[Congressional Record (Bound Edition), Volume 149 (2003), Part 6]
[House]
[Pages 7862-7879]
[From the U.S. Government Publishing Office, www.gpo.gov]




          SMALLPOX EMERGENCY PERSONNEL PROTECTION ACT OF 2003

  Mr. TAUZIN. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 1463) to provide benefits for certain individuals with 
injuries resulting from administration of a smallpox vaccine, and for 
other purposes.
  The Clerk read as follows:

                               H.R. 1463

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Smallpox Emergency Personnel 
     Protection Act of 2003''.

      SEC. 2. SMALLPOX EMERGENCY PERSONNEL PROTECTION.

       Title II of the Public Health Service Act (42 U.S.C. 202 et 
     seq.) is amended by adding at the end the following part:

           ``Part C--Smallpox Emergency Personnel Protection

     ``SEC. 261. DEFINITIONS.

       ``For purposes of this part:
       ``(1) Vaccine.--The term `vaccine' or `smallpox vaccine' 
     means vaccinia (smallpox) vaccines, including the Dryvax 
     vaccine.
       ``(2) Covered individual.--The term `covered individual' 
     means an individual--
       ``(A) who is a health care worker, law enforcement officer, 
     firefighter, security personnel, emergency medical personnel, 
     other public safety personnel, or support personnel for such 
     occupational specialities;
       ``(B) who is or will be functioning in a role identified in 
     a State, local, or Department of Health and Human Services 
     smallpox emergency response plan approved by the Secretary; 
     and
       ``(C) to whom a vaccine is administered pursuant to such 
     approved plan--
       ``(i) during the effective period of the Declaration 
     (including the portion of such period before the enactment of 
     this part); and
       ``(ii) not later than the latest of--

       ``(I) 180 days after the effective date of the initial 
     interim final regulations implementing this part;
       ``(II) 120 days after becoming an individual in an 
     occupation described in subparagraph (A); or
       ``(III) 120 days after becoming an individual identified as 
     a member of a smallpox emergency response plan described in 
     subparagraph (B).

       ``(3) Covered injury.--The term `covered injury' means an 
     injury, disability, illness, condition, or death (other than 
     a minor injury such as minor scarring or minor local 
     reaction) determined, pursuant to the procedures established 
     under section 262, to have been sustained by an individual as 
     the direct result of--
       ``(A) administration to the individual of a vaccine during 
     the effective period of the Declaration; or
       ``(B) accidental vaccinia inoculation of the individual in 
     circumstances in which--
       ``(i) the vaccinia is contracted during the effective 
     period of the Declaration or within 30 days after the end of 
     such period;
       ``(ii) smallpox vaccine has not been administered to the 
     individual; and
       ``(iii) the individual has resided with, or has been in 
     contact with, an individual who is (or who was accidentally 
     inoculated by) a covered individual.
       ``(4) Declaration.--The term `Declaration' means the 
     Declaration Regarding Administration of Smallpox 
     Countermeasures issued by the Secretary on January 24, 2003, 
     and published in the Federal Register on January 28, 2003.
       ``(5) Effective period of the declaration.--The term 
     `effective period of the Declaration' means the effective 
     period specified in the Declaration, unless extended by the 
     Secretary.
       ``(6) Eligible individual.--The term `eligible individual' 
     means an individual who is (as determined in accordance with 
     section 262)--
       ``(A) a covered individual who sustains a covered injury in 
     the manner described in paragraph (3)(A); or
       ``(B) an individual who sustains a covered injury in the 
     manner described in paragraph (3)(B).
       ``(7) Smallpox emergency response plan.--The term `smallpox 
     emergency response plan' or `plan' means a response plan 
     detailing actions to be taken in preparation for a possible 
     smallpox-related emergency during the period prior to the 
     identification of an active case of smallpox either within or 
     outside the United States.

     ``SEC. 262. DETERMINATION OF ELIGIBILITY AND BENEFITS.

       ``(a) In General.--The Secretary shall establish procedures 
     for determining, as applicable with respect to an 
     individual--
       ``(1) whether the individual is an eligible individual;
       ``(2) whether an eligible individual has sustained a 
     covered injury or injuries for which medical benefits or 
     compensation may be available under sections 264 and 265, and 
     the amount of such benefits or compensation;
       ``(3) whether the covered injury or injuries of an eligible 
     individual constitute a compensable disability, or caused the 
     individual's death, for purposes of benefits under section 
     266.
       ``(b) Covered Individuals.--The Secretary may accept a 
     certification, by a Federal, State, or local government 
     entity or private health care entity participating in the 
     administration of covered countermeasures under the 
     Declaration, that an individual is a covered individual.
       ``(c) Criteria for Reimbursement.--
       ``(1) Injuries specified in injury table.--In any case 
     where an injury or other adverse effect specified in the 
     injury table established under section 263 as a known effect 
     of a vaccine manifests in an individual within the time 
     period specified in such table, such injury or other effect 
     shall be presumed to have resulted from administration of 
     such vaccine.
       ``(2) Other determinations.--In making determinations other 
     than those described in paragraph (1) as to the causation or 
     severity of an injury, the Secretary shall employ a 
     preponderance of the evidence standard and take into 
     consideration all relevant medical and scientific evidence 
     presented for consideration, and may obtain and consider the 
     views of qualified medical experts.
       ``(d) Deadline for Filing Request.--The Secretary shall not 
     consider any request for a benefit under this part with 
     respect to an individual, unless--
       ``(1) in the case of a request based on the administration 
     of the vaccine to the individual, the individual provides 
     notice to the Secretary of an adverse effect of the 
     vaccination not later than one year after the date of 
     administration of the vaccine; or
       ``(2) in the case of a request based on accidental vaccinia 
     inoculation, the individual provides notice to the Secretary 
     of an adverse effect of such vaccination not later than two 
     years after the date of the first symptom or manifestation of 
     onset of the adverse effect.
       ``(e) Review of Determination.--
       ``(1) Secretary's review authority.--The Secretary may 
     review a determination under this section at any time on the 
     Secretary's own motion or on application, and may affirm, 
     vacate, or modify such determination in any manner the 
     Secretary deems appropriate.
       ``(2) Judicial and administrative review.--No court of the 
     United States, or of any State, District, territory or 
     possession thereof, shall have subject matter jurisdiction to 
     review, whether by mandamus or otherwise, any action by the 
     Secretary under this section. No officer or employee of the 
     United States shall review any action by the Secretary under 
     this section (unless the President specifically directs 
     otherwise).

     ``SEC. 263. SMALLPOX VACCINE INJURY TABLE.

       ``(a) Smallpox Vaccine Injury Table.--
       ``(1) Establishment required.--The Secretary shall 
     establish by interim final regulation a table identifying 
     adverse effects (including injuries, disabilities, illnesses, 
     conditions, and deaths) that shall be presumed to result from 
     the administration of (or exposure to) a smallpox vaccine, 
     and the time period in which the first symptom or 
     manifestation of onset of each such adverse effect must 
     manifest in order for such presumption to apply.
       ``(2) Amendments.--The Secretary may amend by regulation 
     the table established under paragraph (1). Amendments shall 
     apply retroactively to claims pending at the time of 
     promulgation of final amending regulations and to claims 
     filed subsequently. If the effect of such amendment is to 
     permit an individual who was not, before such amendment, 
     eligible for compensation under this part, such individual 
     may file a request for compensation or file an amended 
     request for such compensation not later than one year after 
     the effective date of such amendment in the case of an 
     individual to whom the vaccine was administered and two years 
     in the case of a request for compensation based on accidental 
     vaccinia inoculation.

[[Page 7863]]



     ``SEC. 264. MEDICAL BENEFITS.

       ``(a) In General.--Subject to the succeeding provisions of 
     this section, the Secretary shall make payment or 
     reimbursement for medical items and services as reasonable 
     and necessary to treat a covered injury of an eligible 
     individual. The Secretary may consider the Federal Employees 
     Compensation Act (5 U.S.C. 8103) and its implementing 
     regulations in determining the amount of such payment and the 
     circumstances under which such payments are reasonable and 
     appropriate.
       ``(b) Benefits Secondary to Other Coverage.--Payment or 
     reimbursement for services or benefits under subsection (a) 
     shall be secondary to any obligation of the United States or 
     any third party (including any State or local governmental 
     entity, private insurance carrier, or employer) under any 
     other provision of law or contractual agreement, to pay for 
     or provide such services or benefits. The Secretary shall 
     have the discretion to establish mechanisms and procedures 
     for providing the secondary benefits under this section.

     ``SEC. 265. COMPENSATION FOR LOST EMPLOYMENT INCOME.

       ``(a) In General.--Subject to the succeeding provisions of 
     this section, the Secretary shall provide compensation to an 
     eligible individual for loss of employment income incurred as 
     a result of a covered injury, at the rate specified in 
     subsection (b).
       ``(b) Amount of Compensation.--
       ``(1) In general.--Compensation under this section shall be 
     at the rate of 66 2/3 percent of monthly employment income, 
     except that such percentage shall be 75 percent in the case 
     of an individual who has one or more dependents. The 
     Secretary may consider the Federal Employees Compensation Act 
     (5 U.S.C. 8114 and 8115) and its implementing regulations in 
     determining the amount of such payment and the circumstances 
     under which such payments are reasonable and appropriate.
       ``(2) Treatment of self-employment income.--For purposes of 
     this section, the term `employment income' includes income 
     from self-employment.
       ``(c) Limitations.--
       ``(1) Benefits secondary to other coverage.--Any 
     compensation under subsection (a) shall be secondary to the 
     obligation of the United States or any third party (including 
     any State or local governmental entity, private insurance 
     carrier, or employer), under any other law or contractual 
     agreement, to pay compensation for loss of employment income 
     and shall not be made to the extent that compensation for 
     loss of employment income has been made under such other 
     obligations in an amount that equals or exceeds the rate 
     specified in subsection (b)(1).
       ``(2) No benefits for death or permanent and total 
     disability.--No payment shall be made under this section in 
     compensation for loss of employment income subsequent to the 
     receipt by an eligible individual (or his survivor or 
     survivors) of benefits under section 266 for death or 
     permanent and total disability.
       ``(3) Limit on total benefits.--Total benefits paid to an 
     individual under this section shall not exceed $50,000 for 
     any year, and the lifetime total of such benefits for the 
     individual may not exceed an amount equal to the amount 
     authorized to be paid under section 266.
       ``(4) Waiting period.--An eligible individual shall not be 
     provided compensation under this section for the first 5 work 
     days of disability.

     ``SEC. 266. PAYMENT FOR DEATH AND PERMANENT, TOTAL 
                   DISABILITY.

       ``(a) Benefit for Permanent and Total Disability.--The 
     Secretary shall pay to an eligible individual who is 
     determined to have a covered injury or injuries meeting the 
     definition of disability in section 216(i) of the Social 
     Security Act (42 U.S.C. 416(i)) an amount determined under 
     subsection (c), in the same manner as disability benefits are 
     paid pursuant to the PSOB program in section 1201(b) of the 
     OCCSSA with respect to an eligible public safety officer 
     (except that payment shall be made to the parent or legal 
     guardian, in the case of an eligible individual who is a 
     minor or is subject to legal guardianship).
       ``(b) Death Benefit.--The Secretary shall pay, in the case 
     of an eligible individual whose death is determined to have 
     resulted from a covered injury or injuries, a death benefit 
     in the amount determined under subsection (c) to the survivor 
     or survivors in the same manner as death benefits are paid 
     pursuant to PSOB program in section 1201 of the OCCSSA with 
     respect to an eligible deceased (except that in the case of 
     an eligible individual who is a minor with no living parent, 
     the legal guardian shall be considered the survivor in the 
     place of the parent).
       ``(c) Benefit Amount.--
       ``(1) In general.--The amount of the disability or death 
     benefit under subsection (a) or (b) in a fiscal year shall 
     equal the amount of the comparable benefit calculated under 
     the PSOB in such fiscal year, without regard to any reduction 
     attributable to a limitation on appropriations, but subject 
     to paragraph (2).
       ``(2) Reduction for payments for lost employment income.--
     The amount of the benefit as determined under paragraph (1) 
     shall be reduced by the total amount of any benefits paid 
     under section 265 with respect to lost employment income.
       ``(d) Benefit in Addition to Medical Benefits.--A benefit 
     under this section shall be in addition to any amounts 
     received by an eligible individual under section 264.
       ``(e) Limitations.--
       ``(1) Disability benefits.--Except as provided in paragraph 
     (3), no benefit is payable under subsection (a) with respect 
     to the disability of an eligible individual if--
       ``(A) a disability benefit is paid or payable with respect 
     to such individual under the PSOB; or
       ``(B) a death benefit is paid or payable with respect to 
     such individual under subsection (b) or the PSOB.
       ``(2) Death benefits.--No benefit is payable under 
     subsection (b) with respect to the death of an eligible 
     individual if--
       ``(A) a disability benefit is paid with respect to such 
     individual under subsection (a) or the PSOB; or
       ``(B) a death benefit is paid or payable with respect to 
     such individual under the PSOB.
       ``(3) Exception in the case of a limitation on 
     appropriations for disability benefits under psob.--In the 
     event that disability benefits available to an eligible 
     individual under the PSOB program are reduced because of a 
     limitation on appropriations, and such reduction would affect 
     the amount that would be payable under paragraph (1) or (2) 
     without regard to this paragraph, benefits shall be available 
     under subsection (a) or (b) to the extent necessary to ensure 
     that such individual (or his survivor or survivors) receives 
     a total amount equal to the amount described in subsection 
     (c).
       ``(f) References.--References in this section--
       ``(1) to the Public Safety Officers' Benefits Program or 
     PSOB are references to the program under part L, subpart 1 of 
     title I of the OCCSSA; and
       ``(2) to the OCCSSA are to the Omnibus Crime Control and 
     Safe Streets Act of 1968 (42 U.S.C. 3796 et seq.).

     ``SEC. 267. ADMINISTRATION.

       ``(a) Administration by Agreement With Other Agency or 
     Agencies.--The Secretary may administer any or all of the 
     provisions of this part through Memorandum of Agreement with 
     the head of any appropriate Federal agency.
       ``(b) Regulations.--The head of the agency administering 
     this part or provisions thereof (including any agency head 
     administering such Act or provisions through a Memorandum of 
     Agreement under subsection (a)) may promulgate such 
     implementing regulations as may be found necessary and 
     appropriate. Initial implementing regulations may be interim 
     final regulations.

     ``SEC. 268. PARTICIPANT EDUCATION REGARDING SMALLPOX 
                   EMERGENCY RESPONSE PLANS.

       ``In reviewing State, local, or Department of Health and 
     Human Services smallpox emergency response plans described in 
     section 261, the Secretary shall ensure that such plans are 
     consistent with guidelines of the Centers for Disease Control 
     and Prevention with respect to the education of individual 
     participants (including information as to the voluntary 
     nature of the program and the availability of potential 
     benefits under this part), and the adequate screening of 
     individuals for vaccine contraindications.

     ``SEC. 269. AUTHORIZATION OF APPROPRIATIONS.

       ``For the purpose of carrying out this part, there are 
     authorized to be appropriated such sums as may be necessary 
     for each of the fiscal years 2003 through 2007, to remain 
     available until expended, including administrative costs and 
     costs of provision and payment of benefits. The Secretary's 
     payment of any benefit under section 264, 265, or 266 shall 
     be subject to the availability of appropriations under this 
     section.

     ``SEC. 270. RELATIONSHIP TO OTHER LAWS.

       ``Except as explicitly provided herein, nothing in this 
     part shall be construed to override or limit any rights an 
     individual may have to seek compensation, benefits, or 
     redress under any other provision of Federal or State law.''.

     SEC. 3. AMENDMENTS TO PROVISION REGARDING TORT LIABILITY FOR 
                   ADMINISTRATION OF SMALLPOX COUNTERMEASURES.

       (a) Amendment to Accidental Vaccinia Inoculation 
     Provision.--Section 224(p)(2)(C)(ii)(II) of such Act (42 
     U.S.C. 233(p)(2)(C)(ii)(II)) is amended by striking ``resides 
     or has resided with'' and inserting ``has resided with, or 
     has had contact with,''.
       (b) Deeming Acts and Omissions to be Within Scope of 
     Employment.--Section 224(p)(2) of such Act (42 U.S.C. 
     233(p)(2)) is amended by adding at the end the following new 
     subparagraph:
       ``(D) Acts and omissions deemed to be within scope of 
     employment.--
       ``(i) In general.--In the case of a claim arising out of 
     alleged transmission of vaccinia from an individual described 
     in clause (ii), acts or omissions by such individual shall be 
     deemed to have been taken within the scope of such 
     individual's office or employment for purposes of--

       ``(I) subsection (a); and
       ``(II) section 1346(b) and chapter 171 of title 28, United 
     States Code.

