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Nurses: Smallpox plan is a tough call
01/20/03
By CHRISTMAS McGAUGHEY
Staff Reporter
Nurses here and across the country are facing a choice that some say
is the toughest of their careers.
In preparation for a potential bioterrorist attack, the federal
government is asking for 500,000 health care workers to voluntarily
receive the smallpox vaccination in coming weeks.
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"It is the most complicated thing I’ve ever had to look at as a health
care professional. Most things are clear-cut and it’s easy to
determine whether you will or you won’t," said Deborah Thomasson,
director of public health nursing for the Alabama Department of Public
Health.
Her thoughts carry particular weight since she oversees all public
health nurses in the state and works for the agency that will
administer the first wave of vaccines here.
"It’s a personal decision — that’s the hard thing," Thomasson said.
"You have to be clear in your own mind that it’s not going to be too
hazardous to you or your children."
In Alabama, the first phase of the federal initiative calls for the
vaccination of up to 12,000 doctors, nurses and health workers.
They would receive not the smallpox virus but another virus — named
"vaccinia" — which provides immunity.
Mobile County has 5,000 registered nurses, while Baldwin County has
about 1,200.
Some area hospital administrators have been meeting with their nurses
and staffing heads for input; others are not discussing it until
leaders decide whether their insti tutions will participate.
As the vaccine start-up looms late this month or in early February,
the American Nursing Association continues to demand that the U.S.
Department of Health and Human Services address several concerns.
In a letter released Friday, the ANA asked the Bush administration to
delay administering the vaccine "until key concerns are addressed
about the health and welfare of those who are immunized." Those
concerns include:
Health and safety: The possible transmission of the vaccinia virus to
others during two to three weeks following vaccination.
Staffing: If workers become ill from the vaccine, it could leave
hospitals short-staffed.
Cost issues: The ANA asks the government to guarantee "the right of
coverage of medical costs associated with receiving the vaccine" and
"compensation for lost time at work ."
Job protection: ANA officials say they want a written guarantee that
there will be no "job discrimination or retaliation for refusing to be
vaccinated."
Juanzetta Flowers, president of the Alabama State Nurses Association,
said "the worst thing to me is that the government is not thinking
through what they’re saying about the protection."
Federal officials have said that the government, not area hospitals,
will shoulder liability. But Flowers said that anyone who suffers harm
will have an extremely difficult time suing the federal government.
And, she said, nurses are worried about their patients.
"Our patients are already so sick when they’re in the hospital
nowadays. They’re already immuno-compromised," Flowers said. Referring
to the vaccinia virus, she said, "This is not a benign thing."
Some area nurses and doctors said their decisions are complicated by
the fact that they have no way to know the actual potential for
bioterrorist attack.
"Is this a real risk, or is the government making a lot of hype about
it?" said Karen Adams, registered nurse who is director of the
emergency room at Thomas Hospital in Fairhope.
Dr. Mike McBrearty, medical director at Thomas, said, "Does somebody
know something we don’t? There’s been an almost 180-degree turn from
the federal government on this. First, they wanted no one to get
vaccinated, now they want to start vaccinating a large number of
people."
He added, "We are cautiously dragging our feet to see what will happen
with this first wave."
Said Adams, "If we get sick, who’s going to cover our salary, our
hospital bills, our medicine?"
Toni Darbe, a registered nurse who works in Thomas’s emergency room,
said she has decided against taking the vaccine. "I don’t feel like
it’s that big a threat, compared to other things," she said. "I’m not
sure the government is being so up front with us about all the
information. They said before that it wasn’t a big deal."
Yet another issue, according to Dr. Herbert Stone of Mobile Infirmary
Medical Center, is the "relative lack of information" about the
vaccine.
"Most of these studies about the implications of the vaccine were
actually done 40 years ago, prior to the eradication of smallpox," he
said.
Doctors, he said, probably are still willing "to go out on a limb from
a personal standpoint because you’re sort of mission-directed. …You
want to respond, and you’ll do what you have to, but you don’t want
that response to be foolhardy or harmful to the people you’re trying
to protect."
Lovie McAboy, president of District 8 of the Alabama Nurses
Association said that nurses in Mobile, Escambia and Baldwin counties
have been talking about the vaccine.
"They are concerned about their families, their jobs, their
co-workers, and concerned about themselves," McAboy said. There are
always risks with vaccines, she said, and the smallpox vaccine is more
hazardous than most.
"I don’t know if people are going to be jumping on the bandwagon and
taking it, or if they are going to be standoffish," she said. She
added, "With all this chemical and germ warfare going on, you don’t
know what is going to happen."
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