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(By The Associated Press) -- The needle that delivers smallpox vaccine is only about 3 inches long, with two tiny prongs at one end. But for legions of health care workers nationwide, it symbolizes a complex personal choice.
These doctors, nurses and public health officials must decide whether to volunteer for the vaccine -- some as early as Friday -- so they could treat patients in a bioterrorist smallpox attack. But the vaccine itself can cause fierce side effects and even sicken others close to those vaccinated.
As an emergency-room nurse in Milwaukee, Lisa Hass-Peters knows she is a prime candidate for a smallpox response team.
But her husband, Jeff, has had two liver transplants, leaving his immune system weakened. That means the smallpox vaccine -- made from a live virus related to smallpox -- could make him sick. He could be infected from the scab on her arm caused by the vaccine.
"I didn't hesitate to decline," said Hass-Peters, who works at Milwaukee's Froedtert Memorial Lutheran Hospital. "If I truly was exposed, I guess I would be weighing my options again. But I don't feel a threat at this particular moment."
The government plans to vaccinate nearly 500,000 health workers, with as many as a dozen states ready to start on Friday. Strictly voluntary, the vaccine is aimed at creating smallpox response teams for treating patients in an attack.
But some health care workers -- and hospitals -- are refusing because of the risks from the vaccine itself.
Though in the minority, major hospitals refusing to vaccinate their workers range from Colorado's largest chain, Centura Health with 10 hospitals, to Grady Memorial Hospital in Atlanta, home of the Centers for Disease Control and Prevention, which is shipping vaccine to the states.
The risk of a smallpox attack is unknown, and the chance that any given person will be exposed is small, an advisory panel for the Institute of Medicine said recently in urging the government to go slower with the vaccinations.
But the risks of the vaccine are well-known. Some people may have sore arms and fever or feel sick enough to miss work. As many as 40 people out of every million vaccinated for the first time will face life-threatening reactions, and one or two will die.
The vaccine is not recommended for people with skin problems, such as eczema, or those with weak immune systems, such as HIV, transplant or cancer patients. The government says even people with close family members in those categories should be screened out.
But sometimes those guidelines aren't enough. Nurse Stephanie Woodrum was struggling with the vaccine decision when a sickly patient at her hospital in South Charleston, W.Va., told her she was worried about being infected by a vaccinated hospital worker.
"My heart just broke for her," said Woodrum, who works at Thomas Memorial Hospital. "She's scared, and she has every right to be. Honestly, have I made up my mind? No, I haven't. It's a real difficult decision for me."
In Pima County, Ariz., county health chief Dr. Elizabeth MacNeill will delay vaccinations for her and her staff for now; but eventually, she'll comply.
There are only four doctors on her staff, and MacNeill personally would be called to respond to a smallpox case.
"If I immunize someone in my program and she has a serious side effect, where do I send her?" she said. "Who pays for that care? If she misses work, how is she compensated? If she ends up with brain damage, how is she covered?"
Health care unions have criticized the Bush administration, accusing it of cutting corners on screening and training. They also worry that people who have side effects or miss work may not be fully compensated; the government says it is working on a plan.
Dr. James Bowes, the chief health officer in Frederick County, Md., believes adequate precautions have been taken. He said he will get the shot and expects several dozen of his staff will as well.
"I think the adverse reactions will be minimal if they're well-screened," he said. "I have no problem with it."
But Sharon Eolis, a nurse practitioner at Cabrini Medical Center in Manhattan, takes a more cynical view. She believes the Bush administration is urging the vaccine simply to "build up a little hysteria" ahead of an attack on Iraq.
She does not want to put herself in danger absent an actual smallpox attack.
More important, she says, are the patients at her hospital who might be accidentally infected.
"The risk just outweighs the benefit here," she said. "The most important thing in a nurse's pledge is first, do no harm."
(Copyright 2003 by The Associated Press. All Rights Reserved.)