       ``(ii) Individuals to whom deeming applies.--An individual 
     is described by this clause if--

[[Page 7864]]

       ``(I) vaccinia vaccine was administered to such individual 
     as provided by subparagraph (B); and
       ``(II) such individual was within a category of individuals 
     covered by a declaration under subparagraph (A)(i).''.

       (c) Exhaustion; Exclusivity; Offset.--Section 224(p)(3) of 
     such Act (42 U.S.C. 233(p)(3)) is amended to read as follows:
       ``(3) Exhaustion; exclusivity; offset.--
       ``(A) Exhaustion.--
       ``(i) In general.--A person may not bring a claim under 
     this subsection unless such person has received a 
     determination about remedies available under section 262.
       ``(ii) Tolling of statute of limitations.--The time limit 
     for filing a claim under this subsection, or for filing an 
     action based on such claim, shall be tolled during the 
     pendency of a determination by the Secretary under section 
     262.
       ``(iii) Construction.--This subsection shall not be 
     construed as superseding or otherwise affecting the 
     application of a requirement, under chapter 171 of title 28, 
     United States Code, to exhaust administrative remedies.
       ``(B) Exclusivity.--The remedy provided by subsection (a) 
     shall be exclusive of any other civil action or proceeding 
     for any claim or suit this subsection encompasses, except for 
     a proceeding under part C of this title.
       ``(C) Offset.--The value of all compensation and benefits 
     provided under part C of this title for an incident or series 
     of incidents shall be offset against the amount of an award, 
     compromise, or settlement of money damages in a claim or suit 
     under this subsection based on the same incident or series of 
     incidents.''.
       (d) Requirement to Cooperate With United States.--Section 
     224(p)(5) of such Act (42 U.S.C. 233(p)(5)) is amended in the 
     caption by striking ``Defendant'' and inserting ``Covered 
     person''.
       (e) Amendment to Definition of Covered Countermeasure.--
     Section 224(p)(7)(A)(i)(II) of such Act (42 U.S.C. 
     233(p)(7)(A)(i)(II)) is amended to read as follows:

       ``(II) used to control or treat the adverse effects of 
     vaccinia inoculation or of administration of another covered 
     countermeasure; and''.

       (f) Amendment to Definition of Covered Person.--Section 
     224(p)(7)(B) of such Act (42 U.S.C. 233(p)(7)(B)) is 
     amended--
       (1) by striking ``includes any person'' and inserting 
     ``means a person'';
       (2) in clause (ii)--
       (A) by striking ``auspices'' and inserting ``auspices--'';
       (B) by redesignating ``such countermeasure'' and all that 
     follows as clause (I) and indenting accordingly; and
       (C) by adding at the end the following:

       ``(II) a determination was made as to whether, or under 
     what circumstances, an individual should receive a covered 
     countermeasure;
       ``(III) the immediate site of administration on the body of 
     a covered countermeasure was monitored, managed, or cared 
     for; or
       ``(IV) an evaluation was made of whether the administration 
     of a countermeasure was effective;'';

       (3) in clause (iii) by striking ``or'';
       (4) by striking clause (iv) and inserting the following:
       ``(iv) a State, a political subdivision of a State, or an 
     agency or official of a State or of such a political 
     subdivision, if such State, subdivision, agency, or official 
     has established requirements, provided policy guidance, 
     supplied technical or scientific advice or assistance, or 
     otherwise supervised or administered a program with respect 
     to administration of such countermeasures;
       ``(v) in the case of a claim arising out of alleged 
     transmission of vaccinia from an individual--

       ``(I) the individual who allegedly transmitted the 
     vaccinia, if vaccinia vaccine was administered to such 
     individual as provided by paragraph (2)(B) and such 
     individual was within a category of individuals covered by a 
     declaration under paragraph (2)(A)(i); or
       ``(II) an entity that employs an individual described by 
     clause (I) or where such individual has privileges or is 
     otherwise authorized to provide health care;

       ``(vi) an official, agent, or employee of a person 
     described in clause (i), (ii), (iii), or (iv);
       ``(vii) a contractor of, or a volunteer working for, a 
     person described in clause (i), (ii), or (iv), if the 
     contractor or volunteer performs a function for which a 
     person described in clause (i), (ii), or (iv) is a covered 
     person; or
       ``(viii) an individual who has privileges or is otherwise 
     authorized to provide health care under the auspices of an 
     entity described in clause (ii) or (v)(II).''.
       (g) Amendment to Definition of Qualified Person.--Section 
     224(p)(7)(C) of such Act (42 U.S.C. 233(p)(7)(C)) is 
     amended--
       (1) by designating ``is authorized to'' and all that 
     follows as clause (i) and indenting accordingly;
       (2) by striking ``individual who'' and inserting 
     ``individual who--''; and
       (3) by striking the period and inserting ``; or
       ``(ii) is otherwise authorized by the Secretary to 
     administer such countermeasure.''.
       (h) Definition of ``Arising Out of Administration of a 
     Covered Countermeasure''.--Section 224(p)(7) of such Act (42 
     U.S.C. 233(p)(7)) is amended by adding at the end the 
     following new subparagraph:
       ``(D) Arising out of administration of a covered 
     countermeasure.--The term `arising out of administration of a 
     covered countermeasure', when used with respect to a claim or 
     liability, includes a claim or liability arising out of--
       ``(i) determining whether, or under what conditions, an 
     individual should receive a covered countermeasure;
       ``(ii) obtaining informed consent of an individual to the 
     administration of a covered countermeasure;
       ``(iii) monitoring, management, or care of an immediate 
     site of administration on the body of a covered 
     countermeasure, or evaluation of whether the administration 
     of the countermeasure has been effective; or
       ``(iv) transmission of vaccinia virus by an individual to 
     whom vaccinia vaccine was administered as provided by 
     paragraph (2)(B).''.
       (i) Technical Correction.--Section 224(p)(2)(A)(ii) of such 
     Act (42 U.S.C. 233(p)(2)(A)(ii)) is amended by striking 
     ``paragraph (8)(A)'' and inserting ``paragraph (7)(A)''.
       (j) Effective Date.--This section shall take effect as of 
     November 25, 2002.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Louisiana (Mr. Tauzin) and the gentlewoman from California (Mrs. Capps) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Louisiana (Mr. Tauzin).


                             General Leave

  Mr. TAUZIN. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
and include extraneous material on the bill, H.R. 1463.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Louisiana?
  There was no objection.
  Mr. TAUZIN. Mr. Speaker, I yield myself 5 minutes.
  Mr. Speaker, I rise today to urge all Members to support H.R. 1463, 
the Smallpox Emergency Personnel Protection Act of 2003, a critical 
bill introduced by the vice chairman of the Committee on Energy and 
Commerce, the gentleman from North Carolina (Mr. Burr).
  In January of this year, our HHS Secretary Tommy Thompson called on 
health personnel and emergency responders from across the Nation to 
join smallpox emergency response teams in order to ensure that our 
country was better prepared to deal with any outbreak of this deadly 
disease caused by terrorists or rogue regimes such as Iraq. These 
patriots have been asked to volunteer to get the smallpox vaccine now 
so that they can administer the vaccine to the public should the need 
arise. Since then, roughly 25,000 American volunteers have indeed 
volunteered for this vaccine.
  These health personnel and emergency responders are indeed to be 
saluted for their service to the country. However, we do not need tens 
of thousands of Americans to respond, we need hundreds of thousands, if 
not millions; and we need these many, many Americans, health personnel, 
and emergency first responders to heed the Secretary's call.
  The legislation before us today, which was requested by the 
administration, provides incentive for such individuals to roll up 
their sleeves and get a shot. The bill does a number of important 
things:
  First, it provides for a total disability and death benefit equal to 
the amount payable under the Public Safety Officers Benefit, the PSOB, 
the existing Federal program that currently pays $262,000 in a lump 
sum, indexed for inflation, to public safety officers who are killed or 
totally disabled in the line of duty.
  Given the sacrifice that we are asking from these smallpox 
volunteers, a small number of whom may indeed suffer severe adverse 
reactions which could include death, it makes sense to provide these 
similar benefits.
  But this bill goes further than the PSOB. It also provides coverage 
for all reasonable and necessary medical expenses that are incurred by 
individuals who are vaccinated and suffer adverse effects, to the 
extent that such expenses are not picked up by their own individual 
primary health insurance. The bill provides also lost employment income 
if an individual misses more

[[Page 7865]]

than 5 days of work due to adverse effects of the vaccine. Under this 
benefit, the individual could receive up to 75 percent of his monthly 
salary and up to $50,000 a year in supplemental wages capped at the 
maximum amount of the PSO death benefit.
  It is important to emphasize that the death and total disability 
benefits are additive to any other death or disability benefit the 
individual is already entitled to under Social Security, under State 
and local government, under employers, or under private insurance 
plans. And the lost wage income under this program, while secondary to 
other similar benefits the person may have, supplements those benefits 
to the extent the Federal program is more generous. For example, many 
States and employers have much lower annual and lifetime caps on 
workers' compensation benefits, which means the higher Federal figures 
in our bill would supplement those other benefits.
  And finally, the legislation provides most sensible and 
noncontroversial technical amendments to last year's Homeland Security 
Bill to provide better liability protections to the hospitals, doctors, 
nurses, and public health officials at the State and local levels who 
we are asking to participate in this most important program.
  I must say I am disappointed, however, that despite the good faith 
efforts on both sides of the aisle, and they have been good faith 
efforts, we are not able to reach a bipartisan agreement on the 
package. I strongly disagree that there should be any doubt as to the 
commitment of the administration or the commitment of the Congress to 
pay these benefits to injured volunteers as these bills become due.
  I also disagree with the notion that the $262,000 caps for disability 
and lost wages do not in fact provide a sufficient compensation 
package. If these caps are good enough for our public police officers 
and our firefighters who die in the line of duty, then I submit to you 
that indeed they are good enough for this program as well.
  A few people have in fact died after taking the vaccine, although we 
do not know they died as a result of vaccine. But either way, we should 
not delay in establishing a compensation program that would help with 
these people, simply because we cannot agree right now on whether a 
$262,000 figure is sufficient or not. We still need to provide, we need 
to move forward with this incentive to make sure people are adequately 
vaccinated to meet this threat.
  Now, let us get the help to the people who need it now. If we find 
out down the road that the program is inadequate or certain respects 
need to be changed, we can always fix it later. This is an emergency. 
This will make sure that we have the people available, ready to 
vaccinate all of America if, God forbid, the worst should happen and we 
suffer a smallpox attack.
  Mr. Speaker, I reserve the balance of my time.
  Mrs. CAPPS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this is an important issue, important to the health and 
safety of our Nation.
  Recent tragedies in the health care community have underscored the 
need for us to address it and pass a robust compensation package for 
victims. The President has called for America's nurses, firefighters, 
and other first responders to be vaccinated against smallpox. Ensuring 
our frontline health care responders are resistant to smallpox would 
enhance our ability to respond to an attack resulting from this kind of 
an outbreak. But this initiative is failing, and to make the program 
work we need to guarantee our first responders that they and their 
families will be compensated if they are harmed or killed by the 
vaccine.
  If the administration insists that these people be vaccinated against 
the disease, then now more than ever it is critical that we provide the 
peace of mind that these frontline people deserve and need. They do not 
want handouts. They just want to know that if something happens to 
them, they and their families will be taken care of. It is not too much 
to ask. But I can tell you that the bill before us, as it is currently 
drafted, will not provide that level of assurance.
  Before I came to Congress I worked as a public health nurse for many 
years. These are my colleagues that we are speaking of. And I know what 
it is like to be on the front line. If you will not take my word for 
it, listen to the American Nurses Association. They represent the 
interests of 2.7 million nurses across this country, and they have 
heard from their members. They oppose this bill because it is 
insufficient to make the program work.
  First, the bill before us does not guarantee that this compensation 
program will be funded, and without a guarantee of funding, nurses and 
other first responders who serve their country and become harmed by the 
vaccine will have no assurance that the bill's promises will be kept.

                              {time}  1415

  Second, this bill puts unfair caps on the wage compensation an 
injured nurse or other first responder can receive. These caps would 
unfairly penalize those families who lose their main source of income.
  We should reject this bill; and instead, we should pass legislation 
such as the gentleman from California (Mr. Waxman) and I have crafted 
with our colleagues and with input with direct guidance from these 
first responders. Our legislation would ensure that medical benefits 
and the compensation in this bill are funded for years to come. It 
would recognize and compensate the longer-term loss of wages that could 
result from such an adverse effect, and it would allow families who 
lose their main source of income because of the vaccine that they be 
fully compensated for their loss.
  This bill would tell nurses that if they take this risk and serve 
their country that their families will not be left without resources or 
hope. Ultimately, the risk of adverse effects is low. Perhaps 200 
people out of the 10 million that we want to vaccinate could be 
affected, but it is so important that we provide the assurance that if 
a person is one of those 200 people they will be compensated 
adequately.
  Congress now has before it the opportunity to instill, first, 
confidence in our first responders and truly prepare us for the 
possible nightmare of a smallpox outbreak. The administration has been 
disappointed thus far in the turnout for the vaccine. If the wrong kind 
of legislation is passed, the turnout runs the risk of remaining small, 
thus, not meeting the goal of the administration.
  If this bill before us is not effective, this is our opportunity to 
fix it. Let us take the time to get it right so that we can create this 
shield against a bioterrorist attack in the form of smallpox.
  I urge my colleagues to support their first responders, to protect 
America from the threat of smallpox. Defeat this bill. Let us take the 
time to get this right.
  Mr. Speaker, I reserve the balance of my time.
  Mr. TAUZIN. Mr. Speaker, I am pleased to yield 5 minutes to the 
gentleman from Ohio (Mr. Boehner), the distinguished chairman of the 
Committee on Education and the Workforce.
  Mr. BOEHNER. Mr. Speaker, I want to thank my colleague for yielding 
me the time.
  Mr. Speaker, I rise today in support of this important legislation to 
establish a compensation program for our Nation's emergency personnel 
in the event they suffer complications from smallpox vaccinations. As 
our United States troops fight the battle for freedom in Iraq, I am 
pleased that Congress can contribute this important piece of 
legislation which has been crafted to aid in our war effort and to 
enhance the safety of our Nation.
  The face of war is changing. While past efforts may have focused 
solely on the armed aggression, the new face of war includes new 
threats in the form of biological or chemical warfare. Our Nation's 
armed services are not the only ones on the front lines of this 
conflict, because the threat of terrorism is here in the United States. 
Our emergency personnel, health care workers, and first responders are 
also on those front lines.

[[Page 7866]]

  Health care workers, law enforcement officers, firefighters and 
others across the country are currently being vaccinated for smallpox. 
With this vaccine, as my colleagues have heard, come some risk of some 
workers having serious reactions to the vaccine. It is also possible, 
though unlikely, that some may suffer life-threatening complications 
and even death, and fittingly, this measure will provide security to 
these workers who put their own health at risk in order to help the 
American public.
  This legislation provides an important backstop to ensure that 
workers and their families will be protected if they suffer 
complications from the smallpox vaccine. Workers injured in the line of 
duty will be compensated first by their employers and second by the 
United States Government. For those who may not have access to workers 
compensation and other employer-sponsored health care, the Federal 
Government will provide appropriate compensation. Even those workers 
who have access to employer-sponsored benefits may receive additional 
compensation from the smallpox fund; and as such, the bill sets a 
Federal floor and ensures that each worker will be adequately 
compensated.
  Under the bill, workers who might suffer a totally disabling injury 
or death as a result of the vaccine will receive cash benefits 
consistent with the amounts of benefits paid under the Public Safety 
Officers Benefits Program. For workers who suffer a less serious 
injury, the bill provides compensation for medical expenses and the 
loss of employment at a rate of 66\2/3\ percent of monthly pay, and 
workers who have dependents will be compensated at a rate of 75 percent 
monthly pay; and if a worker is eligible for less compensation than the 
federally established level, the fund will compensate the individual at 
the higher Federal level.
  As chairman of the Committee on Education and the Workforce, I am 
pleased to assist in helping my colleagues at the Committee on Energy 
and Commerce draft this legislation, which I believe will ensure the 
safety of health care workers and first responders. I am also 
particularly pleased because my committee has primary jurisdiction over 
the employer-sponsored health care and workers compensation disability 
programs, which would include the Federal Employee Compensation Act, 
which will be the primary payers of the compensation. This measure will 
not only help our emergency personnel and first responders but enhance 
the safety of our Nation as well.
  I want to urge my colleagues to support this bill.
  Mrs. CAPPS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I insert for the Record letters from the following 
groups which I have before me. These letters are written by the 
American Public Health Association; the International Union of Police 
Associations; the American Nurses Association; the International 
Association of Firefighters; the American Federation of Teachers; the 
American Federation of State, County and Municipal Employees; the 
Service Employers National Union; and the Infectious Disease Society of 
America.

