Senate Health, Education, Labor and Pensions Committee Holds Hearing on Smallpox Vaccination Plan

FDCH TRANSCRIPTS
Congressional Hearings
Jan. 30, 2003

Senate Health, Education, Labor and Pensions Committee Holds Hearing on Smallpox Vaccination Plan

KENNEDY:

    Thank you very much, Mr. Chairman, and I apologize, I wasn't here the earlier part of the hearing. We were down in the Judiciary Committee with some nominees.

    As I understand it, there's been a very slow process where the states have been signing on for the administration's programs. I understand now that I guess it's California, Connecticut and Vermont have started. New Jersey intends to start either tomorrow or the next couple days; Massachusetts, mid-February. But it's very slow going. And even in Connecticut I think Ms. Baker indicated that a small number of people that might have started but it's very, very extraordinarily limited in its coverage.

    And I think Senator Gregg has pointed to one of the real problems and challenges, and that is what kind of risk are we facing or asking people to take and what can they do about it? As I understand now, most of the private insurers will not compensate the workers if they take it and have an adverse, but that's been the position of most of the private insurance companies. So you have an option about suing the government, and that's not a very satisfactory situation.

KENNEDY:

    Basically, the people look on into it and they're talking about the kind of risks that you talked about, Ms. Baker. There's still a lot of questions that are out there, and it seems to me, as suggested, at least in the questioning of our chairman, unless we are going to develop some kind of compensation fund that's going to help meet the needs of people, as you've described it, we're just not going to get it done. My own state, the small hospital, Cooley Dickinson Hospital, in western Massachusetts -- the only reason I keep remembering it is because it's where I landed after my plane crash that probably saved my life -- they have indicated that they won't participate under the present system. And when I heard about that I asked my staff to look up under the hospitals, and there's a score of hospitals, more than 80 hospitals in 22 states, Medical College Virginia at Richmond, Vanderbilt University, Children's Hospital, Philadelphia, Grady Memorial in Atlanta, all across the country, the list goes on. I'll put it in the record.

    So it seems to me that whatever we're going to do we have to get this up and going is what I'm hearing from our panel. They talked about different other features. Do you believe that that's -- most of you believe that that's a fairly essential part before we're ever going to get a real active program in place, Ms. Baker? I'll just give it and hear the panel quickly, and then I have just one or two questions I'd like to hear from the panel.

BAKER:

    Right. The risks can probably be debated, as Dr. Bicknell said, but, you know, we have old history to rely only at this point, perhaps. But that alone is a risky enough decision to make. To think that you're going to step up and do something that you'll have no safety net is another serious risk. And I think that that can be eliminated and safely taken care of, and I don't know why hospitals wouldn't want to participate if they're going to just take on a huge burden.

    Our hospital, Jackson Memorial, has agreed to pay seven days, 100 percent AD time on the front end if someone's sick. But then it puts you in the predicament of the next after that worker's comp kicks in at 66 percent. So it's still a problem that there's no adequate compensation. That certainly has to make the person, whether it's the hospital or the health care worker, more willing to participate if there are some safety nets in place, financially.

KENNEDY:

    Others want to make a brief comment?

ABRAMSON:

    The only other point I want to make is that if we -- though I think the controls in the hospital setting will be good, if we accidentally inoculate one of our patients, that patient has no recourse, and that has a sense of unfairness to it.

KENNEDY:

    And the pressures hospitals generally are under at this time in terms of the cutbacks, the additional kinds of pressures that they're under. Very quickly, Mr. Bush, are you --in terms of the production of the smallpox vaccine, are you on time? Is Acambis on time and on budget?

BUSH:

    Yes.

KENNEDY:

    Good.

BUSH:

    We're making very good progress.

KENNEDY:

    And can you indicate the interested -- here, Dr. Abramson and Dr. Bicknell, I want to welcome Dr. Bicknell from Massachusetts, Boston University. When you talked about your higher ups, I know just what you were talking about. Dr. Silver (ph) is a -- he's a good friend of mine, and he's a great guy, but he's -- I understood what you were saying.

    (LAUGHTER)

    Let me just quickly, because our time is moving about, both of you, on the support, giving out the vaccine to the public, anyone who wants it, we get asked about that. Just very quickly, I'd ask maybe the panel that and then my time is already up. Do you want to just take a quick each of you -- go ahead.

ABRAMSON:

    We are not in favor of giving it out to the public for the reasons I've stated. I am particularly concerned that day care is a whole different scenario than it was 30 years ago, and we have adults -- even if we just do adults, those adults are taking care of our children in day care. I think the chances of cross-inoculation, the worker to the child, is substantial, and these parents have not volunteered their children to be inoculated. So in a low-risk situation, which is what we have been told, as I sit on the Advisory Committee on Immunization Practices, we have been told the risk is not zero but small. Under the scenario, we are not in favor of it.

BICKNELL:

    Yes. I'd like to say a couple of things. I think the threat issue is an important one, and it seems to me that the determination of threat is not something that physicians can do, public health people can do. That's a national determination. And if the threat is non-trivial, then the question becomes what to do.

    I would agree completely with Dr. Abramson that I think pre- event, pre-attack vaccinating children is not merited. I think the point about day care is a very good one. I think that could be handled. I do, though, think once we have the data, we'll have an enormous amount of data. We've got military data now, in a few months we'll have lots of data, we'll go to 10 million, we'll really know the risks of transmission.

    The transmission, 114 contacts from 14 million people vaccinated, I think if day care is a threat are, let's segregate, plan about that, make sure that people do use the dressing, urge maybe that day care workers do not participate, whatever it may be. But the more vaccination of adults that's done before the fact, the easier it is to control afterwards. There's absolutely no doubt about that.

    And in adults this is -- I think the historical data shows and I think we will find as the data emerges from the military and others, that we are dealing with a vaccine that is not going to be killing adults the way that we've been hearing about or even having the serious adverse events. So I would urge after we get phase two make it widely available to the adult population with appropriate protections. And if people are working and living with high-risk people, hey, don't do those.

KENNEDY:

    Just give each other who want to make a comment a brief comment.

SCHULER:

    I think it's important also to get through at least a phase two and then provide the public with a choice in terms of whether they can proceed or not.

GREGG:

    Anybody else want to comment on Senator Kennedy's...

KENNEDY:

    Thank you, Mr. Chairman.