State starts smallpox program Federal officials urge hospitals to move faster

AUGUSTA – A cadre of 39 state health workers received the smallpox vaccine last week, and some hospitals are finally getting on board with Maine’s bioterrorism emergency plan. Federal officials, though, say the state isn’t moving fast enough.

Dr. Dora Mills, director of Maine’s Bureau of Health, said she was contacted last week by Tommy Thompson, secretary of the federal Department of Health and Human Services, and Dr. Julie Gerberding, head of the Centers for Disease Control. Concerned that the federal government’s goal of having 10 million health care workers and emergency personnel vaccinated by early summer is falling far short of its mark – less that 13,000 nonmilitary vaccines have been administered so far – Thompson and Gerberding are contacting Mills and her counterparts in many states.

Although Mills said there was no discussion of a new or specific bioterrorism threat, “We are being strongly urged to move ahead as quickly as possible,” she said.

Beginning last fall, the state asked all hospitals to recruit and prepare willing volunteers for the smallpox vaccine, but so far only Maine Medical Center in Portland is fully prepared to follow through with employee vaccinations. In the past week or so, however, Mills said, about a dozen other hospitals in southern Maine have committed to vaccinating some of their staff, which she estimates will yield about 450 inoculated workers toward the statewide goal of 600.

Northern hospitals, including those in Bangor, have said they will recruit and train volunteers, but they are waiting for a more immediate threat before vaccinating. Hospitals continue to cite unresolved issues of liability and compensation. They also point to the impact on staffing, the potentially serious complications of the vaccine and a perceived low risk of bioterrorism for their reluctance to ask staff to roll up their sleeves.

Erik Steele, head of emergency planning at Eastern Maine Medical Center in Bangor, said the hospital’s cautious approach to vaccinating staff members is “the responsible thing to do.” He said he’ll look to the state to provide updated information on his concerns. “As our questions are answered, we will reconsider our position,” he said.

“A lot of these issues are about as resolved as they’re going to get,” Mills said. The Homeland Security Act protects hospitals and employers from liability suits, worker’s compensation coverage seems likely and a new federal fund is being established to compensate individuals and their families that suffer severe vaccine-related reactions, she said.

Mills said she’ll be talking with northern hospitals this week to see if there are ways the state can remove barriers to their full participation. For example, in response to hospitals’ concerns about staffing problems related to training requirements, she said the state may be able to compress training time and combine it with screening and other preparation.

Meanwhile, public health workers who received the vaccine last week are being evaluated this week. Though there have been a range of responses, so far no unexpectedly severe or adverse reactions have been reported.

State epidemiologist Dr. Kathleen Gensheimer, for one, said she feels like she’s been hit by a truck. She’s been running a fever and feeling exhausted, and the vaccination site on her upper arm has shown a “more exuberant” response to the skin-pricking inoculation than she expected.

At the other end of the “normal reaction” spectrum is Dr. Anthony Tomassoni, medical director of Maine’s emergency preparedness office. Tomassoni said he’s been “underwhelmed” by his body’s response.

He never developed even a low fever, and the tiny blister that formed on his arm on the second day stayed small and was drying up by day six. Overall, he said, the experience has been anticlimactic.

“We’ve all been so immersed in the publicity surrounding the vaccine [that] you really wonder what will happen,” he said.

Another five or 10 state workers will receive the vaccine in a couple of weeks, along with the first round of hospital workers from southern Maine hospitals. The date has not been confirmed, but Mills said it has been moved up by several weeks in response to federal concerns.

The 50 or so inoculated state health workers will be charged with training and vaccinating the widening circle of hospital staff. Under the plan, hospitals will partner with the state to train a network of smallpox-immune teams that will move into action in the event of a release of the deadly virus. Regional teams will be available to administer a full-scale public vaccination plan in case of such a release, as well as to provide direct medical care to anyone who is exposed.