                                  American Nurses Association,

                                                   March 28, 2003.
       Dear Representative: On behalf of the American Nurses 
     Association (ANA), I urge you to oppose the Smallpox 
     Emergency Personnel Protection Act (H.R. 1463). This bill 
     does not provide adequate education, prescreening, 
     surveillance, and compensation--therefore it will not result 
     in an increase in the number of nurses volunteering for 
     vaccinations. As this bill will be considered under the 
     suspension of the rules, you will be denied the opportunity 
     to vote in favor of the Capps/Waxman substitute that ANA 
     supports.
       The ANA is the only full-service association representing 
     the nation's RNs through our 54 state and territorial 
     constituent member organizations. Our members are well 
     represented in the Administration's plan to vaccinate 10.5 
     million health care workers and first responders.
       ANA supports efforts to ensure that our nation is prepared 
     for a possible terrorist attack. ANA has, since November 
     2002, been trying to work with the Administration to 
     formulate a strong smallpox vaccination program that will 
     encourage nurses to volunteer to be immunized. Since the 
     Administration's plan was first announced, ANA has repeatedly 
     raised questions about the health and safety of nurses who 
     are vaccinated, as well as their patients and families. ANA's 
     concerns have been echoed by many in the public health 
     community and reinforced by an expert panel from the 
     Institute of Medicine. Unfortunately, the Smallpox Emergency 
     Personnel Protection Act (H.R. 1463), fails to address these 
     questions.
       The smallpox vaccine is a live virus. It has the worst 
     record of negative side effects of any vaccine in the world. 
     It is imperative, as a matter of public health, that those 
     being vaccinated understand the risks of the vaccine to 
     themselves and their loved ones, and be prescreened for 
     conditions that require them to refuse the vaccine. The 
     smallpox inoculation site can shed the live virus for up to 
     three weeks. In the 1960s, more than 20% of the adverse 
     vaccination events occurred in secondary contacts. Therefore, 
     the vaccination program poses a risk not only to nurses, but 
     also to their patients and families.
       Members of the armed services have received personalized 
     education, and free and confidential prescreening prior to 
     the administration of the vaccine. This process properly 
     screened out one-third of the potential recipients. The 
     Smallpox Emergency Personnel Protection Act fails to require 
     a similar program. In addition, H.R. 1463 fails to require 
     sufficient funding needed to ensure that state and local 
     public health officials can actually implement the crucial 
     education, prescreening, and surveillance programs. The 
     recent death of a Maryland nurse, a Florida nurse aide, and a 
     National Guardsman only underscore the need for this robust 
     education, prescreening, and surveillance effort. Nurses and 
     other first responders will continue to feel uncomfortable 
     about the vaccine until they receive the reliable information 
     needed to make an informed decision.
       Furthermore, H.R. 1463 contains an insufficient, unfunded 
     compensation program. The Administration is basically asking 
     healthy nurses to place themselves (as well as their patients 
     and families) at risk for the common good. The vaccination 
     has no tangible benefits for nurses; it is sought in the name 
     of homeland security. ANA does not believe that nurses should 
     be made to bear this public risk without the guarantee of a 
     real compensation program. H.R. 1463 contains an unacceptable 
     lifetime cap on wage replacement and fails to ensure that 
     funds will be available for the compensation fund.
       ANA urges you to vote against H.R. 1463. Your no vote does 
     not mean that you oppose a smallpox compensation program. In 
     fact, the solid disapproval of this bill will demonstrate 
     needed support for a real smallpox vaccination program, such 
     as the Capps/Waxman substitute. Please feel free to call Erin 
     McKeon (202) 651-7095 or Christopher Donnellan (202) 651-7088 
     on my staff with any questions regarding this letter.
           Sincerely,
                                           Rose Gonzalez, MPS, RN,
     Director, Government Affairs.
                                  ____

                                       Infectious Diseases Society


                                                   of America,

                                                   March 28, 2003.
     Hon. J. Dennis Hastert,
     Speaker,
     House of Representatives.
       Dear Speaker Hastert: I am writing on behalf of the 
     Infectious Diseases Society of America (IDSA) and the 7,000 
     infectious diseases physicians and scientists we represent to 
     thank you and other House leaders on both sides of the aisle 
     for pursuing a plan to compensate individuals who may be 
     injured during the implementation of the National Smallpox 
     Immunization Plan (NSIP).
       Over the past year, IDSA and its members--including those 
     who were on the frontline of smallpox eradication efforts--
     have provided essential information to the federal and state 
     governments as they have prepared responses to a potential 
     smallpox event. ID physicians will be integrally involved 
     should a bioterrorism event occur; an ID specialist 
     discovered the first anthrax case that occurred in Florida. 
     Presently, many of our members are working with state and 
     local public health officials to oversee NSIP's 
     implementation.
       IDSA's leaders believe strongly, as you do, that the 
     creation of a compensation plan is essential to NSIP's 
     success. As the House moves forward next week to consider 
     legislation to establish such a program, we would like to 
     take this final opportunity to stress to you the expert 
     opinion of our leaders on this subject. IDSA closely reviewed 
     the Administration's proposal, which Congressman Richard Burr 
     introduced this week, H.R. 1463, as well as H.R. 865, 
     sponsored by Congressman Henry Waxman. Certain aspects of the 
     Administration's proposal appear promising. However, IDSA is 
     concerned that the Administration's proposal does not include 
     all of the elements necessary to ensure NSIP's success. 
     Below, we have highlighted the elements that our leaders 
     believe are critical and ask that House leaders include them 
     in whatever legislation the House passes.
       One element that IDSA believes to be of primary 
     significance to the success of NSIP is universal eligibility. 
     That is, all individuals injured as a consequence of NSIP's 
     implementation should be compensated for

[[Page 7867]]

     their injuries. Eligibility should not be promised upon 
     whether injured individuals volunteered to participate in the 
     program or were injured as a result of a secondary 
     transmission. Moreover, such eligibility should extend to 
     individuals who present symptoms that are obviously 
     associated with contact vaccinia, regardless of whether they 
     can establish a link back to a specific vaccinee. Finally, an 
     individual's eligibility should not be limited by an 
     arbitrarily established time limit (e.g., 180 days after 
     interim final rule is published or 120 days after becoming a 
     covered person), but should extend throughout the period of 
     time that NSIP is being implemented as well as for a 
     reasonable period of time after the last vaccination takes 
     place.
       The second essential element IDSA's leaders support is fair 
     and adequate compensation for all individuals who are injured 
     as a consequence of NSIP's implementation. It is just and 
     right that individuals be made whole for the injuries they 
     suffer as the result of a program being carried out under the 
     auspices of national security. Under H.R. 1463, compensation 
     for medical expenses, disability, lost wages and death is 
     modeled after the Public Safety Officers Benefit program 
     (PSOB). The PSOB program is designed to work in conjunction 
     with other benefit programs, such as workers' compensation 
     and health insurance and is designed primarily to deal with 
     death and total, permanent disability. In the case of 
     smallpox, there are no guarantees that a person injured by 
     the smallpox vaccine will be covered by workers' compensation 
     or will be adequately insured. As a result, those injured as 
     a result of NSIP may receive far less compensation than those 
     PSOB currently covers. Therefore, IDSA strongly urges Horse 
     leaders to supplement the PSOB model found in H.R. 1463 to 
     include the following criteria relating to medical expenses, 
     disability, lost wages and/or death:
       Guaranteed immediate medical care for all injured;
       A significantly more generous compensation package for 
     death than what is found in the H.R. 1463;
       Permanent disability benefit of unreimbursed actual wages 
     and unreimbursed medical costs not subject to any 
     limitations;
       Payment of non-economic damages up to $250,000;
       Compensation for temporary disability, including 
     unreimbursed medical costs and unreimbursed actual wages 
     starting at day one.
       Finally, IDSA believes it to be essential that this program 
     be authorized through mandatory funding mechanisms and not be 
     paid for through discretionary funding sources.
       IDSA leaders are available to work with you and other 
     Congressional leaders to achieve quick passage and enactment 
     of a smallpox compensation plan that makes whole all 
     individuals injured during the implementation of President 
     Bush's NSIP. Thank you again for the leadership you have 
     shown in moving this important legislation forward. Should 
     you have any questions, please feel free to contact Robert J. 
     Guidos, JD, IDSA's director of public policy at 703-299-0200.
           Sincerely,
                                                W. Michael Scheld,
     President.
                                  ____

                                         International Association


                                             of Fire Fighters,

                                   Washington, DC. March 28, 2003.
     House of Representatives,
     Washington, DC.
       Dear Representative: On behalf of the nation's more 260,000 
     professional fire fighters and emergency medical personnel, I 
     reluctantly must urge you to vote against H.R. 1463, the 
     Smallpox Emergency Personnel Protection Act, under suspension 
     of the rules.
       While we strongly endorse the need for a comprehensive 
     smallpox vaccination program, H.R. 1463 contains a number of 
     significant deficiencies. Considering this legislation under 
     suspension of the rules will prohibit amendments from being 
     offered to address these concerns.
       As currently drafted, H.R. 1463 fails to adequately provide 
     for education and screening of the workers who are being 
     asked to receive this vaccine. As the recent death of two 
     nurses demonstrates, the vaccine should not be administered 
     to certain people. While H.R. 1463 addresses compensation for 
     people who die from the vaccine, it does not contain adequate 
     safeguards to prevent those deaths from happening in the 
     first place.
       In addition, we have concerns about the compensation 
     package contained in H.R. 1463. The legislation appears to 
     have been crafted to serve as a supplement to workers 
     compensation, but it is far from clear that workers 
     compensation would cover injuries stemming from the vaccine. 
     Because the smallpox vaccination program is a voluntary 
     program, state workers comp systems may deny benefits.
       For these and other reasons, we believe the House should 
     consider improvements to H.R. 1463. We therefore urge you to 
     vote against H.R. 1463 under suspension, so that the House 
     may have the opportunity to debate and consider amendments to 
     the proposal.
           Sincerely,
                                                   Barry Kasinitz,
                                   Director, Governmental Affairs.

  Mr. Speaker, I yield as much time as he may consume to the gentleman 
from California (Mr. Waxman), the ranking member of the Committee on 
Government Reform, with a long history of concern and investigation 
into the vaccine policy of this Nation.
  Mr. WAXMAN. Mr. Speaker, I thank my colleague very much for yielding 
me time to speak on this issue, and I do so with a great deal of regret 
because on the House floor today we should be backing a bill on a 
bipartisan basis without any dissent because, whether one is a Democrat 
or a Republican, all of us want to encourage people in the health care 
and first responder community to get the vaccination for smallpox so 
they can be of service to all of us should, God forbid, there be a 
smallpox attack.
  I am forced now to rise in opposition to this bill, and I want to 
point out that the bill is on the suspension of the rules, which is 
ordinarily reserved for noncontroversial matters. As a matter of fact, 
this bill is very controversial. It should have been debated and 
considered under the rules of the House. That would have given Members 
an opportunity to put forward alternatives so that the Members of the 
House of Representatives could listen to a debate and make choices on 
policies.
  Instead, what we have is a suspension calendar being used to close 
off any opportunity for amendments, to prevent alternatives from being 
put forward so our colleagues who have been duly elected in 435 
districts in this country, could have the right to choose what they 
thought was the best policy. This suspension of the rules procedure is 
nothing more than a gag to prevent Members, Democrats and Republicans, 
from being able to make choices, which is what they were elected to do.
  The reason I oppose this bill is substantive. This bill will not 
adequately compensate nurses, firefighters, police officers, and other 
first responders who are injured by the smallpox vaccine, a vaccine 
that they take voluntarily in order to make sure that the country is 
prepared for a bioterrorist attack.
  We have tried to work with the Republicans to craft legislation that 
all of these groups can support. However, the Republicans were 
unwilling to agree to a meaningful compensation program and have put 
forward H.R. 1463, a bill that is opposed by every one of these groups.
  The issue of how to compensate people for smallpox vaccine injuries 
is only hard if someone decides to make it hard, and that seems to be 
what the House Republican leadership and the Bush administration have 
done. The science is not hard. For every million people who are 
immunized against smallpox, one of two will die and 10 to 20 will 
become severely ill or disabled.
  The policy is not hard. If people get injured in the line of public 
duty, the public should compensate them, and the administration has 
asked nurses and firefighters and other first responders to take 
smallpox shots, not for their own good, but to protect all Americans in 
case of a bioterrorist attack.
  The substance is not hard. A compensation program should be clear 
about what it covers. It should provide decent benefits if someone is 
disabled or killed, and it should have guaranteed funding.
  The law is not hard. We have a successful program of no-fault 
compensation for children who are injured by vaccines. We have programs 
for Federal workers and even Federal volunteers who are disabled or 
killed. We even have a program for compensation of people hurt or 
killed on September 11, 2001.
  The budgeting is not hard. If every nurse or firefighter got the 
average award from the September 11 fund, which they will not, we would 
only be committing $18 to $33 million per million vaccinations. At 
most, that is 400ths of 1 percent of what the administration has 
requested for the war.
  The process is not hard. If there is honest disagreement about 
legislation, which there is, then the House should be allowed to debate 
amendments and make choices. This should be an easy one, but the House 
leadership and the administration are making it very hard.

[[Page 7868]]

  H.R. 1463 includes a lifetime cap on wage assistance for injured 
first responders and their families. This means that the families of 
nurses or other first responders may have to fend for themselves 
without a bread winner after just a few years of compensation. The 
lump-sum payment offered by H.R. 1463 is clearly inadequate for death 
or permanent disability for a nurse who has a family to support.
  A second problem is that H.R. 1463 requires that funding for the 
compensation program be subject to the uncertainties of the 
appropriations process. A guaranteed funding stream is a linchpin of a 
successful and meaningful compensation program. Without it, Congress is 
making a promise that it may not keep.
  A third problem with this legislation is that it limits eligibility 
for compensation for those people who are vaccinated within a short 
time period after the implementation of the program. This provision is 
not only vigorously opposed by all of the groups being asked to take 
the vaccine but also by the State and local officials running the 
vaccination program.
  I genuinely do not understand why the House leadership and the 
administration have decided to draw this line. The smallpox 
immunization program is not working. Everyone agrees that one of the 
reasons that there is not a compensation program in place to reassure 
nurses and firefighters and other first responders, that if they are 
injured by the vaccine, they and their families will be provided for, 
and the representatives of those organizations agree that the 
Republican bill is not enough to reassure their members.
  Those same representatives agree that the proposals made by the 
gentlewoman from California (Mrs. Capps) and some of the others of us 
who were working with her will succeed. It is very disappointing that 
the legislative process has been cut short and that the gentlewoman 
from California (Mrs. Capps) has been denied the chance, even the 
chance, to offer her amendment.
  Why are the leadership and the administration making this so hard? I 
do not have an answer to that question, but I do know what we need to 
do next. Let us defeat this bill, negotiate a reasonable one, and then 
move on to the genuinely tough problems facing our country.
  I would like to respond to the comparisons of H.R. 1463 with the 
Public Safety Officers Benefit program. This was alluded to by the 
gentleman from Louisiana (Mr. Tauzin). This is a false comparison. The 
Public Safety Officers Benefit program is meant to supplement what 
police officers and others receive when injured in the line of duty. 
There are many other State and local programs that also provide 
compensation.
  In contrast, H.R. 1463 is the sole source of compensation for many 
health care workers and their contacts who may be injured.

