Letter from UFCW International President Doug Dority to Local Unions with Health Care Memberships

January 3, 2003

Dear Brothers and Sisters:

As you are probably aware, on December 13, 2002, President Bush announced the federal government's Smallpox Vaccination Program, a program that includes vaccinating approximately 500,000 health care workers against smallpox, to "better protect the American people against the threat of smallpox attack by hostile groups or governments," (Centers for Disease Control and Prevention (CDC) web site, December 18, 2002).

Under the program, the Department of Health and Human Services (DHHS) is working with state and local governments to form volunteer Smallpox Response Teams, which can provide "critical services to their fellow Americans" in the event of a smallpox attack. State and local public health departments were required to develop plans for the Smallpox Response Teams and submit them to the CDC by December 16, 2002. Health care workers who volunteer to be part of these response teams will be asked to receive smallpox vaccinations.

The President's program contains the following elements:

• January 24, 2003, or sometime thereafter, smallpox vaccinations of the initial group of volunteer health care workers will begin. Within 30 days, approximately 500,000 will be vaccinated.

• An additional 10 million "first responders" will be inoculated within 60 to 90days after the initial round of vaccinations.

The United Food and Commercial Workers International Union believes that the President's program, as currently described, has a number of serious flaws and gaps that will unnecessarily jeopardize health care workers, their families, and patients under their care if not resolved. The aspects of the program which should be addressed prior to volunteering are as follows:

• Training and education should be conducted, on work time, for all health care workers who may be asked to participate in the vaccination program. It is critical to the decision-making process that this training and education program be conducted prior to the vaccinations being conducted, and prior to asking workers to volunteer for the vaccine. The education sessions must be more than a packet of written materials. The training must be conducted by a competent, knowledgeable instructor who can answer questions raised about the vaccine and the program.

• Workers should be made aware that the smallpox vaccination carries significant risks. The vaccine infects you with "live" Vaccinia virus, that protects you against smallpox. The Vaccinia virus is not the smallpox virus and cannot give you smallpox, but it can cause severe reactions, complications, and even death. The education about the smallpox vaccination should include all aspects of the smallpox disease, transmission, the vaccination, and care of the vaccination site. Also, the risks of adverse reactions, both to the individual receiving the vaccine, as well as to others with whom that person comes in contact, such as family members and patients, must be discussed.

• Upon learning of the risks, no worker should be penalized in matters of pay, benefits, or job status if they decline the vaccine. There should be a clearly written policy in place that health care workers will not suffer discrimination for refusing to participate in any smallpox vaccination program.

• Understandable, informed consent forms should be used in the process of volunteering to be vaccinated.

• Confidential, free, and voluntary medical screening for conditions listed below should be provided to health care workers (this is not a complete list of contraindications). Health care workers should have a clear understanding if they are appropriate candidates for the vaccine. Individuals with certain conditions, or individuals who live with someone with these conditions, should not receive the vaccine. These conditions include: pregnancy, infection with HIV, cancer, and other illnesses that may be associated with immune system suppression, eczema, or other skin disorders.

• Health care workers who volunteer to receive the vaccine should not face loss of income. It has been reported that over 30 percent of people vaccinated can anticipate significant malaise and flu-like symptoms up to six days after vaccination. Workers who volunteer should be guaranteed paid administrative leave, if these symptoms prevent them from being able to come to work. They should not be made to use personal sick leave, unpaid leave, or vacation time.

• Compensation should be provided for personal or family/household medical costs resulting from vaccine-related illnesses or complications.

• A plan should be in place by the health care facility to protect immune-compromised patients from recently vaccinated health care workers.

• For health care workers who may be required to administer the vaccine, the federal Needlestick Prevention and Safety Act of 2000 requires the use of safer needles with integrated safety features to prevent worker needlestick injuries. Workers should be guaranteed that only needles with these integrated safety features will be used in the smallpox vaccination program. Safer bifurcated needles, the kind of needle used to deliver the smallpox vaccine, are currently available through at least one company, Univec.

While members who work in health care will have to make their own decisions as to whether they should volunteer to be vaccinated, we feel strongly that these issues should be resolved before a decision is made. We are providing local unions with this preliminary information in order to assist you in taking steps to ensure your health care members are protected. We are enclosing a fact sheet for distribution to members on the risks and contraindications to health care workers of the smallpox vaccine. The UFCW Occupational Safety and Health Office will continue to provide updated information available about the smallpox vaccine and the federal government's program through the UFCW's web site (www.ufcw.org) and fax. Please call the Occupational Safety and Health office or my office if you have any questions.