From The Bloviator, public health policy researcher, blogger, and blogcritic.

The CDC recently released its smallpox vaccination clinic guidelines, which offer voluntary vaccination at the first sign of an outbreak, but not before. Many in the Blogosphere have wondered why the government will not give the public pre-exposure access to the shots. A little lesson in recent political and public health history gives us great insight into the process:

One of the driving forces behind the hesitancy of the federal government to recommend more widespread access to the smallpox vaccination was the swine flu episode of 1976. On Friday, the 13th of February, 1976, a number of soldiers in training at Fort Dix, New Jersey, were reported to have fallen ill with influenza, with one of the recruits dying from the illness. Studies showed that several of those who had the flu symptoms appeared to have a similar virus strain to that which caused the Great Influenza Pandemic of 1918, which was responsible for 40 million deaths worldwide, including half a million in the U.S.. Media coverage was intense, predicting a similar catastrophe, and calling for access to vaccinations. The public health community, in association with the pharmaceutical industry, felt it could rise to the occasion and rapidly produce and distribute enough vaccines to meet the demand. The CDC, headed by director David Sencer and advised by a panel of immunization experts, recommended to President Ford that a mass immunization campaign take place. President Ford announced that every man, woman and child should be immunized against the threat of swine flu, and Congress quickly passed a $134 million appropriation to pay for the effort.

The feeling was that it was better to be safe than sorry: that getting everyone vaccinated, even if the risk to the entire population was vague or overstated, was the most prudent approach to the outbreak.

As one of the policymakers involved with the process indicated, there was also a dose of arrogance, heroic aspirations and envy on the part of the public health policymakers when coming to this decision. As Reuel Stallones of the University of Texas School of Public Health (one of the members of the CDC advisory panel) later wrote:

It was an opportunity to strike a blow for epidemiology in the interest of humanity. The rewards have gone overwhelmingly to molecular biology which doesn't do much for humanity. Epidemiology ranks low in the hierarchy - in the pecking order, the rewards system. Yet it holds the key to reducing lots of human suffering.

However, two large, interconnected roadblocks to implementing this policy were the issues of supply and liability. Insurance companies told the pharmaceutical companies that they would not cover injuries caused by the swine flu vaccine, which in turn jeopardized the vaccine supply. Congress responded by modifying the Tort Claims Act to promise that the government would underwrite any liability for problems arising out of the vaccination.

The plan rolled out on October 1, 1976, and free immunizations were made available to the public. Three elderly people in Pittsburgh died after receiving the vaccine. The media started its "body count" reporting. The President and his family, in an attempt to allay public fears, got shots on prime-time television.