                              {time}  1430

  And let me emphasize that point. It is not just the first responders 
who may be injured, but the family members who may be injured as well, 
by the vaccine taken by the nurse or firefighter or police officer, 
because they can be subject to injury by exposure to the person who has 
been immunized.
  A true comparison would compare H.R. 1463 with other compensation 
programs. By a true comparison, H.R. 1463 is clearly not adequate. This 
bill provides far less than benefits provided to Americans injured by 
childhood vaccines in the National Vaccine Injury Compensation Program. 
H.R. 1463 provides far less than what Federal employees receive, 
civilian or military, if injured under the Federal Employee 
Compensation Act. And H.R. 1463 also provides far less than what 
Members of Congress can get if injured or disabled.
  If it is good enough for Members of this body, we should not hesitate 
to provide it to those Americans on the front lines of any bioterrorist 
attack who are protecting all Americans. We are subject to compensation 
without caps. We ought to do the same for those who are standing up for 
all Americans should there be a terrorist attack of smallpox.
  People have told us they need to have a program that will counsel 
them and educate them, because some people should not be immunized at 
all. But there is no such provision for that kind of screening 
mechanism, an educational effort in the Republican bill, even though it 
would save money because people would not be immunized if they knew 
they might be at a high risk. And people have told us that if they are 
going to be asked to be at risk, we ought to stand behind them. The 
Republican bill does not stand behind these first responders.
  This should be negotiated on a bipartisan basis, or at least let the 
House work its will. I urge our colleagues to vote against this H.R. 
1463, defeat it on the suspension calendar and insist that we go back 
and work on legislation that will accomplish the purpose that all of us 
have in mind in providing legislation for such a Smallpox Emergency 
Personnel Protection Act.
  Mr. Speaker, I wish to provide for the Record two letters, one from 
the Service Employees International Union and one from the American 
Federation of State, County, and Municipal Employees, which I think 
further elaborates on this issue.

         American Federation of State, County and Municipal 
           Employees, AFL-CIO,
                                   Washington, DC, March 28, 2003.
       Dear Representative: On behalf of the 1.3 million members 
     of the American Federation of State, County and Municipal 
     Employees (AFSCME), including over 360,000 health care 
     workers and first responders, we are writing to urge you to 
     oppose H.R. 1463, introduced by Representative Richard Burr 
     and scheduled on the suspension calendar for Monday, March 
     31.
       H.R. 1463 would establish a deeply flawed smallpox 
     compensation program for health care workers and first 
     responders injured by the smallpox vaccination. However, this 
     legislation fails to safeguard the health and safety of 
     workers asked to volunteer for the smallpox vaccination 
     program. Moreover, the bill fails to address the concerns of 
     workers who fear that a serious injury or death from the 
     smallpox vaccine would lead to economic catastrophe for 
     themselves and their families.
       While the Administration had hoped to vaccinate up to 10.5 
     million workers, only about 21,000 workers have been 
     vaccinated thus far. Clearly, there has been a great 
     reluctance among health care workers and first responders to 
     risk the loss of health and income without an adequate safety 
     net for themselves and their families. While the legislation 
     is premised on the assumption that workers will be eligible 
     for workers' compensation in the event of an injury, the 
     reality is that, in most states, workers cannot depend on 
     this. In fact, there are only 14 states where it appears at 
     all certain that claims for benefits will be honored by the 
     state workers' compensation system.
       Therefore, workers in most states who are permanently and 
     totally disabled will be eligible only for this bill's 
     maximum lump sum payment of $262,100. This represents about 
     five years' wages for the average nurse--not enough to 
     sustain an individual or family over a lifetime. For a worker 
     who suffers partial or temporary disability, the benefit is 
     also capped at $262,100 over a lifetime. Health care workers 
     and first responders who suffer injuries that limit their 
     ability to earn a living must be compensated at a level that 
     reflects their reduced earnings capability for the duration 
     of their injury. If the aim of the legislation is to 
     encourage workers to be vaccinated, H.R. 1463 will not do the 
     job. Workers will continue to be reluctant to be vaccinated 
     in the absence of assurances that they will not face economic 
     ruin should they become injured.
       While the bill provides medical benefits for the treatment 
     of injuries or illnesses, it does not provide medical 
     benefits for rehabilitation, palliative care or long term 
     care that may be needed. This is a significant gap in health 
     coverage for workers asked to risk their health.
       Another significant flaw in the bill is that funding for 
     compensation and medical benefits are not mandatory. Workers 
     who have lost their health and livelihood should not have to 
     wage a fight for compensation each year during the 
     appropriations process.
       The legislation fails to ensure that the smallpox program 
     will be carried out safely, in stark contrast to the program 
     in place for military personnel. The bill does not require 
     that health departments make medical tests, such as pregnancy 
     tests, available to workers in order to screen out those who 
     ought not to be vaccinated. The legislation also fails to 
     include requirements for monitoring those who are vaccinated 
     to catch adverse reactions before they develop into life 
     threatening complications, similar to the military plan. 
     There is also no funding for state and local public health 
     departments to carry out this expensive program safely.
       The legislation also fails to include a table of injuries 
     that ensure that workers will be

[[Page 7869]]

     awarded compensation quickly. After years of experience with 
     the smallpox vaccine, there are injuries, that occur within 
     specific time periods, that are known to be caused by the 
     vaccine. This schedule of injuries must be included to ensure 
     that compensation will be quick and certain. Otherwise, 
     workers cannot be certain before receiving the vaccine that 
     the most likely serious injuries will qualify for 
     compensation.
       We also object to the bill's requirement that workers 
     receive the vaccination within 180 days of the date 
     regulations are issued. Any worker that is vaccinated under 
     the Secretary's declaration must be eligible for federal 
     compensation. It is punitive to deny compensation to a worker 
     who opts to participate at a later date.
       H.R. 1463 is deeply flawed. We strongly urge you to oppose 
     this bill.
           Sincerely,
                                              Charles M. Loveless,
     Director of Legislation.
                                  ____

                                                   March 28, 2003.
       Dear Representative: On behalf of the 1.5 million members 
     of the Service Employees International Union (SEIU), 
     including over 750,000 health care workers and first 
     responders, I am urging you to vote against H.R. 1463 because 
     it fails to provide adequate protection to frontline workers 
     who are volunteering for the smallpox vaccination program. 
     The bill, introduced by Representative Richard Burr, is 
     expected to come before the House for a vote as early as 
     Monday, March 31, and will be offered under suspension 
     without providing an opportunity to vote for a stronger bill.
       Since the Administration first announced the civilian 
     voluntary smallpox vaccination program, SEIU has worked to 
     protect health care workers, first responders, their patients 
     and the public through aggressive education, medical 
     screening, and surveillance, and to ensure they would have 
     access to a good compensation program. Now that three people 
     have died and others have experienced cardiac-related 
     problems in the days after their inoculations this only 
     reinforces the critical need for a comprehensive program--
     which this legislation does not provide.
       We understand the urgency of the program, especially in 
     this time of war. But at the same time, frontline workers who 
     respond to the call to protect other citizens in a time of 
     national crisis deserve the same protections being provided 
     to our military. To address the serious gaps in this plan, it 
     is incumbent upon Congress to develop bipartisan legislation 
     that encompasses the following issues:
       Aggressive medical screening, monitoring and treatment--The 
     legislation must provide for a program to screen out workers 
     with any and all contraindicaions. Additionally, medical 
     surveillance is essential to assess the program's 
     effectiveness and ensure that any adverse reactions are 
     treated before they become life threatening, as evidenced by 
     the recent reports of heart related problems.
       Adequate compensation--Already, there has been a great 
     reluctance among health care workers to risk injury and loss 
     of income without an adequate safety net for themselves and 
     their families. Any compensation package must be retroactive 
     and cover anyone who suffers a serious reaction as a result 
     of the vaccine, as well as those injured through close 
     contact with a vaccine recipient.
       Ful accountability--Thorough investigation of, and full 
     disclosure of adverse events under both the military and 
     civilian plan must be reported immediately, and organizations 
     representing potential vaccine recipients deserve 
     notification along with the news media.
       Guaranteed funding--There must be mandatory funding for the 
     compensation program to ensure money is available to 
     compensate those who have been injured or died as a result of 
     the vaccine. As was recently recommended by the Institute of 
     Medicine, there must be a clear commitment that adequate 
     funding shall be provided to the states to implement 
     education, screening, and medical surveillance through the 
     emergency supplemental for Homeland Security needs.
       It is absolutely critical that this nation's vaccination 
     plan does not pose increased risks to the American people. We 
     believe the program should be suspended until there is good 
     legislation that ensures these safeguards are in place. 
     Please vote against H.R. 1463, the Smallpox Emergency 
     Personnel Protection Act, and take immediate action to 
     support stronger legislation that will truly protect health 
     care workers, patients, and the public.
           Sincerely,
                                                  Andrew L. Stern,
                                          International President.

  Mr. TAUZIN. Mr. Speaker, I yield myself 2 minutes to briefly set the 
record straight.
  There has been extraordinary negotiations with the minority on this 
bill, over 2 weeks of it. The administration brought this bill to us as 
an emergency. It called upon us immediately to give authority to 
provide these benefits to people who would volunteer to vaccinate 
American citizens in the event of an attack of smallpox in this 
country, which could come at any time, as we know, particularly as 
hostilities are engaged in the Middle East and Iraq.
  It brought it to us as an emergency and we took over 2 weeks to 
negotiate. And we negotiated over a dozen changes, I am told. The most 
important change we made was to bring up that disability cap from 
$50,000 a year, that out-of-work cap, to the same level we provide for 
policemen and firemen in this country. And, Mr. Speaker, I would say to 
the gentleman from California (Mr. Waxman) that this is a supplemental 
program, just as that program is. It is on top of. It is full secondary 
coverage of medical benefits with no deductibles. That is a lot better 
than most plans. It is primary lump sum disability and death benefit 
that, under the Federal Public Safety Officers and Employees is equal 
to $262,000. It is secondary coverage for temporary and partial 
disability from $50,000 a year, again we raised it from the 
administration provision, all the way up to the $262,000 level. It is 
on top of disability benefits under Social Security; on top of the 
benefits available in the State Employee or Private Disability 
Benefits, and we still preserve the right to sue in Federal torts claim 
court.
  Doggone right we are behind those volunteers. Doggone right this is 
an emergency. But we took 2 weeks, and I took it with a great deal of 
pain on my conscience because I thought every night, when we were 
negotiating this thing with our colleagues over here, I thought every 
night, what happens if tomorrow we get hit and we have not passed this 
bill yet and we do not have enough volunteers out there to vaccinate 
all of America. What happens if every day I take negotiating with the 
other side is a day we put our country at risk. And I suffered every 
night with that thought for 2 weeks. We have negotiated this bill to a 
point that it ought to get passed today.
  Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. 
Burgess).
  Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding me this 
time, and today I rise in support of H.R. 1463, the Smallpox Emergency 
Personnel Act of 2003.
  I will just add, in light of the comments made by the chairman, that 
I come to this body as a physician and I likely, myself, will take this 
vaccination to become a first responder.
  Mr. Speaker, H.R. 1463 is a meaningful first step toward ensuring the 
broadest acceptance of the President's call for voluntary vaccinations 
by public safety personnel. In my home State of Texas, to date, only 
1,700 first responders have been vaccinated for smallpox. Of this 
number, Texas health officials report that there have been no adverse 
reactions to date.
  A number of factors can be attributed to the slow roll-out of this 
vaccination campaign, but one of the major factors involved is first 
responders are hesitant to take a vaccine with potential side effects. 
We must be very clear about the current vaccination campaign. Different 
people react to different medications differently. A great majority of 
those who will receive this smallpox vaccination will have no reaction 
at all. A handful, however, could face complications. Some of these may 
be as minor as a rash. A small percentage of that number could face 
more serious health complications, such as postvaccinial encephalitis 
or endocarditis.
  H.R. 1463 will ensure that a broad safety net is available for those 
very few individuals that may suffer from an adverse reaction to the 
smallpox vaccine. Under this bill, first responders are provided with 
death and disability benefits comparable to the benefits police 
officers and firefighters already have access to under the Public 
Safety Officers Benefit Program. First responders who have an adverse 
reaction could also qualify for lost employment income benefits, 
coverage for medical expenses, and certain liability protections. H.R. 
1463 will give first responders peace of mind to do something that will 
protect all Americans.
  First responders are on the front lines of our war against terrorism 
and play a vital role in the instance of a terrorist attack. Our 
enemies have shown us that they will go to any

[[Page 7870]]

length to kill innocent men, women and children. If they ever obtain a 
weapon as horrifying and as devastating as smallpox, let there be no 
mistake, there will be no hesitancy that they would use it. However, if 
they were able to employ such a weapon, American first responders will 
have a greater ability to protect all of us if they have already been 
inoculated from this debilitating and life-threatening disease.
  Americans are counting on our health care professionals to be 
vaccinated against smallpox. By vaccinating these important first 
responders, we will be able to contain a potential outbreak and save 
thousands of lives. Americans are looking to the House of 
Representatives for leadership on this issue. For that reason, I urge 
my colleagues to protect first responders and give them the peace of 
mind to protect all of us.
  Mrs. CAPPS. Mr. Speaker, could I inquire what time remains?
  The SPEAKER pro tempore (Mr. Petri). The gentlewoman from California 
(Mrs. Capps) has 14\1/2\ minutes remaining and the gentleman from 
Louisiana (Mr. Tauzin) has 6\1/2\ minutes remaining.
  Mrs. CAPPS. Mr. Speaker, I yield myself such time as I may consume to 
say, with all due respect to my chairman, for whom I have a great deal 
of respect, that I commend him for his sense of urgency about the 
timing of this. The first responders, my colleagues who are nurses, 
have told us that they want confidence before they are going to roll up 
their sleeves and take this vaccine, and that this bill does not give 
them the confidence and that is why we stand in opposition to this 
bill.
  Mr. Speaker, I yield 2 minutes to the gentleman from California (Mr. 
Waxman) for a response.
  Mr. WAXMAN. Mr. Speaker, I thank the gentlewoman for yielding this 
time to me.
  The administration has asked people to take this immunization in the 
health care area and first responders have not been doing it. One of 
the reasons, according to the Institute of Medicine, is because they do 
not feel that they are going to be backed up by the government when 
they take the risk of some adverse event.
  Now, I want to point out to my good friend, the gentleman from 
Louisiana, the chairman of the committee, that he should not 
personalize this whole matter and have it on his conscience that we 
cannot pass this bill today. Of course, this could have come under the 
rules and we could have had opportunity for amendments to consider. But 
I want to point out that we asked for smallpox compensation as part of 
the bioterrorism bill in 2001, we asked for smallpox compensation as 
part of the homeland security bill in 2002, we formally requested an 
administration proposal in December 2002, and we proposed our own bill 
in February of this year. Only in March, 2 weeks ago, did the majority 
respond. And now, of course, it is take it or leave it. Take it or 
leave it. That is what we are being told.
  This is a bad policy and a bad process by which to protect the public 
health. We had negotiations by staff. It might have helped for Members 
to sit down and talk this through. And if Members and staff cannot 
agree, then we have committees and subcommittees to consider the 
details of legislation. And if it is too urgent for committees and 
subcommittees to act after all this time, at least let the House 
consider a bill and consider various alternatives.
  I think we are now engaged in a very bad process, and I think that we 
are being asked to take very bad policy that is going to be self-
defeating. Because if many of the nurses do not want it, and the 
firefighters do not want it, and the police members do not want it, and 
other first responders do not feel it is adequate and they are not 
going to be compensated, then we are not accomplishing the goal that we 
should for all of us.
  The SPEAKER pro tempore. The Chair wishes to inform the House that he 
misspoke in response to the inquiry of the gentlewoman from California 
(Mrs. Capps). There was 4\1/2\ minutes remaining, not 14\1/2\ minutes. 
I apologize to the gentlewoman.
  Mrs. CAPPS. Could I beg of the Chair to consider then, because I was 
generous in yielding to my colleague, that we be given more time, 
because we have several people who still wish to speak?
  Mr. WAXMAN. Mr. Speaker, I ask unanimous consent, and I hope the 
gentleman on the other side will appreciate this since we were 
misinformed on the time, that we be given an additional 5 minutes on 
each side.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  Mr. TAUZIN. Mr. Speaker, reserving the right to object, why do we not 
take such time as the gentleman consumed. I think the gentlewoman 
yielded the gentleman 2 minutes. And what time did the gentleman just 
use, Mr. Speaker?
  The SPEAKER pro tempore. Two minutes.
  Mr. TAUZIN. Mr. Speaker, I would suggest, instead, that we add an 
additional 2 minutes to each side, in fairness.
  So, Mr. Speaker, I ask unanimous consent that each side be granted 2 
additional minutes to make up for the inaccurate call of the Chair.
  Mr. WAXMAN. Mr. Speaker, will the gentleman yield?
  Mr. TAUZIN. I would be happy to yield to the gentleman from 
California.
  Mr. WAXMAN. That may well work, but again we have another example of 
trying to say no more than a certain amount. And it may be adequate, 
but let us be generous to our colleagues and let us be generous to the 
first responders.
  Mr. TAUZIN. Mr. Speaker, reclaiming my time, I will be happy to just 
object and not have any extension, if the gentleman wants to argue 
about a couple of minutes.
  The SPEAKER pro tempore. Objection is heard.
  Mr. TAUZIN. Otherwise, I ask unanimous consent that each side be 
accorded 2 additional minutes to make up for the error of the Chair.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Louisiana?
  There was no objection.
  The SPEAKER pro tempore. Each side will have an additional 2 minutes.
  Mrs. CAPPS. Mr. Speaker, could I now inquire how much time is 
remaining?
  The SPEAKER pro tempore. The gentlewoman from California (Mrs. Capps) 
has 4 minutes remaining, and the gentleman from Louisiana (Mr. Tauzin) 
has 8\1/2\ minutes.
  Mrs. CAPPS. Mr. Speaker, I reserve the balance of my time.
  Mr. TAUZIN. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Cox), chairman of the Select Committee on Homeland 
Security.

