The Heartland Institute
(HI is a libertarian think tank that aims to promote social movements in support of ideas such as parental choice in education, market-based approaches to environmental protection, privatization of public services, and deregulation following the principle that property rights and markets do a better job than government bureaucracies. Supported by private contributions, HI does not accept government funds or conduct "contract" research for special interest groups.)
CHICAGO -- Thumbs down on smallpox vaccine program: Fewer than 1 percent of targeted first responders were vaccinated by February's end.
By Conrad F. Meier
Health care professionals nationwide are refusing to be inoculated against smallpox, worried about the vaccine's side effects and not sure the threat of a biological attack justifies the risk posed by vaccination.
Federal officials hoped to inoculate almost 450,000 health care workers in February, the program's first month. Despite President George W. Bush's request for voluntary participation, the vaccination rate came in at about 1 percent of the goal. As of the end of February, just 4,200 people in 27 states had been vaccinated. Many hospitals have said they will not participate.
Health and Human Services Secretary Tommy Thompson was disappointed by the response. "I think there are a lot of people who believe that it's not an issue and haven't seen any evidence that they should be concerned about a smallpox epidemic."
The first round of the federal vaccination program targeted members of first-response public health teams. They are most likely to encounter contagious patients and would be needed to care for sick people in the event of a chemical attack.
An official at the Centers for Disease Control and Prevention explained to Health Care News that the vaccine is risky. It is made with a live virus that can infect the body. Experts estimate between 15 and 50 people of every 1 million vaccinated for the first time will face life-threatening complications, and one or two will die.
Dr. Thomas Mack, a professor of preventive medicine at the Keck School of Medicine, University of Southern California at Los Angeles, recently told Medscape: "Vaccinating large numbers of staff identified by the hospitals as well as the general public is a mistake, because the deaths from vaccine complications will outweigh any limited increase in protection. Mass vaccination will guarantee a few deaths."
Katharine Eaves, a nursing supervisor from Los Angeles, told the Washington Post: "There is a period after vaccination where a person is infectious and should not be at work or caring for patients. That's two to three weeks. I can't have my staff at home for that long."
The Post also quoted Robert Scates, a representative of the Chicago firefighters union, as saying: "I'm not going to take (the vaccine). I know too much about it. I was born in 1946, so I had the smallpox vaccine when I was growing up. As far as I'm concerned, I've already had it."
The last known U.S. smallpox case was in 1949, and routine vaccinations against the disease ended in the United States in 1972. All stocks of the virus were supposedly destroyed, except for samples in special labs in Atlanta and Moscow. Experts suspect some of the Russian stock might be in the hands of hostile nations, including Iraq.
Anticipating the U.S.-led war in Iraq, Bush started the vaccination program last December. He ordered inoculations for the military, and the Pentagon says it is reaching its goal of inoculating 500,000 military personnel. Fewer than 10 soldiers reportedly had serious reactions. All have recovered.
The vaccine's risk has caused some to ask who will compensate those hurt by the vaccine, for lost wages and medical expenses. People hurt by other vaccines can tap into a federal compensation fund, but the smallpox vaccine is not covered. Some health care unions have urged their members to refuse the vaccine until the government can guarantee compensation for anybody injured by it. Some would be eligible for workers compensation, but those benefits often are skimpy.
"If everything is done perfectly, without any negligence, some percentage of people given the vaccine will be injured by it," Louisiana State University's Dr. Katherine C. Rathbun told the New York Times. "It's a dangerous vaccine and they will not be compensated under the law."
Thompson has said that he is working on a federal compensation program, but he has yet to formally present one. His plan, which will be subject to Congressional approval, is said to be based on a similar compensation agreement currently available to police officers and firefighters harmed in the line of duty. A public statement released last month by HHS explains that victims of adverse reactions to the smallpox vaccine would be compensated under rules established in the Public Safety Officers Benefit Program.
The plan currently pays a $262,100 benefit for death or total and permanent disability. In addition, individuals would be compensated for two-thirds of lost wages after the fifth day from work, up to a maximum of $50,000. HHS also states that some as yet undefined compensation would be made available to third parties who contract vaccina from medical response team workers who have been vaccinated.
Compensation for injury isn't the only issue raised by opponents of the vaccine program. Hospital administrators worry that vaccinated health care professionals could accidentally spread the virus used in the vaccine to patients, many of whom are weak and particularly susceptible to injury. Many administrators are not convinced the risk of the disease is greater than the risk of the vaccine.
One hospital to decline participation is Grady Hospital in Atlanta.
Carlos del Rio, chief of medicine at Grady, explains: "You have a disease that hasn't been seen anywhere in the world in nearly 30 years. The risk of the vaccine is higher than the risk of us having a case of smallpox."
