President Bush asked more than 500,000 healthcare workers across the nation to volunteer for smallpox vaccination as part of the administration's pre-emptive response to a possible bioterrorism attack.

The president's December request drew a cautionary response from AFT president Sandra Feldman, who is concerned about the "rushed pace with which the Bush administration wants to implement its plan."

Specifically, the White House and the Centers for Disease Control and Prevention would like to have designated healthcare workers vaccinated within 30 days of initiation of the program, which, at press time, was scheduled to commence Jan. 24.

The plan "seems hasty," Feldman said in a Dec. 13 statement, especially if there is no imminent danger of a smallpox attack, which President Bush himself noted in his announcement. "This approach could lead to unnecessary loss or risk of life and costly oversights due to the rush to action, which in turn could threaten our already strained healthcare system," Feldman said. "At the very least, there needs to be a comprehensive preparedness plan that includes the use of safe needle devices, free medical screening, and training conducted before the administration of vaccinations to avoid any potentially deadly mistakes."

The union also insists--and is taking its case to Congress--that healthcare workers' rights also must be protected, including the right to decline the vaccination, as well as paid administrative leave for workers who may require time off due to the vaccination's potential side effects, including a possible period of contagiousness.

Public health workers are the obvious work corps to take the lead in the president's plan. "There is certainly controversy," says Ann (Lowekamp) Dec, president of the Baltimore County Federation of Public Health Nurses, an affiliate of AFT Public Employees, referring both to questions about the vaccination's safety and to employee concerns about illness brought on by the vaccination and work assignments.

"We know there are possible serious side effects," Dec says. "It is voluntary for us to receive [the vaccination] unless there is an actual attack--and many of the nurses have volunteered. But there are outstanding issues regarding sick time, such as will we have to use our own sick time? If we become seriously ill, will we receive Workers' Compensation?"

Dec did not volunteer for the vaccination because she has dermatitis, which is one of the contraindications of the smallpox vaccination. Lee Masaschi, who works with Dec at the Eastern Family Resource Center in Baltimore, did not volunteer for the vaccination either.

"I'm waiting to see the logistics of the whole thing," Masaschi says. "How are these response teams going to be utilized [and what will be] the chain of command? Are we going to be pulled off our regular assignments? Baltimore County is a large health department compared to other jurisdictions in Maryland. I [want to know] if these first-response teams will be utilized in smaller areas that don't have the staff."

In addition to employee concerns over work assignments and illness stemming from the vaccination, the AFT has identified other safeguards that need to be in place to protect members, including confidential, voluntary HIV testing, pregnancy tests and screening for chronic illnesses--such as diabetes, atopic dermatitis, eczema and cancer--that may be associated with immune suppression.

The AFT maintains that these services should be provided free of charge to healthcare workers prior to vaccination.

"It is a real threat and we have to protect ourselves--and the public," Dec notes. "But the question with any vaccination is: Are the positives going to outweigh the negatives?"