Smallpox compensation legilsation passes: Adequate funding still needed for successful program

Nevada RNformation, Aug 2003 by McKeon, Erin

WASHINGTON Watch

Last December, the Bush administration announced plans to vaccinate 10.5 million civilian health care workers and first responders against the smallpox virus. RNs, among other frontline workers, are a primary focus of this effort. The ANA was disappointed that the administration went forward with plans to vaccinate 500,000 health care workers on January 24 despite our repeated calls to delay the process until key health and compensation concerns could be adequately addressed.

In February, representatives Lois Capps (D-CA) and Henry Waxman (D-CA) and senators Barbara Mikulski (D-- MD) and Ted Kennedy (D-MA) worked to develop legislation that meets the concerns of the ANA. These proposals contained grants to states that would defray the costs of offering education, prescreening, and medical surveillance, as well as a compensation program with uncapped wage replacements and mandatory funding.

Faced with lagging participation in the vaccination program, the Bush administration formulated its own compensation plan in March. This proposal (HR 1463, S 719) did not contain grants to states to support the administration of the vaccine, arbitrarily capped wage replacements, and contained a coercive time frame that ends compensation after 180 days.

A month later, the administration forced a vote in the House of Representatives on HR 1463, which the ANA actively opposed. The bill was successfully rejected on March 31 by a vote of 206 to 198.

After the House victory, the ANA continued intense negotiations with the White House and Congress. These negotiations resulted in the final Smallpox Emergency Personnel Protection Act of 2003 (PL 108-20). This law clarifies the role of the federal government in assuring the proper administration of smallpox vaccinations and establishes a compensation program for individuals injured by the vaccine. Preliminary funding for this law was included in the FY 2003 supplemental appropriations bill (HR 1559) and signed into law April 16 by President Bush.

The ANA's enthusiasm is tempered by concerns that the law fails to mandate adequate injury-prevention activities. The law requires the federal government to ensure that state and local vaccination plans establish procedures regarding pre-vaccination education, medical screening, and adverse event surveillance.

The ANA championed efforts to authorize grants to states that would require the implementation of aggressive education and prescreening efforts-rather than the softer plan review requirement contained in the compromise.

"Members of the U.S. armed services have rightly received personalized education, and free and confidential prescreening prior to the administration of the vaccine," said ANA president Barbara Blakeney, MS, APRN, BC, ANP. "This process properly screened out one-third of the potential recipients. But Congress's final legislative package still does not ensure that nurses and other health care workers will receive similar support."

The costs associated with the program (estimated at $250 per vaccination) are already causing obvious hardships to participating states. The ANA is concerned that education, prescreening, and surveillance efforts will prove too costly to maintain as the program is vastly expanded to reach the administration's revised goal of 2 million vaccinations (as of press time, 32,000 civilians had received the vaccination). The supplemental appropriation includes $100 million to fund these efforts, much less than the $500 million needed to cover the cost of vaccinating 2 million people.

The Compensation Package

The final smallpox compromise also authorized as much as $50,000 annually in lost wages to anyone permanently disabled as a result of vaccination. Although successful in removing the proposed cap on wage replacements, the ANA is disappointed that these payments will cease when the injured person reaches age 65. The temporarily disabled could collect the same benefit, up to a lifetime maximum of $262,000. Spousal benefits in cases of death would also be $262,000, less any lost wages paid prior to the death.

The guardian of surviving children would be offered a choice between the $262,000 flat payment, or $50,000 annually until the minor turns age 18.

The ANA urges readers to consider the decision-making tree and other materials provided on its Web site prior to volunteering to undergo the vaccination. For more information visit www.nursingworld.org/news/disaster/smallpox.htm.

Erin McKeon is an associate director in the American Nurses Association's Department of Government Affairs.