in contacts of people who received the oral polio vaccine in the National Vaccine Injury Compensation Program. Without reimbursement for these losses, the committee fears that some, perhaps many, public health and health care workers will decline vaccination, thus undermining the effectiveness of the program’s implementation.

Some of these adverse reactions may be covered by state worker’s compensation programs. However, there is much uncertainty surrounding the types of vaccine adverse reactions and circumstances leading to those vaccine adverse reactions that would be coverable under each state’s worker’s compensation law. Public health and health care workers who are considering vaccination need accurate information about the rights and protections that are available to them under their state’s worker’s compensation law. The committee recommends that CDC and its state and local public health partners immediately work to clarify each state’s worker’s compensation program’s position on coverage for smallpox vaccine–related injuries and illnesses for workers covered under their programs.

At the time of the issuance of this report, the implications of the Homeland Security Act were not fully understood by many of the state and local public health and health care partners in the smallpox vaccination program. This led to confusion and concern that individuals who have volunteered to be part of the nation’s defense against bioterrorism—the public health and health care workers who participate in precautionary vaccination and their family members who are at risk of accidental inoculation—are inadequately protected financially from liability, compared to the much smaller group of public health and health care workers who agree to administer the vaccine (AHA, 2002; McDonough, 2003).

The committee heard during discussion that these concerns have been raised with DHHS and other administration officials (SEIU, 2002). These concerns may change as more is learned about the adverse reaction rates during phase I of the vaccination program. The committee also understands that the 108th Congress might address these issues. The committee urges timely attention and communication about the progress of these deliberations. Without this, concerns about the financial burden for caring for the adverse reactions of the smallpox vaccine (and the sobering consideration that some small but real number of vaccinees or their contacts could die or suffer permanent disability subsequent to vaccination) could greatly decrease the number of people who volunteer for smallpox vaccination. This could seriously affect the program’s achievement of its overall goals of increasing U.S. terrorism preparedness. The committee recommends that CDC and DHHS support all efforts, some of which might be administratively or legislatively bold and creative, to bring this issue of compensation for smallpox vaccine adverse reactions—including those reactions that oc-

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