 232
North Carolina 1,209   North Dakota 402
No. Mariana Islands 0   Ohio 1,721
Oklahoma 298   Oregon 79
Palau 0   Pennsylvania 93
Puerto Rico 7   Rhode Island 22
South Carolina 811   South Dakota 730
Tennessee 2,429   Texas 3,450
Utah 256   Vermont 83
Virgin Islands 0   Virginia 760
Washington 446   West Virginia 734
Wisconsin 754   Wyoming 404
Total # of Individuals Vaccinated COB 4/25/03 34,541
 

[Comment: The hard part for clinicians advising people on whether to participate in the program is weighing the known risk of the vaccine against the unknown risk of bioterrorism. I think the response to the immunization program would be better if information on the bioterrorism risk was made public. Then providers could make a more rational risk/benefit decision.  William L. Newkirk, MD, FACPM]