                              {time}  1445

  Mr. COX. Mr. Speaker, we are here in extraordinary circumstances, 
rushing this legislation to the floor as we must, because we are facing 
an emergency. We have got to provide compensation to those workers who 
may be injured or killed by the smallpox vaccine. The Committee on 
Energy and Commerce, of which I am proud to be a member, has done very, 
very important work to bring this bill to the floor in these emergency 
circumstances. The Committee on Homeland Security, of which I am also 
the chairman, has an abiding interest in making sure that our first 
responders are capable of dealing with crises such as this. If smallpox 
is used against American citizens as a weapon, we have got to be 
prepared and we have to be sure that the first responders do not 
themselves become weapons, because even though they are not manifesting 
the symptoms they are spreading the disease.
  Smallpox spreads so fast that it is estimated it will kill at least 
30 percent of its unvaccinated victims. Immunity is suspected to have 
waned among people who were vaccinated before smallpox was thought to 
have been eradicated in the 1970s. Like many of the Members of this 
Chamber, I am such a person who has had such a vaccination. Yet I am 
probably not protected.
  Once contracted, smallpox incubates for 10 to 12 days, causing fever 
and nausea. As the symptoms abate, the victim

[[Page 7871]]

becomes infectious but does not develop the tell-tale rash for another 
2 to 4 days. That is why it is so important that these first responders 
be protected.
  As we speak, there is no cure for smallpox. The vaccine we have works 
well before exposure, but evidence of post-exposure efficacy is only 
anecdotal. That anecdotal evidence points to the vaccine only working 
if the victim is inoculated within 4 days of contact with smallpox.
  Our strategy to counter a smallpox attack depends on our first 
responders having already been vaccinated. It is going to be hard 
enough for public health officials to react within the necessary window 
of time. Administering the vaccine after the detection of a smallpox 
outbreak to a mobile American public with little or no immunity will 
cause immense problems. Doing so when first responders are not already 
themselves protected against smallpox could prove impossible. So far, 
only 20,000 nonmilitary personnel have been vaccinated. That is not 
nearly enough.
  Taking the vaccine means taking a risk. Therefore, we must reassure 
our health care workers and our first responders that we understand 
this risk and we will stand by them. That is why I support the 
gentleman from North Carolina's vaccination compensation legislation, 
that is why I support putting this legislation on the floor in this 
emergency circumstance as we have, and that is why I support the 
leadership of the gentleman from Louisiana in bringing this to a quick 
and hopefully positive vote.
  Mrs. CAPPS. Mr. Speaker, I am happy to yield 1\1/2\ minutes to the 
gentleman from Ohio (Mr. Strickland), a member of the Subcommittee on 
Health.
  Mr. STRICKLAND. Mr. Speaker, I am truly puzzled at the leadership on 
the other side. We are told that the administration sent this bill over 
here as an emergency. Yet I think they know that this bill is likely to 
be defeated because of the way it is being dealt with. If it is an 
emergency, ought we not to work together so that we can pass a bill? 
What is happening here today will result in the delay of this bill 
being passed.
  The chairman of our committee says, of course, we are for the 
volunteers and I believe he is sincere. But if we are for the 
volunteers, why do we not listen to the volunteers? In the first 2 
months of the administration's smallpox vaccine program, only about 
25,000 of a planned 450,000 health workers have received the vaccine. 
Last week, three people died from heart attacks after receiving the 
vaccine, two health workers and a 55-year-old National Guard member. 
All three people had risk factors for heart disease, although it is not 
currently known whether the vaccine caused the heart attacks.
  As a result of these challenges, a compensation program is needed, 
but these health care workers, these first responders are worried that 
the bill before us will not adequately provide for education and 
screening of the workers who are being asked to take the vaccine. If we 
screen the people who are at risk, we may save their lives and we can 
save money.
  I am disappointed. I think we all know this bill is likely to go down 
to defeat, and unnecessarily so. Let us work together in this House. If 
not on this bill, what bill can we ever work together on?
  Mr. Speaker, I include for the Record three letters, one from the 
International Union of Police Associations, one from the American 
Public Health Association and the other from the American Federation of 
Teachers in opposition to the administration's plan.

                                     International Union of Police


                                         Associations AFL-CIO,

                                   Alexandria, VA, March 27, 2003.
     Hon. Ted Kennedy,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Kennedy: On behalf of the International Union 
     of Police Associations, AFL-CIO, representing law enforcement 
     professionals from more than 500 agencies across the country 
     and in Puerto Rico, I am writing to voice our concern 
     regarding the Smallpox Compensation Program currently being 
     debated in the House.
       We urge you to work to ensure that this legislation will 
     provide the security demanded and deserved by our first 
     responders who elect to take the smallpox vaccine in order to 
     better serve a nation at war. We hope this would include 
     crucial screening and education for both the emergency 
     personnel and their immediate families.
       A mandatory funding provision is also needed to ensure that 
     the varying states' workers' compensation laws will not 
     withhold compensation based on the fact that the vaccination 
     is voluntary.
       We also believe that there should be no five-day waiting 
     period for compensation benefits. Furthermore, we hope to see 
     some protection for those who elect not to take it.
       We are asking more and more of those health care and public 
     safety workers on the front lines of our nation's homeland 
     security efforts. Providing them with ample security should 
     they become disabled in their duties is critical, necessary, 
     and is clearly and simply the right thing to do. I applaud 
     your efforts to correct the deficiencies in this proposed 
     legislation and will be privileged to assist you and your 
     staff in these efforts.
           Respectfully,

                                               Dennis Slocumb,

     International Executive Vice President.
                                  ____



                           American Public Health Association,

                                   Washington, DC, March 30, 2003.
       Dear Representative: On behalf of the American Public 
     Health Association (APHA), representing more than 50,000 
     members from over 50 public health occupations, I urge you to 
     oppose the H.R. 1463 in its current form and work to 
     strengthen this legislation before it is brought to the house 
     floor for a vote.
       APHA strongly supports legislation to address current 
     impediments to the national smallpox preparedness effort, 
     including lack of compensation for those who become injured, 
     ill, disabled or die; protections from liability for 
     volunteer vaccinators and health systems; and adequate 
     federal resources to enable public health systems to 
     implement a smallpox vaccination program safely and 
     effectively.
       We are concerned that the current proposal before the House 
     of Representatives fails to include a number of essential 
     elements of a workable compensation program that will 
     adequately protect volunteers and help to assure a successful 
     program.
       We respectfully suggest that the proposed legislation be 
     strengthened in the following ways:
       1. The compensation program should be financed by a 
     mandatory funding source. It is important that volunteers who 
     are injured, ill, disabled or die are assured that the 
     protection they expect from a compensation program will be 
     realized. We learned a clear lesson from the Radiation 
     Exposure Compensation Act (RECA) Trust Fund when earlier this 
     decade appropriations to the fund were not sufficient to pay 
     claims and hundreds ill from Cold War-era exposure to 
     radiation were left with IOUs. We have also learned in recent 
     weeks that we have more to learn about the effects of the 
     smallpox vaccine. Reports of heart inflammation and failure 
     in possibly connection with the vaccine warn us that we must 
     not have all the information at present to make an 
     appropriate judgment about the amount of appropriation it 
     will take to ensure that compensation can be guaranteed. 
     Those first responders who volunteer to be vaccinated deserve 
     to be assured that adequate compensation will be available 
     for them.
       2. Payment for illness, injury, disability, or death should 
     include compensation for all lost wages, taking into account 
     an individual's projected future earnings. Volunteers and 
     their families should be confident that should they become 
     unable to work due to disability they will not have to lose 
     their income for future years, jeopardizing the income 
     security for themselves and their families. In the rare case 
     of death, family members, including children, should not be 
     left uncompensated because of a loved one's sacrifice to 
     protect others. Death and disability benefits should not be 
     reduced by wages replaced before death or disability occurs. 
     Compensation should be 100%, begin without delay, and should 
     not be subject to a cap.
       3. Volunteers should be compensated for adverse events 
     regardless of the date on which they received the vaccine. 
     Imposing an artifical time period in which one must volunteer 
     is contrary to the goal of the vaccination program. Success 
     should not be measured on the numbers vaccinated a specific 
     period of time but rather, on whether at any given time we 
     have a sufficient cadre of vaccinated first responders across 
     the country. Speed should not be our measure--safety should. 
     As we have seen from the start of the program, any number of 
     barriers may result in extending the time in which we expect 
     vaccinations to occur, including unexpected new possible 
     complications from the vaccine. Establishing a set time frame 
     for vaccination eliminates adjustments needed for 
     unanticipated events.
       4. Adequate Funds are needed to ensure that state and local 
     health systems are prepared. Any proposal should recognize 
     the need for additional funds to state and local health 
     departments and health systems to implement the smallpox 
     program. Current funds for bioterrorism preparedness efforts

[[Page 7872]]

     have been largely spent and obligated. States and localities 
     and health systems are preparing for a broad array of 
     potential threats in a time of great budgetary strain and 
     increased demand for services. The recent outbreak of Severe 
     Acute Respiratory Syndrome (SARS) is but one example of how 
     public health is required to serve a dual role, protecting 
     Americans from the latest emerging infectious diseases, the 
     leading causes of death such as chronic diseases, and 
     preparing for intentional acts of biological terrorism or 
     war.
       Resources are needed to ensure that the important smallpox 
     preparedness program can proceed without shifting resources 
     from other bioterrorism preparedness requirements and while 
     maintaining our important programs to protect Americans from 
     everyday health threats.
       Again, we commend you for recognizing the importance of 
     this legislation, we urge you to do it thoughtfully, and we 
     remain ready to implement the smallpox preparedness program 
     safely, efficiently and effectively.
           Sincerely,
                                       Georges Benjamin, MD. FACP,
     Executive Director.
                                  ____

                                            American Federation of


                                            Teachers, AFL-CIO,

                                   Washington, DC, March 28, 2003.
     House of Representatives,
     Washington, DC.
       Dear Representative: On behalf of the more than 1 million 
     members of the American Federation of Teachers, including 
     more than 65,000 healthcare professionals, I urge you to vote 
     against considering H.R. 1413, the Smallpox Emergency 
     Personnel Protection Act, under suspension of the rules. This 
     procedure will prevent the House from consideration of the 
     Capps-Waxman substitute, which is vastly superior to the 
     Administration's proposal, H.R. 1413. Capps-Waxman provides 
     increased education and screening, as well as a realistic 
     compensation package for those who suffer a serious adverse 
     reaction.
       As you know, most workers have refused to participate in 
     the smallpox inoculation program. Most believe there has not 
     been sufficient information about the need for immediate 
     vaccination. Further, there are serious doubts about the 
     efficacy of existing education and screening programs, as 
     well as the lack of a federal compensation program for 
     healthcare volunteers and innocent victims who may suffer 
     adverse reactions.
       Since last fall, healthcare unions and other organizations 
     have been working to develop a bipartisan program that would 
     address these issues. Our proposal is based on the existing 
     Department of Defense smallpox program, as is the Capps-
     Waxman substitute. The Administration's proposal that is 
     being rushed to the House floor does not provide the same 
     protections that are offered in the Capps-Waxman substitute.


                        education and screening

       The need to increase the education and screening of 
     volunteers is clear. This requires additional funding. The 
     Department of Defense's comprehensive education and screening 
     program, for example, screened out 30 percent of those who 
     were to be inoculated. The recent death of two nurses and the 
     serious adverse reactions of others demonstrate the 
     limitations of the existing program, which continues 
     unchanged under H.R. 1413. Screening out those who are 
     counter-indicated is essential to prevent adverse reactions 
     and to protect healthcare workers who volunteer. The Capps-
     Waxman substitute addresses this critical need by providing 
     additional funding for our public health agencies that are 
     responsible for this program to assure complete education and 
     screening. The Administration proposal does not.


                              compensation

       Since the smallpox program is a voluntary federal program, 
     injured individuals should be compensated by the federal 
     government for the cost of both medical treatment and lost 
     wages. The Administration's proposal seems to assume that 
     there is adequate wage compensation through the workers' 
     compensation system. Unfortunately, we have found only 14 
     states that can assure workers that they will be covered 
     under workers' compensation. The remainder of the states are 
     not sure that this program is ``work related'' since it is 
     voluntary. Further, innocent third parties who suffer adverse 
     reactions are not covered by workers' compensation. Also, 
     many workers or innocent third parties are not covered by 
     health insurance or may be subject to health insurance 
     exclusions; therefore, full federal health insurance coverage 
     for medical treatment is essential. While the Administration 
     bill does cover health insurance, its restrictive definitions 
     on disability and caps on financial benefits do not assure 
     necessary wage replacement. The Capps-Waxman substitute 
     includes necessary federally financed healthcare and provides 
     the victims lost wages for the duration of the disability 
     caused by an adverse reaction.
       The bottom line is that a reasonable compensation program 
     for adverse smallpox reactions should provide federal 
     compensation for full medical coverage and adequate wage 
     replacement. There should be no exclusions from this 
     coverage, such as the five-day waiting period in the 
     Administration program. This five-day exclusion is a major 
     concern of many of our members. Further, restrictions in the 
     Administration's proposals, such as capping benefit payments 
     and using the 180-day rule forcing workers to choose to get 
     the vaccination or forgo compensation, are unacceptable. The 
     Capps-Waxman substitute satisfactorily addresses these 
     issues.
       Finally, this new program must be mandatorily funded and 
     include a table of injuries in the statute to ensure workers 
     get compensation, a provision in Capps-Waxman and not the 
     Administration legislation.
       Unfortunately, under the suspension of the rules procedure, 
     the House will be precluded from addressing these issues. Our 
     nurses, other health care workers, and first responders are 
     dedicated professionals and will not shirk their duties to 
     help the public. However, they deserve the best screening, 
     education, and compensation program for volunteering to 
     receive this potentially dangerous vaccine. They deserve a 
     vote on the Capps-Waxman substitute.
       On behalf of the American Federation of Teachers, I urge 
     you to oppose consideration of H.R. 1413 under suspension of 
     the rules and demand a vote on the Capps-Waxman substitute.
           Sincerely,

                                              Charlotte Fraas,

                              Director, Department of Legislation.

