Smallpox vaccination: the health-care workers say no

The Bush Administration’s plan to vaccinate health-care workers against smallpox struck me when it was announced as a bad compromise between vaccinating no one and vaccinating the entire population (or maybe the entire population of people who have been vaccinated before). I was perturbed enough to call an acquaintance now holding a high position in the Administration, running a unit that might have been expected to have been involved in thinking the problem through. That official referred me to a subordinate, who listened to my back-of-the-envelope analysis and said he’d check it out and get back to me. He did in fact call back a couple of days later, saying roughly, “It looks to us as if you’re probably right, but we didn’t get consulted. This one was called at the very top.”

Apparently, the analysis wasn’t the only thing the Bush crew skimped on; they also didn’t bother to do the necessary spadework with the health-care workers themselves. So now that the program has been rolled out, the workers are refusing the shots in droves, leaving the strategy in even more of a mess than it otherwise would have been.

Part of the problem seems to be that workers who have reactions to the shots severe enough to keep them out of work for a while would have to rely on the notoriously inadequate worker’s compensation system to cover their health care costs and lost earnings. (Perhaps if their lobbyists had been somewhat more generous to Republican campaign funds, someone in the Administration would have considered their interests before proposing a plan affecting their interests.) Now you might say — the editors of the Wall Street Journal do say, in an editorial dated today and quoted in Phil Carter’s Intel Dump — that the country needs to have these people vaccinated, and that they ought to be patriotic enough to do the right thing. But on the other hand you might say that if the country needs them vaccinated, then the country damned well ought to pay the full cost of the vaccination, rather than leaving the risk on people few of whom are rich enough to benefit from a cut in dividend taxation.

[Of course, the Bush Administration hasn’t exactly been setting a shining example of putting the national interest first in what it keeps saying is wartime; I’m offering a prize for the first reader who can cite an instance in which the administration has forgone some partisan advantage, neglected to push some favored proposal, or accepted something it would otherwise have opposed, in order either to enhance national unity or deal with the practical necessities of fighting terrorism. Remember, they’re still proposing to finance this alleged war with tax cuts for their contributor base. And of course the editors of the Wall Street Journal aren’t about to forgo the opportunity for a little union-bashing, it being well known that accusing people you hate anyway of lacking patriotism is a good way of ensuring their cooperation.]

Now the Administration is finally developing a compensation program to take care of the health care workers who will get sick from the shots. But I doubt that alone, especially coming so late in the process, will do the job. Someone needs to make the case that the program makes sense, to lay out clearly the threat we face and the options for dealing with it. If singling out health care workers to be vaccinated — in effect making them the guinea pigs in a huge experiment — is justified, then let someone demonstrate that proposition in the face of critical questioning.

Even that won’t do the job entirely. The California Nurses’ Association, for example, is resisting the vaccinations at least in part because it opposes the Administration’s plan to invade Iraq. That strikes me as an intolerable mixing of roles; the CNA ought to defend its members’ interests, and is free to express its political opinions, but nobody put them in charge of foreign policy. But I doubt that ideological nonsense of that sort is a major problem here. The problem is a plan that may be poorly conceived and has certainly been poorly explained, combined with a failure to consult the opinions, or consider the interests, of the heath care workers that they and their representatives could reasonably interpret as an expression of contempt.

As the Lord tried to explain to Moses [Num. 20:1-13], bad things happen if you just strike the rock: you have to speak to the rock.

UPDATE For a dissenting view, see Virginia Postrel, She quotes this piece by Jonathan Rauch, arguing that reluctance by health-care workers will make it harder to mount the full national vaccination that he thinks (and I tentatively agree) is necessary. But why criticize the health-care workers for doing something that will hold up a program that no one in power has proposed?

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com