CDC Director Julie Gerberding responds by saying she has been in meetings where intelligence information was shared, and she knows a real risk exists. So far, many remain unpersuaded.
In one interview, Dr. M. Ward Hinds, health officer for the Seattle-area Snohomish Health District, explained: "Hospitals are deciding the risk is so low as to be immeasurable." In his five-county region, just three of eight hospitals will offer the vaccine to their workers.
The unwillingness of first responders to participate in the vaccination program raises doubts about whether federal officials will move to the next stage of the plan, which targets as many as 10 million other health care workers, firefighters, police and other emergency early response personnel. In December, federal officials said the vaccination project would move seamlessly from the first to the second stages. But now, some are questioning whether it is even needed.
Leslie Fisher, infection control coordinator for Santa Rosa Memorial Hospital, is one who questions the need, saying: "You're taking healthy health care workers and asking them to undergo a procedure that has some degree of risk to it in the absence of a clear threat."
(Conrad F. Meier is managing editor of Health Care News.)
The Heritage Foundation
WASHINGTON -- Russia's flat-tax miracle
by Daniel J. Mitchell
It's never fun to admit failure. But Russia's 13 percent flat tax forces me to confess a certain degree of incompetence. For 10 years, I've been working in Washington to replace our convoluted tax code with a simple and fair flat tax. But as every taxpayer can attest, my efforts have not borne fruit.
Yet in Russia, President Vladimir Putin -- the former head of the Soviet KGB -- implemented a flat tax in 2001. Not only a flat tax, but a flat tax with a 13 percent rate, 4 percentage points lower than the supposedly "radical" plan espoused by Steve Forbes and former House Majority Leader Dick Armey. And it's been a big success.
Imagine how this makes me feel. I've tried to help reform the tax system in the United States, a nation the rest of the world considers the home of unfettered capitalism and free-market principles. Yet every year, our tax code gets bigger and more complicated. In Russia, by contrast, the flat tax has been in place for more than two years. And this reform took place in a nation still trying to overcome the legacy of more than 70 years of communist dictatorship.
Remember the saying: "To the victors go the spoils"? It must not be true. We won the Cold War, but Russia gets a flat tax while America is stuck with a Byzantine tax system based on class-warfare ideology.
But perhaps our luck will change. The Russian flat tax has been so successful that even American politicians might learn the right lessons. Let's look at the evidence: Russia's economy has expanded by about 10 percent since it adopted a flat tax. That may not be spectacular, but it's better than the United States, and it's very impressive compared with the anemic growth rates we see elsewhere in Europe.
It also appears, conventional wisdom aside, that a low tax rate doesn't mean less money for government. Over the last two years, inflation-adjusted income tax revenue in Russia has grown 50 percent. Why? Because people are willing to produce more and pay their taxes when the system if fair and tax rates are low -- exactly what former president Ronald Reagan predicted when he triggered America's economic boom with lower tax rates 20 years ago.
Ironically, the former communists in Moscow understand supply-side economics, yet liberals in Congress are still relying on the politics of hate-and-envy.
Interestingly, the flat tax is just one of several positive reforms enacted by Putin. Russia also has reduced the corporate rate of tax from 35 percent to 24 percent. (U.S.-based companies still pay 35 percent, the second-highest corporate tax among industrialized nations). Small businesses also get better treatment. The old system with high tax rates has been replaced by a new system where companies can choose either a 6 percent tax on gross revenue or a 15 percent tax on profits.
Of course, Putin can do more. Russia still needs to privatize inefficient state-run industries. It also would be nice if he supported President Bush in the Middle East; after all, Bush has supported Putin's flat tax.
During a state visit in 2001, Bush said: "I am impressed by the fact that (Putin) has instituted tax reform -- a flat tax. And as he pointed out to me, it is one of the lowest tax rates in Europe. He and I share something in common: We both proudly stand here as tax reformers."
The success of Russia's flat tax shouldn't surprise anyone. Hong Kong has had a flat tax for a long time, and it's been the world's fastest-growing economy over some 50 years. Indeed, there are growing signs that China may implement a flat tax in the near future.
Talk about a man-bites-dog story! One of the few remaining communist nations may get a flat tax before America. At this rate, the United States may wind up in the same category as France, Cuba and North Korea.
To be fair, Bush is moving America in the right direction. He already has pushed one tax cut through Congress (though most of it has yet to take effect). Now he is urging lawmakers to end the double taxation of dividends and expand Individual Retirement Accounts. All of these policies shift us -- slowly but surely -- in the direction of a flat tax.
It would be nice, however, if we got to a flat tax during my lifetime. And even if we implemented the flat tax because we didn't want to fall behind the rest of the world, at least I'll be able to tell myself that my efforts weren't wasted.
(Daniel Mitchell is the McKenna fellow in political economy at the Heritage Foundation.)