  Mrs. CAPPS. Mr. Speaker, I yield 1\1/2\ 
minutes to the gentleman from Massachusetts (Mr. Markey).
  Mr. MARKEY. Mr. Speaker, who opposes this bill? The nurses, the 
police, the fire, the Public Health Association of the United States. 
They all oppose it. These are the health care heroes in our country. 
The reason that legislation is so important is that these people are 
going to be asked to put their lives on the line. They are the first 
responders. How busy are we that we can give them 20 minutes of debate, 
each side having 20 minutes to debate their fate? How hard would it be 
for us to have worked all day Friday to allow amendments to have been 
made that represents what the teachers, what the nurses, what the 
doctors, what the police and what the fire want for protections? How 
hard would it have been for us to have worked all day today if there is 
an emergency? Do we not as Members of Congress owe to these heroes 
working on a Friday and a Monday so we can debate what their needs are?
  Then why is it important? It is important because the adverse 
reactions from the smallpox vaccine are a real concern. This bill 
coerces volunteers to be vaccinated within 180 days after the 
regulations are issued or they lose their rights to lost wages and to 
disability payments and even to death payments. They lose them. A 
pregnant nurse has only 180 days to be vaccinated after her baby is 
born.
  This is wrong. Vote ``no'' on this bill. Let us have a full debate on 
the House floor with amendments.
  Mrs. CAPPS. Mr. Speaker, I yield myself the balance of my time.
  I stand here with my colleagues in opposition to this bill, drafted 
by the leadership with a kind of arrogance that presumes to know what 
is best for our first responders than they themselves know. With their 
testimony, with their letters, with their anguish, they implore us to 
give them the confidence that they need if they are going to be asked 
to take a risk to become a part of the shield to protect this Nation 
against terrorist attack.
  We need to defeat this legislation for them so that they can have 
confidence in this House that we can do what is right, not just for 
them but for our Nation in this time of peril. And so I will close by 
using some of the language of my colleague, the ranking member of the 
Committee on Energy and Commerce, the gentleman from Michigan (Mr. 
Dingell) who says in his written statement, ``Right after we defeat 
this bill, I hope that we can set about the task of creating bipartisan 
legislation that all Members of the House can support. The very people 
this bill purports to help, nurses, EMTs, police officers, 
firefighters, find this hastily crafted legislation lacking. Why? 
Because it fails to address their very significant concerns.''
  Mr. TAUZIN. Mr. Speaker, I yield myself the balance of my time.
  Let me address the two principal objections to this bill. The first 
is that some of the first responders would like more coverage. They 
would like more coverage than we currently provide for

[[Page 7873]]

police officers and firefighters who take the chances to go out and 
fight fires and sacrifice their lives, to go out and fight the criminal 
elements on the street and take the bullets and sometimes die and 
sometimes end up disabled and have a lifetime of lost wages. They would 
like to have more benefits than those individuals. But this is not a 
management-labor union discussion. This is an emergency. When the other 
side asked for time, for 2 weeks to work with us in a bipartisan 
fashion to up the benefits comparable to what police and firemen have, 
we did that. It is now in the bill.
  The other objection they raise is that, well, this is not due 
process. We have taken this bill to the floor under suspension. We are 
not taking it through all the committees of jurisdiction. How many 
committees claim jurisdiction on this bill, Mr. Speaker? Let us start 
with the Committee on Education and the Workforce. We heard from the 
chairman who instead worked with us cooperatively to get this bill to 
the floor. Judiciary could have a claim on this bill. Judiciary worked 
with us cooperatively to get this bill to the floor. Appropriations 
could certainly have a claim on this bill, but they have worked with us 
to get this bill to the floor.
  Why have all the committees worked with us to get this bill to the 
floor without all the markups and all the committees that might have 
jurisdiction on it? Because they know the emergency. They understand 
how important it is to get this bill done and signed by the President 
immediately. We have all been briefed. We have all been briefed about 
the danger of smallpox terrorism. We have all been briefed about how 
easy it would be for a country like Iraq, which we know probably has 
smallpox virus, to slip it into this country, to expose someone and 
then begin exposing our general population. They know that in 2 weeks, 
everyone once exposed becomes a carrier and exposes more people and 
that second- and third- and fourth-generation exposure occurs and we 
lose 30 percent of the population of America potentially. They know the 
danger. They know the emergency. Every committee has cooperated with 
us.
  For 2 weeks we negotiated with the other side, a fair negotiation to 
get this bill in a way that you could accept it. We made a dozen 
changes, raised the amount of the benefits, changed the percentages to 
75 percent for those with dependents. We built a program as good as any 
program for anyone in the Federal service, and we built it as good as 
the policemen and firemen.
  But that is not enough. Enough is never enough. But we do not have 
time to quibble about what is enough here. Do not come to this floor 
saying that no one supports this bill in the health care community. Let 
me read to my colleagues the supporters: The American Hospital 
Association, people who will be on the front line taking care of all 
these people infected with smallpox if we are not careful; the American 
Medical Association, the doctors who have to deliver the care; the 
American College of Emergency Physicians who are going to meet every 
sick person coming in with smallpox to an emergency room; the Alliance 
of Specialty Medicines, representing 160,000 physicians, among many 
others who support this bill.
  This is an emergency. The administration, the Homeland Security 
Office, have told us we need to give this benefit to those people who 
will volunteer to take this vaccine to protect themselves and then to 
protect us. No one is coerced to do this. This bill does not mandate a 
single person take the vaccine. It simply gives the same rich mix of 
benefits to those who will volunteer to take this vaccine and protect 
the rest of us, to be ready to go into action to prevent the second- 
and third- and fourth-generation exposures that could wipe out so many 
in this country. It simply says to them, if you volunteer, we give you 
this coverage. If you volunteer, if you want to be one of those who 
serve this country in this special way, you get the benefits of this 
bill.
  This bill needs to get passed now. It is an emergency. That is why it 
is on suspension. We ought to have the courage to pass it. If it does 
not pass today, it is only because somebody on the other side thinks 
enough is never enough and you want to quibble about numbers when the 
country is at stake.
  Mr. Speaker, this bill ought to get passed. It needs to get passed 
now.
  Mr. HOLT. Mr. Speaker, on September 11, 2001, as thousands fled over 
lower Manhattan during the terrorist strikes, many ran towards the 
burning buildings.
  These brave men and women were first responders--the police, 
firefighters, and emergency medical personnel who risk their lives 
every day to protect their fellow citizens.
  It would seem like the least we could do for them would be to not 
only applaud their efforts, but also provide them with support they 
need so they can do their jobs even better.
  Unfortunately, this Congress has found it appropriate not to support, 
but to shortchange these everyday heroes.
  A month and a half ago, we finally managed to pass the FY03 spending 
bill. Many of us here in this body sought to add vital funding for 
first responders, but we were denied. Our first responders were denied.
  Today, apparently, this body is poised to again deny our first 
responders--in this case, the men and women who will first respond to 
the unthinkable: a smallpox attack.
  The need for the president's smallpox vaccination program is 
questionable, but now that the program exists, there is no doubt that 
we need to address compensation for those who volunteer for and are 
injured by the vaccine. In terms of negative side effects, this 
vaccine--essentially the same as the original developed in 1796--is 
perhaps the most dangerous one we currently have. In this most initial 
wave of vaccinations, we have already seen several serious injuries and 
even a few deaths possibly attributable to the vaccine.
  That is why adequate compensation for vaccine injury is so crucial. 
Our first responders want to know that if they take the brave step of 
volunteering for the vaccination and get sick or die, they and their 
family will be taken care of.
  The absence of a good compensation program has doubtless contributed 
to the snail's pace that the president's vaccination program has taken. 
Only 25,000 of the 500,000 in the ``initial wave'' of healthcare 
workers have actually been vaccinated.
  The bill before us will not assure these workers that they will be 
adequately compensated. The lifetime cap of $262,100 is small change 
for someone who is permanently disabled.
  This bill also only covers workers vaccinated during a specific short 
time period after implementation. What kind of an incentive is this for 
new healthcare providers to get vaccinated in the future?
  As the American Nurses Association has written, ``the bill does not 
provide adequate education, prescreening, surveillance, and 
compensation.''
  Mr. Speaker, I have been working in this Congress to show my strong 
support for our first responders. Today I will continue to show this 
support by voting ``no.''
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I cannot support H.R. 1463, 
the Smallpox Vaccination Compensation Act. Our nation's first 
responders and health care workers take risks every day in order to 
serve the public good. Our firefighters face the risk to their lives 
every time they are called to duty. Health care workers come into 
contact with deadly germs on a regular basis. Even now, with the threat 
of bioterriorist attacks upon them, they are not flinching. They are 
there at work, serving the public good and putting themselves in harm's 
way.
  And now that it seems that on top of the physical risks they are 
taking, the Republican leadership has decided that they and their 
families should also shoulder the financial risk of the fight against 
terrorism. We are asking that they serve as a kind of barrier, 
protecting the American public against the horrors of smallpox. If the 
virus were somehow leaked into the U.S., of course we would expect our 
first responders to be there at the sight of the emergency, and 
infected individuals would end up at our hospitals. We are trying to 
encourage those who work on the front lines to come in and get 
vaccinated, so that they do not get infected and pass the virus on to 
their families and the public.
  But the vaccination program has been an utter failure so far, because 
the smallpox vaccination itself also carries with it moderate danger. 
As scientists have been telling us, the vaccination can make some 
people sick, or can even lead to death in rare circumstances. Whereas 
the death rate can be reduced or eliminated by good education and 
screening of people who might be at risk for complications, some of 
those who are vaccinated will become ill. They may have to be 
quarantined;

[[Page 7874]]

they will miss work, perhaps for a long time. In today's economy--with 
medical costs what they are--this could be devastating, especially for 
someone with a family to support. Too many of our first responders and 
health workers have decided they cannot take that risk, and are asking 
that the Federal Government that is in charge of protecting the 
homeland--assume that risk for them. That seems fair enough.
  The author of the bill before us today recognized the problem, and 
gave the bill the right name, but just didn't do a good job of matching 
resources with the needs out there. The problem with that is that if we 
don't give adequate assurances to people that they will be covered for 
any unfortunate episodes--they will not get vaccinated. Then in 6 
months, or a year, we will find ourselves in this same situation--
totally vulnerable to a smallpox attack. We cannot afford to take that 
risk. We must get it right the first time.
  We are hearing from group after group of experts and people effected 
by this, saying, ``Do not support this bill. It is not enough.'' The 
American Nurses Association, the Association of Firefighters, the 
American Federation of State, County and Municipal Employees--and the 
list goes on. These are not the money-grubbing types; they are humble 
civil servants who deserve our support. They are saying that this 
compensation package may not be enough to entice them to join the 
voluntary smallpox vaccination program. If they do not sign up, they 
will be vulnerable, and so will the American people.
  The Democratic Capps-Waxman substitute would have gotten the job 
done. The Republican bill does not ensure adequate funding is available 
to compensate health care workers and other first responders injured by 
the smallpox vaccine. The Capps-Waxman substitute provides for 
mandatory funding for this program.
  The Republican bill would pay only 66.6.% of an injured worker's lost 
wages with a lifetime cap of $50,000. The Capps-Waxman amendment would 
pay 66.6% of lost wages up to $75,000 per year for as long as the 
worker is disabled. Workers with dependents would receive 75% of lost 
wages up to $75,000 per year for as long as the worker was disabled.
  The Republican bill would not compensate health care workers and 
other first responders for lost wages for the first five days they are 
injured. The Capps-Waxman substitute would ensure that health care 
workers and other first responders who are out of work for longer than 
five days would have their unreimbursed lost wages compensated from the 
first day they missed work.
  The Republican bill provides that a health care worker or other first 
responder who is killed by the smallpox vaccine receives only a flat 
death benefit. The Capps-Waxman substitute would pay a death benefit as 
well as any lost wages for workers who have dependents when they die.
  Finally, the Capps-Waxman substitute has a specific authorization for 
funding for States to educate and screen potential vaccinees. The 
Republican bill does not. This is a critical component. There have been 
several deaths recently that occurred within a week or so after 
vaccinations. We must at the very least provide adequate education to 
people we want to get vaccinated to see if they are at risk for 
vaccine-related disease. They deserve that.
  I will vote against H.R. 1463, and urge my colleagues to do the same.
  Mr. LEVIN. Mr. Speaker, since September 11, we have begun to prepare 
for a number of events that once seemed unthinkable. One of them is an 
epidemic of smallpox, a deadly disease that we thought we had erased 
from the earth. The best way for us to protect ourselves against that 
is to vaccinate our first responders--the nurses, policemen, and 
firefighters that we would depend on to recognize a smallpox outbreak 
and quickly act to protect all of us against a disease that spreads 
rapidly and kills a third of its victims.
  But in the three and a half months since President Bush announced 
plans to vaccinate 500,000 first responders, fewer than 25,000 have 
volunteered. In Michigan, where we had a goal of vaccinating 5,000 
people, fewer than five hundred people have been vaccinated.
  The smallpox vaccine has the worst record of negative side effects, 
including death, of any vaccine in our history. Experts estimate that 
one in a million people vaccinated will die, and many more will become 
ill, some seriously. Sadly, three people who volunteered to be 
vaccinated have already died.
  These are sobering statistics, but it is not the personal danger that 
is keeping first responders from volunteering. Every day, our police, 
firefighters, and health care workers risk injury and death to help 
others. But giving them the smallpox vaccine without proper education, 
pre-screening, and surveillance doesn't just endanger them--it 
endangers all of us. When smallpox vaccination was still widespread, 
nearly 20 percent of infections from the vaccine came from secondary 
contact. And asking first responders to be vaccinated without a safety 
net if they become ill, are disabled, or die endangers their families 
and those who depend on them for support.
  The Republican leadership says we don't have time to have a 
discussion with nurses, policemen, firefighters, and other first 
responders about what kind of program they need to feel safe because 
preparing for bioterrorism is an emergency. But if we don't have that 
discussion, we will have done nothing to address the emergency.
  Receiving the smallpox vaccine is voluntary for first responders. 
First responders don't think the current program is safe, so they are 
declining the vaccine. That's why our current program isn't working and 
why after months of saying a vaccine injury compensation system wasn't 
necessary, House Republicans are willing to bring up a bill. But if the 
bill we pass doesn't make first responders feel safe, they still won't 
volunteer to be vaccinated, and we'll be right back where we started, 
except we'll have wasted a lot of time on a program we already know 
will be ineffective.
  Wouldn't it make more sense to get it right the first time? By voting 
against this bill, which the International Union of Firefighters, the 
American Nurses Association, and the International Union of Police 
Associations say does not address the concerns that have prevented them 
from being vaccinated, I hope to give the House an opportunity to sit 
down with first responders and craft a workable solution. It is 
precisely because this is an emergency that we don't have time to pass 
unworkable legislation, wait for it to fail, and start again.
  I regret that we did not have the opportunity to vote on a real 
solution tonight. I hope we can move immediately to pass a real 
solution, without wasting any more time on political gamesmanship.
  Mr. CARDIN. Mr. Speaker, I rise in opposition to H.R. 1463. The House 
should be considering a bill today that responds to two basic 
questions: how do we encourage first responders--nurses, emergency room 
doctors, police, and firefighters--to volunteer for smallpox 
vaccinations; and second, how do we compensate them for any injury, 
disability or fatality they suffer in the event of an adverse reaction. 
Instead, the bill we are voting on--with no opportunity to amend or 
offer a substitute--accomplishes neither.
  Last week, a 57-year-old nurse from my own state of Maryland died 
within 5 days of receiving the smallpox vaccine. The CDC is still 
investigating the nexus between the vaccine and her death. But to date, 
12 health care workers who received the vaccine have experienced severe 
heart problems within days of inoculation, and 3 have died. These 
deaths and complications are sending waves of panic through the health 
care community.
  On January 24, the President and HHS Secretary Thompson called for 
450,000 first responders to be inoculated against smallpox. Today, as 
we come to the floor to consider this bill, the Administration has 
reached only 5 percent of its goal. The response has been dismal not 
because these workers lack dedication to public health and safety, but 
because they have justifiable doubts that this vaccine is safe and that 
if they are injured or die, they and their survivors will be 
compensated fairly.
  Initial risk assessments by HHS did not come close to estimating the 
percentage of workers who would be at risk of illness or death from the 
smallpox vaccine. Many individuals are well on their way to heart 
disease, even though they have no symptoms and feel fine. Many 
Americans who have high blood pressure and diabetes are completely 
unaware of their condition.
  Both high blood pressure and diabetes increase the risk for heart 
disease. Unfortunately, these serious problems usually don't cause 
symptoms until they've already done their damage. They silently harm 
many organs, including the heart and kidneys. Often people are not 
diagnosed with these problems until it is too late to prevent damage. 
By the time symptoms are present, the condition may be critical.
  Scientific studies have indicated that for every 100,000 who are 
immunized against smallpox, 2 or 3 will die. But the U.S. has only 
immunized 29,000 persons so far, and three deaths have already 
occurred. Why the decrepancy? HHS's initial risk assessments were based 
on immunization of much younger subjects, who are at far lower risk of 
heart disease. But the three workers who died were all in their 
fifties, and the average age of nurses in our workforce is 45. Those 
who would be immunized under the president's plan are at much higher 
peril of adverse reactions.
  The CDC had already announced a temporary medical deferral for 
persons diagnosed

