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Historically, vaccination policy has been administered by local authorities. This reflected the public health responsibilities and powers as set out by Victorian Public Health Acts and arrangements dating back to before the modern era. But while local authorities technically had the power to use vaccines not yet recommended by central government - such as the use of diphtheria immunisation before 1940 - in reality they often did not due to resource constraints and the personal priorities of individual Medical Officers of Health.

Some local authorities in the United Kingdom provided smallpox variolation by inoculation free of charge. The success of these policies is disputed, but these were the forerunners of later vaccination policy.

Local authorities were required to offer Smallpox vaccination free of charge by the Vaccination Act 1840. Variolation was banned. Vaccination of children was made compulsory in 1853. Although punishments were made more stringent in subsequent Acts, by the later years of the nineteenth century public resistance to compulsion (combined with declining rates of smallpox) led to a re-evaluation of policy. The Royal Commission recommended that compulsion be relaxed; and in the Vaccination Act 1898, conscientious objectors were given the ability to opt out of the procedure. This effectively ended compulsion, although the Vaccination Acts were not repealed until the National Health Service Act 1946 came into force in 1948.

Since 1963, the Joint Committee on Vaccination and Immunisation (JCVI) has advised the British health authorities on