CDC National Vaccination Plan Is Flawed

This article originally appeared in the Atlantic Journal-Constitution on January 10, 2002.

The Bush administration’s response to a smallpox threat is a bad idea. It is an all-government-all-the-time approach that leaves citizens in the dark and denies them the opportunity to choose. Federal bureaucrats should not make such life-and-death decisions. Americans should be free to choose the smallpox vaccine if and when they want it.

The proposal, being pushed by the Centers for Disease Control (CDC), has several flaws. First, the administration would spend $428 million to buy 155 million doses of smallpox vaccine. Then the government would stockpile it in the event of a terrorist attack. If an outbreak occurs, the government would take strict measures against the population, including forced medical examination, forced vaccination, quarantine and destruction of property. Finally, people who refused to comply with the emergency measures would be subject to criminal penalties, and state police could enforce the measures at gunpoint.

That’s government—and that’s a bad idea.

But it gets worse. For the Department of Health and Human Services is pushing a similar plan: the “Model State Emergency Health Powers Act.” This top-down plan is a draconian move orchestrated by the lobbyists that represent the public health establishment. Among other bad things, it grants governors the authority to declare a state of emergency to deal with the threat of bio-terrorism in a harsh way. Because terms such as epidemic or infectious diseases are poorly defined, the plan would give a bureaucrat the ability to declare a state of emergency when it pleases him (flu, gastroenteritis, AIDS…), destroy property, and incarcerate people.

The measure also calls for information-exchange among doctors, pharmacists, and health organizations to place the population under surveillance between outbreaks. This would violate the doctor-patient privilege and one’s right to privacy. Unfortunately, this scheme is not the first attempt by health authorities to deprive individuals of their privacy. It seems that parts of the plan have been sitting on the administration’s shelves waiting for the right opportunity. The anthrax scare provided it.

Before indulging states’ hunger for new powers, we should ask why the CDC or HHS is unprepared to deal with smallpox despite a decade of warnings by D.A Henderson about how the use of smallpox as a biological weapon would cripple this country. (Henderson directed the World Health Organization’s successful global smallpox eradication campaign from 1966 to 1977.)

The CDC and HHS also disregarded reports about Iran and Iraq gaining access to a virulent strain of smallpox in the early 1970s to work on a weaponized form of the virus. One would think that because the United States lists Iran and Iraq as sponsors of international terrorism it should have induced some preparation from “public health” authorities. But it didn’t. Instead, the CDC was busy spending its $2.6 billion on policy pronouncements about seat belts, obesity, and gun control instead of focusing on potential epidemics.

But if the HHS proposal is troublesome, the administration’s plan to control the vaccine while waiting for an outbreak is questionable. Now, the government is stockpiling the vaccine and relying on health workers and the public to react calmly, quickly, and competently in case of an outbreak while a containment strategy is implemented. That means that even if everything works according to plan, people who were infected at the onset of the attack would die while they might have lived had they been previously vaccinated. Furthermore, if any step of the process fails, the number of casualties could rise unnecessarily.

Instead, the administration should make the smallpox vaccine available to the public. After being apprised of the risk of vaccination, people should be allowed to decide whether they want to be inoculated with the vaccine or want to take the risk not to be vaccinated in case of an outbreak. Also, letting people decide before the panic occurs allows doctors and patients to evaluate on a patient-by-patient basis the risk posed by the vaccine. Once the crisis is upon us, health authorities will be cranking out vaccinations without wondering who is likely to be killed by the vaccine.

According to an Associated Press poll, three-fifths of Americans said they would want a smallpox vaccination if it were available, despite health risks that include potential death. However, even if only 40 million people were vaccinated it would create “community immunity,” which would lower the rate of transmission of the disease. Also there would be 40 million fewer people to vaccinate in a crisis, without mentioning the fact that a well-vaccinated population is probably unattractive to bio-terrorists.

The HHS and CDC plans violate constitutional rights. They also provide no additional tools to fight bio-terrorism. The right approach is to make the vaccine available to the public and to let individuals and doctors, rather than public authorities, decide who should be vaccinated.

Veronique de Rugy is a policy analyst at the Cato Institute.