[[Page 7875]]

with heart disease, and late last week it expanded that category to 
include individuals with three of more ``major risk factors'' for heart 
disease, including smoking, diabetes, high blood pressure and high 
cholesterol. Small wonder that the participation rate among our health 
care workers is so low. It is likely to remain low until workers gain 
confidence that government has a better understanding of risk factors.
  Our nation's first responders should be protected against smallpox. 
But a vaccination program can only succeed to the extent that 
government succeeds in assuring workers that potential side effects 
will be minimized, and that they will be treated fairly and compensated 
adequately in the event of illness, disability, or death.
  The underlying bill fails these tests. It limits payments for lost 
income to any annual maximum of $50,000. There is no wage replacement 
for those who suffer permanently disability or death. Why would nurses, 
who earn an average salary of $40,000, risk their families' future for 
so little?
  The Burr bill won't begin replacing lost wages until 5 days have 
passed. A national program ought to provide first dollar compensation, 
not last-resort coverage. The Burr bill also imposes a deadline of 180 
days for workers to qualify for compensation. Those vaccinated after 
that time would not qualify. How can we know how long it take our 
States and localities to vaccinate a sufficient number of volunteers?
  In addition, the bill provides no funding for education, screening, 
or surveillance. The National Association of County and City Health 
Officials has estimated that to provide pre-vaccination education and 
screening, and surveillance for adverse reactions would cost between 
$154 and $284 per person. If the Administration plans to vaccinate 
500,000 workers in Phase I and another 10 million in Phase II, we are 
talking about a $2 billion unfunded mandate to our localities.
  Mr. Speaker, our towns' and cities' budgets are already strained as 
they conduct other bioterrorism preparedness activities. Our localities 
do not have sufficient funds to prepare for chemical, biological and 
radiological terrorism, and more than half of our local governments 
have reported that smallpox and other bioterrorism planning has 
negatively affected other local public health services. They are 
delaying programs, turning down community requests, and reducing the 
frequency of client visits.
  Mr. Speaker, we have asked America's first responders to put their 
lives on the line to protect the rest of us. The compensation we offer 
must be adequate; it must be immediate; it must be guaranteed. I 
believe the House is united in its appreciation of and support for our 
first responders. Legislation to compensate them for their illness, 
disability or death should reflect that level of support. I am 
disappointed that the bill before us does not do that. I urge the House 
to reject this bill and I call upon the leadership to return with 
legislation that will provide a meaningful compensation program for 
those on the front line against bioterrorism.
  Ms. SCHAKOWSKY. Mr. Speaker, the Smallpox Emergency Personnel 
Protection Act (H.R. 1463) is being rushed to the House floor today for 
a vote under suspension, denying us the opportunity to amend this bill 
to ensure that the compensation we offer our first responders is both 
adequate and meaningful. I have serious concerns both about the 
deficiencies in H.R. 1463 and the process by which it was brought to 
the floor. This is an ill-considered bill that fails to provide 
adequate compensation for persons volunteering for the smallpox 
inoculation and, therefore, will undermine the very goal of encouraging 
first responders to participate in the vaccine program. Three recently 
immunized military personnel and civilian health care workers have died 
of fatal heart attacks and Federal health experts are investigating at 
least 15 more cases of possible cardiac reactions to the immunization. 
Given recent events such as these, the limitations of H.R. 1463 will 
likely result in even more refusals by first responders to volunteer 
for the smallpox vaccine.
  H.R. 1463 fails to offer meaningful compensation, does not have 
guaranteed funding, and attempts to coerce first responders into 
getting inoculated. It will not work. That is why it is opposed by many 
organizations representing first responders, including the American 
Nurses Association, International Union of Police Associations, 
International Association of Firefighters, American Federation of 
Teachers, American Public Health Association, Infectious Diseases 
Society of America, American Federation of State, County and Municipal 
Employees, and the Service Employees International Union.
  H.R. 1463 is based on the false assumption that nurses, firefighters 
and other first responders will be compensated by other benefit 
programs, such as workers' compensation and health insurance. In the 
case of smallpox, however, there are no guarantees that a person 
injured by the smallpox vaccine will be covered by workers' 
compensation or will be adequately insured. In fact, there are only 14 
States where it appears at all certain that claims for benefits will be 
honored by the State workers' compensation program, based on a recent 
survey by the AFL-CIO. As a result, those injured by the smallpox 
vaccine may receive far less total compensation than other first 
responders currently covered by their Public Safety Officers Benefit 
program.
  If, for example, under H.R. 1463, a 30-year-old nurse were 
permanently injured or killed as a result of the vaccine, she or her 
survivors would be eligible for a one-time lump sum payment of 
$262,100. This amount is equivalent to 5 years' pay for the average 
nurse. This is not adequate compensation for a nurse unable to work, 
her family or her survivors. Partial and temporary disabilities as a 
result of the smallpox vaccine are also arbitrarily capped with a 
lifetime payout at $262,100. Compensation should be provided to workers 
for the duration of disability or to survivors' families until the 
spouse remarries or the children are no longer minors. If workers are 
worried about their economic security, and that of their families, they 
for good reason will continue to be reluctant about getting the 
vaccination.
  Although the compensation offered through H.R. 1423 is scant at best, 
our first responders cannot even rely on benefits offered because there 
is no guaranteed funding. H.R. 1423 is funded by discretionary spending 
and would be subject to the annual appropriations process. Funding for 
compensation and medical care should be mandatory spending, similar to 
the Vaccine Injury Compensation Program for injuries due to childhood 
vaccines. Workers should not have to worry each year about whether 
there will be an adequate appropriation to provide promised benefits 
and medical care.
  As if lack of compensation and funding did not make this bill already 
untenable, H.R. 1423 attempts to coerce workers into getting the 
vaccine. Current workers must receive the vaccination within 180 days 
following the issuance of interim final regulations in order to be 
eligible for compensation. New hires must be vaccinated within 120 days 
of hire to be eligible. There is no exception in the event that the 
public health department is unable to meet the deadline or a worker has 
a temporary condition that prevents immediate vaccination, such as 
pregnancy or the presence of an infant at home. Smallpox vaccination 
should be voluntary. When legislation only allows first responders to 
be eligible for compensation if they are vaccinated within months of 
the bill's passage, we know that people on the front line are being 
manipulated into getting the vaccine and getting it quickly.
  Our first responders deserve better. They deserve a full and fair 
smallpox compensation package. Unfortunately, we do not have the 
opportunity to correct the deficiencies in H.R. 1463 because we are 
denied the opportunity to consider amendments. I oppose H.R. 1463 and 
look forward to voting on an effective alternative when the bill is 
brought under a rule that allows for a full and fair opportunity for 
amendment.
  Mr. UDALL of Colorado. Mr. Speaker, I regret that I cannot support 
this bill.
  When President Bush called for the voluntary vaccination against 
smallpox of 500,000 health care workers and other first responders last 
December, many criticized the plan for being incomplete. Not only did 
it not include a federal compensation fund to help those injured by the 
vaccine or their survivors, but the plan did not provide adequate 
education, prescreening, or surveillance. The relatively few numbers of 
health care workers and first responders who have received the 
vaccine--only about 21,700 to date--indicate that there are real 
concerns about the plan's shortcomings.
  After all, the smallpox vaccine uses a live strain of the virus. The 
vaccine has the worst record of negative side effects of any vaccine in 
the world. So it is critical that those being vaccinated understand the 
risks involved and be prescreened for conditions that require them to 
avoid the vaccine. The recent deaths of a nurse, a nurses aide, and a 
National Guardsman after their vaccinations only underscore this point.
  Like the President's plan, this bill has serious shortcomings. In 
particular, I'm concerned that the compensation program is not 
comprehensive enough and that it does not provide adequate education 
and safeguards. I believe that the House must consider improvements to 
this bill. But the Democrats are being denied the opportunity to offer 
amendments to do that.

[[Page 7876]]

  For these reasons, Mr. Speaker, I must oppose this legislation in its 
present form.
  Mr. STARK. Mr. Speaker, I rise in opposition to H.R. 1463, the 
Smallpox Emergency Personnel Protection Act.
  This Republican legislation has a lot more to do with public 
relations than protecting our first responders so that they can do 
their job to protect the rest of us. No one doubts that the possibility 
of a terrorist attack is very real. Yet, Republicans are asking 
Congress today to short change those Americans on the front lines here 
at home--our doctors, nurses, police officers, fire fighters and others 
willing to risk both serious physical harm and financial ruin.
  Congress has a great responsibility to provide security to these 
brave and selfless Americans. The smallpox vaccine is the most 
dangerous vaccine in current use. Thus, the decision to become 
inoculated is not one to be taken lightly. Those who are willing to 
step forward and receive inoculation to assure that they'll be there to 
protect others if the need arises, do so at a risk to their lives and, 
by secondary transmission, to the lives of loved ones. At a minimum, we 
need to assure these people that they and their families have 
affordable access to healthcare and won't confront financial hardship 
if they have an adverse reaction to the vaccine.
  We are not talking about a small number of people at risk. Experts 
estimate that out of the 10 million healthcare and first responders who 
the Administration is requesting to volunteer for this smallpox 
inoculation program, approximately 10,000 will experience serious, 
though not life-threatening reactions, upwards of 520 will experience 
potentially life-threatening reactions and it is anticipated that 5 to 
10 people will die. These estimates do not include those individuals 
who may be secondarily exposed to the live virus by being in contact 
with an inoculated individual. Furthermore, just in the last week we've 
discovered something previously unknown about the smallpox vaccine; it 
may cause heart attacks in people with particular cardiac conditions.
  The Administration's Smallpox Vaccine Compensations bill is 
inadequate in numerous ways. Among its inadequacies, it:
  Fails to provide adequate funding to ensure that state and local 
public health officials can implement needed pre-inoculation education 
and screening and post-inoculation surveillance programs;
  Ignores the need for work place protection standards for individuals 
who refuse to volunteer for the vaccine program;
  Provides no requirement that health insurance companies guarantee 
health insurance coverage for adverse medical events that occur from 
participating in this voluntary program;
  Fails to guarantee immediate access to medical care for volunteers 
who have no insurance or who are not eligible for Medicaid or Medicare;
  Provides a wholly inadequate death benefit and a benefit for 
permanent and total disability limited to $262,100. This in no way 
replaces the lifetime income that will be lost to the families of the 
brave individuals who volunteer for this inoculation and are adversely 
affected;
  Fails to compensate individuals who become sick and miss work for 5 
or fewer days;
  Doesn't guarantee that the compensation program is even funded. 
Rather than making it a mandatory appropriation which would assure that 
the program is fully funded, it is discretionary spending; subject to 
the vagaries of the annual appropriations process.
  These many inadequacies have lead every major organization 
representing nurses, fire fighters, and other frontline personnel to 
oppose the legislation. These organizations include the American 
Nursing Association (ANA), the American Public Health Association 
(APHA), the International Association of Fire Fighters, the Infectious 
Disease Society of America and the Service Employees International 
Union (SEIU).
  My colleagues, Representatives Henry Waxman and Lois Capps, have 
introduced legislation (H.R. 865) to create a smallpox inoculation 
compensation program that would meet the needs of these brave 
volunteers. Unfortunately, the Republican Leadership has forbidden that 
bill to be considered by the full House. For that reason, we are forced 
to vote NO today and try to get the Republican Leadership to recognize 
that providing true protection to our emergency personnel who have 
volunteered to become inoculated against smallpox is a priority for 
this Congress. We need to do the job right!
  I urge my colleagues to vote against H.R. 1463 today and insist that 
a compensation bill that truly protects the interests of these 
volunteers for the smallpox inoculation program be returned to this 
Chamber for a vote and passage.
  Mr. TOWNS. Mr. Speaker, I rise today in opposition to H.R. 1463. 
While it offers significant liability protections to those entities 
that are responsible for administering the vaccination program, it 
simply does not provide the protection required by frontline health 
workers who have been asked to volunteer for the national smallpox 
vaccination program. More to the point, we have had three recent 
deaths, which can be reasonably traced to the vaccinations, and several 
other workers and military personnel have experienced cardiac-related 
problems after being vaccinated.
  All the major unions--Service Employees International Union, American 
Federation of Teachers, American Nurses Association, International 
Association of Firefighters, International Union of Police 
Associations--who represent health workers and first responders, have 
declared that this legislation fails to provide an adequate 
compensation program. Thus far, only 14 states have been able to 
definitely assure workers that workers' compensation programs would 
cover them. Further, innocent third parties who suffer adverse 
reactions are not covered by workers' compensation. In the '60's, more 
than 20% of the adverse vaccination events occurred in secondary 
contacts. Therefore, the vaccination program poses a risk not only to 
first responders, but also to their patients and their families.
  Moreover, public health experts, like the Centers for Disease 
Control's Advisory Committee on Immunization Practices, now question 
whether anyone with three or more ``major risk factors'' for heart 
disease, including smoking, diabetes, high blood pressure and/or high 
cholesterol should receive the smallpox vaccine. Given the cost of 
screening for the above factors, it is particularly troubling that 
there is no guaranteed funding for medical screening, education or 
surveillance. Our armed services personnel received personalized 
education, and free and confidential prescreening prior to the 
administration of the vaccine. This process resulted in one-third of 
the potential recipients being screened out of the program. We should 
offer the same education and screening opportunities to our nurses and 
first responders.
  Finally, Mr. Speaker, even though this bill falls short on a 
compensation and education and screening program, I remain hopeful that 
the Emergency Supplemental will at least provide adequate funding for 
States and localities to administer this program when and if an 
adequate compensation program is put in place.
  Mr. SENSENBRENNER. Mr. Speaker, the bill before the House today, H.R. 
1463 contains several provisions that are within the jurisdiction of 
the House Committee on the Judiciary as provided in Rule X of the Rules 
of the House of Representatives for the 108th Congress. The Committee 
on the Judiciary would normally proceed under regular order to examine 
legislation containing such provisions within our jurisdiction and take 
appropriate actions in Committee meetings.
  However, the Bush Administration has maintained that there is a 
pressing need for this legislation's swift passage in order to provide 
first responders and other emergency personnel with all due 
encouragement and assurances to participate in ongoing smallpox 
vaccinations. Because of the exigent circumstances, the Committee on 
the Judiciary, like the Committee on Energy and Commerce and the 
Committee on Education and the Workforce, has elected not to hold a 
hearing or markup on this legislation and has allowed it to proceed for 
consideration by the full House. The Committee's deferral of action 
should not be interpreted as any lack of jurisdiction over or interest 
in H.R. 1463.
  The primary purpose of the bill is to establish a compensation 
program for emergency personnel directed to receive smallpox vaccines 
pursuant to authorities granted by the 107th Congress in legislation 
establishing a Department of Homeland Security. This new program is to 
be established under the Public Health Service Act and is to be under 
the direction and control of the Secretary of Health and Human 
Services. The bulk of the provisions in Section 2 of H.R. 1463 
dedicated to establishing the new compensation program are outside the 
scope of the Judiciary Committee's jurisdiction.
  However, H.R. 1463 also contains provisions related to judicial 
review of determinations made by the Secretary of HHS under the Act and 
provisions modifying existing statutes concerning the liability of the 
United States and remedies available under the Federal Tort Claims Act 
(Chapter 171 and section 1346(b) of Title 28 United States Code) for 
covered persons suffering injury resulting from smallpox vaccinations. 
These provisions are clearly within the Rule X jurisdiction of the 
Committee on the Judiciary.
  For example, Section 2 of H.R. _ adds new provisions titled ``(e) 
Review of Determination''

