A top federal official acknowledged Thursday that the smallpox vaccination program was off to a slow start, citing the unresolved issue of compensation for people harmed by the vaccine as well as confusion about the risk of a bioterrorism attack.

Federal officials had hoped states would vaccinate close to 500,000 health care workers in about a month, beginning in late January. Two weeks into the program, just 16 states have begun delivering inoculations. As of Wednesday, 687 people had been inoculated, mostly those who will vaccinate others.

The director of the Centers for Disease Control and Prevention said the program should not be measured by the number of people vaccinated or by how long it takes.

"Our goal is not achievement of a number. Our goal is achievement of a preparedness capacity," Dr. Julie Gerberding said. "We want the state and local health jurisdictions to implement this program as fast as they can but more importantly, as safely as they can."

Gerberding said the compensation issue has become a significant stumbling block. Based on historic data, a small number of people vaccinated will face life-threatening injuries, and federal officials acknowledge they need a way to offer compensation for lost wages and medical expenses.

Reimbursement for lost wages and medical expenses is now only available through the workers' compensation system, which has many holes.

Gerberding said the Bush administration is getting "closer and closer" to proposing a solution. An existing compensation fund helps people injured by other vaccines, but does not include smallpox.

State officials, hospitals and unions have expressed concerns about compensation, saying the issue is a barrier to recruiting people for the vaccination program.

At the same time, Gerberding said, many offered the vaccine are confused about the risk of that smallpox, which was eradicated in the 1970s, will return through bioterrorism. Federal officials have said there is no imminent threat, but a risk exists.

"That is not a very helpful parameter to people who are used to having very precise information," she said. "There is a great uncertainty about the probability of a smallpox attack."

In Charlotte, N.C., the Presbyterian Healthcare system is not participating, given the certain risk of the vaccine and the unknown risk of an attack, said spokesman Kevin McCarthy.

The hospital sees "no credible evidence of smallpox threat," he said. "Maybe if we were New York or Washington, D.C., maybe we would. We don't see the risk at this point."

In Atlanta, just two of seven metro trauma centers are participating, but that could change if the threat becomes better defined, said Dr. Kathleen Toomey, director of the Georgia Division of Public Health.

"If that intelligence changes, if there's more risk, all hospitals said they will reassess whether to get vaccinated," she said.

The vaccination program is being conducted by 50 states, the District of Columbia and three large cities - Los Angeles, New York and Chicago, as well as U.S. territories.

So far, vaccinations have begun in Colorado, Connecticut, Georgia, Iowa, Kentucky, Los Angeles County, New Hampshire, New Jersey, New York state, North Carolina, Pennsylvania, South Dakota, Tennessee, Vermont, Virginia and Wyoming.

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On the Net: CDC smallpox information: https://www.cdc.gov/smallpox

https://www.cdc.gov/smallpox