A Republican-crafted bill compensating people injured or killed by the smallpox vaccine was defeated in the House Monday amid debate over the size of the payments, and the troubled vaccination program was temporarily suspended in at least ten states.
State officials said they were suspending the program to give federal officials time to investigate the vaccine's role in three heart attack deaths.
Despite widespread agreement that compensation is needed for people injured or killed by the vaccine, which carries rare but serious risks, the House has been unable to agree on a package of benefits.
On Monday, the House defeated, 206-184, a GOP-backed bill establishing a set of payments. Republicans were invoking rules needing a two-thirds majority, but they failed to get even a simple majority.
It was a rare defeat for House Republicans, who were not sure what to do next. They were considering attaching it to a spending bill moving through Congress now.
Democrats complained that the Republican bill was not generous enough to persuade health care workers and others to sign up for the vaccine.
All involved with the government's smallpox program believe it's imperative that Congress establish payments for those injured or killed by the vaccine. Congress has already barred most lawsuits that might stem from the vaccine, and state workers' compensation programs offer only spotty coverage.
The number of people volunteering for the shot is well below what was expected, partly because of concerns that injured people won't be compensated for medical expenses, lost work time and other expenses.
The national vaccination program also has suffered from questions about the relationship between the vaccine and heart problems after three people died of heart attacks after being inoculated.
While experts suspect the vaccine is probably not to blame, nine states — Arizona, California, Illinois, Maine, Michigan, Nevada, New York, Vermont and Washington state — have suspended their programs during an investigation.
An tenth state, Connecticut, ordered a two-day suspension. And in Idaho, state officials recommended that that local health districts temporarily suspend vaccinations.
The Centers for Disease Control and Prevention told states Monday that it is now recommending that people with heart disease — or at risk of heart disease — refrain from vaccination. The CDC was sending out new forms to help states screen people for the vaccine.
Still, some predicted the heart problems would continue to hold the program back.
"Even if this is not related to the vaccine at all ... a lot of people have been spooked to begin with," said Dr. Elizabeth MacNeill, chief medical officer for the Pima County Health Department in Arizona. "I think this will make it even harder to get people to volunteer."
The heart attacks have also sharpened demands that Congress act on compensation. While heart attack has never been associated with the smallpox vaccine, known risks include terrible rashes, blindness and life-threatening infections.
The Republican bill, based on a proposal from President Bush, would provide $262,100 if a person should die or be permanently and totally disabled by the vaccine. The amount is based on an existing program to compensate injured police and firefighters.
Those less severely injured by the vaccine could receive up to $50,000 per year in lost wages, up to a maximum of $262,100, if they are out of work for at least five days. They could also get unpaid medical expenses.
The Democrats' version would provide the same $262,100 for those who die or are permanently disabled but would pay $75,000 per year in lost wages, with no lifetime cap.
Additionally, the Democrats would guarantee the money, while the Republican bill would force this program to compete for funding each year.
There is similar disagreement in the Senate, where a committee was considering the matter later this week.
House Republicans, fearing the Democratic plan might pass, were trying to arrange things so they would not have to vote on it. They argued their version was generous enough.
"If these caps are good enough for our public police officers and our firefighters who die in the line of duty, then I submit that indeed they are good enough for this program as well," said Rep. Billy Tauzin, R-La.
Democrats said the GOP compensation package would persuade too few workers to be vaccinated, given the known risks.
"The bill that is on the floor today will not give nurses, firefighters, other first responders the assurances that they need to be vaccinated," said Rep. Lois Capps, D-Calif. "It will not work."