A contemporary analysis of the smallpox vaccination program
The terrorist events of Fall 2001, forced Americans to examine their vulnerability to terrorism. Agencies began reviewing and devising plans for preparation and response to potential bioterrorist threats. A policy response to smallpox, a serious bioterrorist agent was the national voluntary vaccination program announced by President George W. Bush in December 2002. The response to the smallpox vaccination program fell short of the original goals and expectations.
The purpose of this case study research was to explore why the smallpox vaccination program fell short by examining the policymaking process and identifying the factors contributing to this outcome. The policy models by Kingdon and Longest provide the framework to examine the policymaking process and served as an organizing framework for the coded data. This case study was limited in time from June 2001 to December 2003 and included the policy windows opened by the events of Fall 2001 and the Iraq war. This case study research incorporated field notes, documents, and interviews from 26 selected key participants.
Results of this case study research concluded that the smallpox vaccination program was a top-down policy that failed to include key partners in policy formulation. This policy represented a unique intersection of public health and national security. Study participants cited lack of compensation, poor communication, and lack of clear objectives as major barriers to the program. Interest groups and organizations, especially nursing, had a profound effect on the program response as issues, such as the lack of a compensation plan, were not answered or addressed to their satisfaction.
The program response fell far short of the original goal of vaccinating 500,000 health care workers in the initial phase with approximately 39,000 vaccinated. However, the data supported that despite the outcome there was movement toward development of a program of smallpox preparedness. This case study which included national security as well as public health threats can provide an instrumental example for future bioterrorism policy formulation. Nursing and public health experts need to be an ongoing part of the policy process to effect change and improve our national security and health.