09 March 2003

Plans and Policy

It is Sunday. I slept late and turned on the coffee when the solar disc rose above the trees to the East. I checked the Blackberry Personal Data Assistant this morning and there was nothing new in the e-mail queue. Maybe the office takes Sundays off. My Boss said this would be a good weekend to relax. He smiled mysteriously, since things seem likely to be busy soon. We worked yesterday, which is to say that there were a couple issues to accommodate, and a major policy initiative to track. And the Boss got to move some of the paper that had piled up during the week of meetings.

We are approaching the Ides of March, and North Koreas may pop off a rocket and our forces are encircling Saddam, and the Iraqis seem to be feeling their oats, calling the President a Fascist, and Jimmy Carter is writing in the New York Times about our policy being the most disturbing change in a couple years. Plans and policy, that's us.

Whatever else happens, my first week in the office witnessed a major initiative being placed on the policy table. I have found that you date things in this town by what policy soap bubble is floating by at the moment. This first one I saw in my new capacity was the President's smallpox vaccination initiative. It was the culmination of a Policy Coordinating Committee action that has been going on for a year or more. I was part of the early PCC meetings last year regarding Disaster Response and what we were going to do against the host of terrorist threats.

Smallpox was one of the issues. The question was deceptively simple, as are all of these issues. Smallpox was eliminated as a disease in the world twenty years ago. Only the US and the Russians maintained any stock of the germs, and the international vaccination program had been terminated. Even before the Global War on Terrorism, there had been an attempt to vaccinate the Armed Forces, just in case they had to confront infected people overseas. But there was a problem. While small, there was a statistically significant chance that the vaccination could cause a reaction severe enough to kill a small number of people. One of those damned-if-you-do, damned-if-you-don't deals.

In the first iteration of the vaccination program some of the Air Force Reserve pilots refused to participate, saying there were potential side-effects that would get them fired from their civilian jobs as airline pilots. With the post 9-11 environment, those objections largely went away, at least for the military. Since smallpox could be unleashed easily as a weapon, and the consequences were so grave, even the pilots basically shut up and got with the program. But any larger initiative to protect America as a whole had the same sort of issues the pilots had, plus politics. Fear, uncertainty, Unions.

The way things work here, Issues require formation of a Policy to accommodate Concerns and gain Consensus. That sometimes results in Legislation, or sometimes a Policy Debacle.

To avoid the last, the current process was carefully coordinated through my new office under the capable hands of my new Boss, the Assistant Secretary, It was worked through the Interagency process and through the Department's General Counsel and Deputy and the Chief of Staff. They decided to build on an existing program-of-record was a good model. They chose the Public Safety Officer's Program, which is administered through Justice to provide a safety net for law-enforcement and fire personnel who are injured or killed in the line of duty. The PSOP gives a cop or a fireman up to $266,200 if he/she is disabled, and another $266,100 to their families if they die. It is an odd number, but there is a reason. It started at an even quarter-million but inflation has caused it to increase. All good programs include an allowance for inflation. The smallpox version of the PSOP is targeted to protect public health professionals, there is another (up to) $50K for lost wages after the state-mandated five-day waiting period derived from local Workman's Compensation rules.

The program is supposed to include everyone who may get infected as a result of contact with someone covered in Phase One of the vaccination program, that is, emergency hospital workers who would do inoculations in case of emergency. They had talked about a half-million people covered by Phase One, and the response had been slow, with only around 13,000 actually vaccinated. Phase Two covers the first responders, cops and firemen and emergency medical crews, and Phase Three is inoculation of the general public.

This being Washington, of course there is a political subtext to this. That wrinkle is that some of the Unions and other fellow-travelers have decided to oppose the vaccination program as an antiwar position. I will grant that the two are related, but each stand quite well on their own. Not going to war in Iraq does not equal no attack on the US with smallpox. But politics on the national stage are often just shorthand for something else.

I was in the room last week when the grownups held a phone teleconference with the State Health Directors. The politics of it is that people are not as concerned about the dangers of the vaccine (It is small but real) so I looked it up and it is something we used to take as a matter of course. Those of us of a certain age had the smallpox vaccination when we were babies. I checked my records the other day. I got a booster in 1977 before going overseas, and that was just around the time the disease was eradicated in the wild.

You might want to check your records. They tell me there may be some residual protection from our earlier inoculations so long ago. Then there may not be any benefit left, so I wouldn't count on it.

If there is an outbreak anywhere, the Government will quickly move to combine all three phases into one. It will be fast and it will be frantic. The last outbreak that happened in 1947 resulted in the vaccination of 4.7 million people in New York City.

Anyhow, that is what I am doing for a living now, or rather, I am going to meetings about things like that. I am exulting in the weather. It is already in the sixties, shorts weather here. I do not think I will address any policy issues today. Perhaps I will run some errands to address personal concerns, and I think I may very well do them with the top down on my freshly washed car.

Anyhow, that is my plan. But being a graduate of the War College, I also know that no plan survives first contact with the enemy. Time's winged chariot is on my heels, as the poem says, and after I take care of my sons college educations, there are things I want to do.

I have a policy on that, and hope to achieve general consensus on the issue.