Problems and Purpose

Prompted by the controversy over a possible relationship between vaccines and autism, and the lack of trust this dispute reflected between the federal Centers for Disease Control and Prevention and some segments of the public, an initiative began in 2001 to find ways the CDC could work productively with the public and, in so doing, build greater trust.

After reviewing the types of work conducted by the agency, the CDC determined that active public involvement in making policy about vaccines was the most suitable way to engage citizens. The CDC decided to take this approach because science policy decisions often involve difficult choices between competing values. Officials at the CDC who led this work came to believe that as the repository of our core public values, citizens are the ones who hold and best understand the values with which our policies should be aligned when making public policy decisions. As public opinion analyst Daniel Yankelovich noted, public engagement can help identify the “boundaries of political permission" in decisions about complex public policy. [1]

Background History and Context

An initial meeting was held at Wingspread in Racine Wisconsin in July, 2002. It consisted of an ad hoc group of approximately 40 stakeholders representing the full breadth of key interests around vaccines. A follow-up meeting was held in Denver in 2003. The Wingspread group developed a new model for engaging the public that included both citizens-at-large and representatives of stakeholder organizations, including the sponsoring governmental agency. The new model was piloted on a difficult, values-based national policy decision facing the CDC and its parent agency, the federal Department of Health and Human Services (HHS).

This first project was an inquiry into what the federal government should recommend to state and local health departments regarding who should be vaccinated first in a severe influenza pandemic when supplies of vaccine would likely be limited. The scenario to be considered involved difficult decisions about the need to ration life-saving treatment. This required a basic understanding of pandemic influenza and the weighing of equivalent or nearly equivalent values. Knowledge about influenza was essential but not sufficient for making the decision, thereby qualifying citizens to participate.

Conducted in 2005 as the “Public Engagement Pilot Project on Pandemic Influenza” or (PEPPPI), the project succeeded in providing a “proof of principle” that it is both possible and productive for a federal agency to engage the public in a values-oriented policy decision on health policy, and in this case, on vaccines.

Due to the success of the first project, a second project was commissioned in 2006 by the CDC's Coordinating Center for Infectious Diseases (CCID) on the question of which community control measures for pandemic influenza would be acceptable (e.g., closing schools in the early stages of a pandemic, asking sick people and their seemingly healthy contacts to stay at home, and cancelling football games and other mass events). Citizen participants in the project were informed that slowing the spread of the disease with control measures would decrease the odds of hospitals and other services being overwhelmed. The citizen participants were asked to weigh these potential benefits against disruptive social costs. 

Based on the early successes of these two projects, a series of seven other public engagement projects were organized by the CDC and/or HHS's National Vaccine Program Office (NVPO) from 2007 to 2009. Each project made use of or modified the new model of joint citizen and stakeholder public engagement that the agencies began to identify as a Decision-focused Public Engagement Table (DPET).

In the decade following the initial meeting at Wingspread, a total of nine projects were carried out, including two projects that focused on the question of who first to vaccinate in a pandemic. The project topics and titles were:

• The First Public Engagement Pilot Project on Pandemic Influenza Vaccine Priorities
• The Public Engagement Project on Community Control Measures for Pandemic Influenza
• A Federal Agency Public Engagement Project on Objectives and Prioritization Criteria
• The Second Public Engagement Project on Influenza Vaccine Priorities
• Use of Public and Stakeholder Engagements to Inform
• National Guidance on At-Risk Populations and Pandemic Influenza
• The Public Engagement Project on Setting Priorities for CDC Vaccine Safety Research
• The Public Engagement Six-State Demonstration Project
• Public Engagement on the National Vaccine Plan
• Public Engagement Project on the H1N1 Pandemic Influenza Plan

Organizing, Supporting, and Funding Entities

Participant Recruitment and Selection

Methods and Tools Used

What Went On: Process, Interaction, and Participation

Influence, Outcomes, and Effects

Analysis and Lessons Learned

See Also

References

[1} Yankelovich, D. (1991). Coming to public judgment: Making democracy work in a complex world. Syracuse, NY: Syracuse University Press.

External Links

Notes