[[Page 7877]]

that affects the role of the courts and established review procedures 
mandated by the Administrative Procedures Act--both within the 
Committee's jurisdiction. Furthermore, Section 3 of H.R. 1463 amends 42 
U.S.C. Sec. 233(p) to assume liability for the government relative to a 
new category of acts and omissions by those acting within the scope of 
their duties as part of the smallpox vaccination program. Section 3 of 
the bill also modifies the requirements for exhaustion of remedies, 
statute of limitations, offsets, and exclusivity of relief available 
for tort claims in federal district courts arising from smallpox 
vaccinations administered under a declaration by the Secretary of HHS. 
These provisions of H.R. 1463 are also clearly within the Rule X 
jurisdiction of the Committee on the Judiciary.
  If the Committee on the Judiciary had the luxury of unlimited time, 
we would certainly seek the normal referral of H.R. 1463 to examine 
these and other provisions further and consider any appropriate 
changes. However, as I stated earlier, the Administration has pleaded 
the need for swift passage and implementation of this new compensation 
program to encourage necessary smallpox vaccinations. The 
Administration and many of my colleagues believe that the importance of 
these vaccinations to the security of our homeland against biological 
attack outweighs considerations about the normal legislative process in 
this case. I do not dispute that assessment, and therefore as Chairman 
of the Committee on the Judiciary I have agreed that this bill should 
move forward in an expedited fashion without the normal review by our 
Committee.
  Mr. UDALL of New Mexico. Mr. Speaker, I rise in opposition to the 
Small Pox Vaccination Compensation Fund Act.
  We should give pause about voting for a smallpox bill that does not 
safeguard the health, safety and livelihood of workers asked to 
volunteer for the smallpox vaccination. This bill is opposed is by a 
number of groups, including the International Association of Fire 
Fighters and the American Nurses Association.
  There has been a great reluctance among health care workers and first 
responders to risk the loss of health and income without an adequate 
safety net for themselves and their families. While the legislation is 
promised on the assumption that workers will be eligible for workers' 
compensation in the event of an injury, the reality is that, in most 
states, workers cannot depend on this. In fact, there are only 14 
states where it appears certain that claims for benefits will be 
honored by the state workers' compensation system.
  Therefore, workers who are permanently and totally disabled will be 
eligible only for this bill's maximum benefit of $262,100. This 
represents about five years' wages for the average nurse. For a worker 
who becomes partially disabled either temporarily or for life, the 
maximum benefit payable is only $50,000. If the aim of the legislation 
is to encourage workers to be vaccinated, this bill will not do the 
job. Workers will continue to be reluctant to be vaccinated in the 
absence of assurances that the economic security of their families will 
not be jeopardized.
  I also object to the bill's requirement that workers receive the 
vaccination within 120 days of the date regulations are issued. Any 
worker who is vaccinated under the Secretary's declaration must be 
eligible for federal compensation. It is punitive to deny compensation 
to a worker who participates at a late date.
  The legislation fails to ensure that the smallpox program will be 
carried out safely, in stark contrast to the program in place for 
military personnel. The bill does not establish any standards for 
ensuring that workers are properly educated and medically screened 
prior to volunteering for the vaccination. A careful program to screen 
out workers with contraindications will not only save lives, it will 
reduce the amount of federal money needed for compensation. The 
legislation also fails to include requirements for monitoring those who 
are vaccinated to catch adverse reactions before they develop into life 
threatening complications. There is also no funding for state and local 
public health departments to carry out the program safely.
  Another significant flaw in the bill is that funding for the 
compensation program is not mandatory. Workers who have lost their 
health and livelihood should not have to wage a fight for compensation 
each year during the appropriations process.
  The legislation also fails to include a table of injuries that 
ensures that workers will be awarded compensation quickly. After years 
of experience with the smallpox vaccine, there are injuries, that occur 
within specific timeframes, that are known to be caused by the vaccine. 
This schedule of injuries must be included to ensure that compensation 
will be quick and certain. Otherwise, workers cannot be certain before 
receiving the vaccine that the most likely serious injuries will 
qualify for compensation.
  Unfortuantely, but not surprisingly, the House Rules Committee has 
denied an opportunity for an alternative measure to be on the floor. 
Had the Capps-Waxman substitute been allowed, I would have supported 
it. In contrast to the proposal designed by the Bush administration and 
introduced by Representative Burr, the Capps-Waxman substitute includes 
measures to safeguard the health and safety of workers asked to 
volunteer for the smallpox vaccination program. Moreover, the Capps-
Waxman substitute better addresses the concerns of workers who fear 
that a serious injury or death from the smallpox vaccine would lead to 
economic catastrophe for themselves and their families. As a result, 
the Capps-Waxman substitute will provide for a safer and more effective 
smallpox vaccination program.
  The Burr legislation is deeply flawed and I urge my colleagues to 
oppose it.
  Mr. BURR. Mr. Speaker, this legislation, ``The Smallpox Emergency 
Personnel Protection Act,'' is another positive step towards preparing 
our citizens for a bioterrorist attack.
  For more than 2 years, I have been working on legislation to 
strengthen and build our nation's public health system. The first bill 
was signed into law in 2000 and established grant programs to address 
core public health capacity needs. The second bill was last year's 
bioterrorism legislation. In part, that legislation built on the grant 
structure created in 2000 and sent a significant amount of money to our 
public health infrastructure. That money is currently funding basic 
needs such as computers and Internet access for public health 
departments and more specific needs such as decontamination chambers. 
Needs that are essential for providing public health care services and 
critical for bioterrorism preparedness.
  On January 24 of this year, Secretary Tommy Thompson asked hospital 
workers, police officers, firefighters, and other public officials, to 
volunteer to receive the smallpox vaccination. Understandably, the 
reception was lukewarm. Nurses and physicians were concerned about the 
side effects of the vaccine and wanted to be compensated for any 
medical care or lost employment they incurred as a result of their 
vaccination. Hospitals were worried about liability. And public health 
departments were worried about the cost.
  In response, we have H.R. 1413. This legislation addresses the 
concerns of all of those individuals. We will now compensate vaccinated 
individuals for lost wages and medical expenses. Additionally, if they 
suffer a permanent disability, or, in the very unfortunate and unlikely 
case, death, we will give them the same amount of money that police 
officers and firefighters receive if killed in the line of duty. The 
legislation clarifies that if a vaccinated individual infects other 
individuals--they too are eligible for those benefits. Finally, the 
legislation amends the Homeland Security Act to ensure that hospitals, 
pharmacists, public health departments and any other involved 
individuals will not be liable for properly vaccinating people who then 
suffer adverse reactions.
  One very important point about this legislation is that it continues 
to give the Centers for Disease Control and Prevention, State and local 
health departments, and hospitals the flexibility they need to 
correctly vaccinate thousands of people. In light of the unfortunate 
situation in Maryland, concerns have been raised about vaccinating 
individuals with heart conditions. The CDC Director promptly responded 
by recommending that those individuals be screened out of the 
vaccination pool. We all want this program to be successful, and 
success depends on flexibility and Federal Government support when 
individuals suffer adverse reactions.
  Let me end by saying that I am extremely proud of North Carolina and 
its response to Secretary Thompson's request. Thus far 26 hospitals 
have vaccination plans, 875 individuals have been vaccinated, and many 
more have volunteered. I believe that this legislation will reassure 
all of the current and future vaccination recipients in North Carolina 
and around this country that the Federal Government wants this program 
to work and backs up our request through compensation benefits.
  Ms. PELOSI. Mr. Speaker, I had hoped to come to the Floor today with 
a bill I could recommend to my colleagues on both sides of the aisle.
  We had been working together, over the past few days, in serious 
negotiations over what would be required of a vaccine program in order 
for our nurses and first responders to feel secure enough to put their 
health, their lives, and their livelihoods on the line by taking a 
smallpox vaccination.
  There was progress on some features that are reflected in this bill. 
We are grateful for that.

[[Page 7878]]

  But unfortunately, those talks broke down last week and we find 
ourselves instead in a process that restricts our discussion of this 
issue and does not allow us to consider a Democratic alternative--
proposed by colleagues Lois Capps and Henry Waxman--that is based on 
the recommendations of the nurses, the firefighters, the police, the 
emergency medical technicians, and other first responders.
  They are being asked to step forward and take a vaccination that has 
the potential for dangerous side effects--including the possibility of 
death.
  Make no mistake about it. The votes that count are not the votes that 
we will cast here in this body. The votes that count are the votes of 
those men and women who are nurses, medical workers, firefighters, 
EMTs, police officers, and others who will go to the state health 
department and roll up their sleeves and take a risk to help improve 
the nation's prepareness against terrorist attack.
  These are not people who avoid risk. They take risks almost every 
day. You know who they are. They are the caregivers who tend to the 
sick, rescue the victims, and walk the streets to make us safer.
  They are the night-duty emergency room nurses who crawled through the 
rubble of the Federal Building in Oklahoma City to try to find 
someone--anyone--who was still alive.
  They are the firefighters who ran up the stairs instead of down the 
stairs in the World Trade Center to help the last of the people trapped 
in that horrific nightmare to escape.
  They are the police officers who walk the beat every day and who risk 
their lives to keep us safe.
  They are also mothers and fathers, caregivers for elderly parents, 
and breadwinners for their families. And they have a very human and 
understandable desire to protect their families in case something goes 
wrong.
  It is an unfortunate fact that some of the people who will take the 
smallpox vaccine will suffer serious adverse effects that could cause 
them to be unable to continue their current job, see their pay reduced 
or--if they were to become totally and permanently disabled--lose the 
ability to work altogether.
  They could even lose their lives. We have all seen the news reports 
of the National Guardsman, the nurse's aide in Florida, and the nurse 
on the Eastern Shore of Maryland. Each of them received the vaccine, 
but then later died of cardiac arrest.
  We don't know, yet, whether there is a direct link between the 
smallpox vaccine and these heart problems. The Centers for Disease 
Control have not been able to definitively rule a connection in or out.
  But the CDC has now recommended that anyone who has a known heart 
ailment not receive the smallpox vaccination.
  And New York State and Illinois--as well as a number of 
municipalities--have temporarily suspended any further vaccinations 
until there is a more thorough investigation.
  The bottom line is, whether any connection is proven between the 
smallpox vaccine and heart disease, there will ultimately be injuries 
and deaths from the vaccine. There is no question of that.
  The choice of whether to get vaccinated is up to the nurses and the 
other first responders themselves based, in part, on the adequacy of 
the vaccine program we provide for them.
  That is why we believe an adequate smallpox vaccine compensation 
package has to have a clear education component so that the health care 
workers and other first responders will know what the most likely side 
effects will be and what the effects could be on their families.
  Legislation of this kind should have the strongest possible pre-
screening program based upon the most up-to-date information.
  It should have an aggressive monitoring program so that health 
experts can follow up the vaccinations and look out for patterns of 
adverse reactions so we can adjust the pre-screening program.
  And it should provide a level of financial security so those who take 
the vaccination can be assured that their families will receive 
compensation if they become disabled or lose their lives protecting 
Americans from the horrific effects of a terrorist-sponsored smallpox 
attack.
  The Republican bill falls short on each of these counts.
  There is a better way. We can defeat this bill under the suspension 
of the rules. We can go back to the negotiating table or we can bring a 
new bill to the Floor with a substitute amendment that the nurses and 
first responders say will truly respond to their concerns.
  My colleagues, I urge you to defeat the Burr bill today. Let us have 
a vote on the Capps-Waxman proposal that will better protect our public 
servants--our heroes and our heroines--and better produce the desired 
effect of having more frontline workers inoculated against a smallpox 
attack.
  Mr. Speaker, I urge a ``no'' vote on the Republican bill.
  Mr. DINGELL. Mr. Speaker, I join the millions of our Nation's first 
responders in opposition to H.R. 1463, the Smallpox Emergency Personnel 
Protection Act of 2003.'' Right after we defeat this bill, I hope that 
we set about the task of crafting bipartisan legislation that all 
members of the House can support. The very people this bill purports to 
help--nurses, EMTs, police officers, firefighters--find this hastily 
crafted legislation lacking. Why? Because it fails to address their 
very significant concerns.
  Mr. Speaker, we are voting on smallpox vaccine injury legislation 
today because the Administration's current vaccine program is not 
working. Only a fraction of the number of first responders that the 
Administration has said are needed to protect us have volunteered to 
take the smallpox vaccine. The Administration has recommended that as 
many as ten million first responders be vaccinated for smallpox so that 
if we ever are attacked by the use of smallpox we will have a core 
capacity of health care and emergency personnel vaccinated and able to 
take appropriate action right away. The latest numbers from CDC 
indicate that less than 26,000 of them have been vaccinated. Why so 
few? Because the vaccination carries with it substantial risks, 
including adverse affects that could cause disability and, in some 
cases, death.
  Proponents of H.R. 1463 will make much of what they think that bill 
does. I ask you to focus on what it lacks. H.R. 1463 does not do enough 
to ensure adequate screening and education and otherwise prevent 
adverse events from happening in the first place. In the event that 
tragedy strikes and someone is injured or killed by the vaccine, H.R. 
1463 does not make adequate provision for lost wages. And, what H.R. 
1463 lacks is support from the people to whom it is intended to appeal. 
H.R. 1463 is opposed by the American Public Health Association, the 
International Union of Police Associations, the American Nurses 
Association, the International Association of Fire Fighters, the 
American Federation of Teachers, the American Federation of State, 
County, and Municipal Employees, the Service Employees International 
Union, and the Infectious Disease Society of America.
  Finally, Mr. Speaker, we are all aware of accounts of three deaths in 
the last week or so from cardiac arrest in persons who received the 
smallpox vaccine. Health care officials cannot positively rule out the 
smallpox vaccine as the cause or a contributing factor in these deaths. 
The CDC has taken swift action to revise its guidelines and has 
indicated that there may be further revisions. These uncertainties 
about the known, and I hasten to add the unknown, risks of the smallpox 
vaccine have greatly increased the fear factor among prospective 
vaccinees. We should be doing all we can to obtain and assess the 
relevant information on the vaccine and smallpox risks. That cannot be 
done by using the process by which this bill is before us today. We 
have had no hearings, no markups, and no opportunity to perfect this 
bill on the floor with amendments. All we have is the administration's 
proposal and a take it or leave it procedure.
  I recommend that we listen to our first responders, vote ``no'' on 
H.R. 1463, and get busy writing legislation we can all support.
  Mr. BROWN of Ohio. Mr. Speaker. This isn't, or shouldn't be, a 
partisan debate. Democrats and Republican members of Congress are in 
the same boat. The question we have to answer for ourselves is: do we 
vote ``yes'' to a bad bill, or do we demand something better?
  The answer to that question is important. Critical protections for 
first responders and their families hang in the balance.
  H.R. 1463 is supposed to protect members of the police, the nation's 
nurses, our firefighters, and other first responders who voluntarily 
receive a smallpox vaccine, and sustain an injury from that vaccine.
  But the Nation's first responders oppose this bill. This bill is 
supposed to increase the number of first responders who voluntarily 
receive a smallpox vaccine.
  But the bioterrorism experts who helped put together the smallpox 
vaccine program say H.R. 1463 won't work. It won't improve 
participation rates.
  So the choice both Republican and Democrat members of Congress face 
is whether to dismiss the concerns of first responders, ignore the 
advice of bioterrorism experts, and vote for this bill anyway.
  Have members of Congress become so far removed from the people we 
represent that we would pass a bill opposed by the very men and women 
it is supposed to protect?
  Do we in Congress really think we know better than bioterrorism 
experts when it comes to bioterrorism preparedness?

[[Page 7879]]

  Protecting first responders and their families in the event of a 
vaccine injury and bolstering vaccine participation rates are important 
objectives.
  They are time-sensitive objectives. The National Smallpox Vaccination 
program is already underway, and participation is lagging far behind 
goal.
  About 25,000 people have been vaccinated, less than 5 percent of the 
March 1 benchmark. The experts tell us H.R. 1463 won't jumpstart the 
smallpox vaccine program, so it won't enhance bioterrorism 
preparedness.
  Congress must now waste valuable time enacting the wrong bill, 
particularly when our nation's ability to respond to bioterrorism is at 
stake.
  Nor should members of either side of the aisle support legislation 
that is unapol-
ogetically dismissive of the very people this bill alleges to protect . 
. . the nurses, firefighters, police, and others who voluntarily place 
themselves at risk on our behalf.
  Public health experts and first responders tell us that H.R. 1463 
falls short in fundamental ways.
  To meet the goals of efficiency, timeliness, fairness, and program 
integrity, the compensation program must be backed by an injury table. 
H.R. 1463 lacks one.
  Responsible administration of any vaccination program requires 
education, pre-screening and surveillance. H.R. 1463 requires these 
activities, but doesn't fund them.
  A lynchpin in any compensation program is guaranteed funding. Without 
it, financial protection is a possibility, not a promise. There''s no 
security in that. And there is no guaranteed funding in H.R. 1463.
  The incidence of smallpox vaccine injury is rare. However, in the 
event a serious injury occurs, volunteers may be out of work for an 
extended period or permanently. First responder volunteers, and their 
families, must be assured adequate and continuing financial protection.
  H.R. 1463 would cap funding so that wage replacement would run out 
after about five years. For permanent disability or death. 
``Inadequate'' doesn't begin to describe it. ``Insulting'' is closer to 
the mark.
  H.R. 1463 is not a legitimate financial safeguard. It's a placebo. 
Our nurses, firefighters, EMTs, and other first responders deserve 
better.
  Mr. TAUZIN. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Petri). The question is on the motion 
offered by the gentleman from Louisiana (Mr. Tauzin) that the House 
suspend the rules and pass the bill, H.R. 1463.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of 
those present have voted in the affirmative.
  Mrs. CAPPS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

                          ____________________