In the year of its formal existence from March to March, the swine flu program chalked up numbers of accomplishments which give it weight historically. In these terms it may go down as a qualified success. More than 40 million civilians were inoculated, twice the number ever reached before in one flu season. A notable surveillance system was developed, better than anything before. A serious side-effect of influenza vaccination, Guillain-Barré syndrome, occasionally fatal, was tracked by that system and remains under investigation. A critical policy problem for all public health interventions and research, the problem of liability, was brought into sharp focus for the first time; it is now being addressed at policy levels both in HEW and in Congress. The flu as a disease and shots as a preventive were dramatized sufficiently so that a permanent program aimed at high risk groups is now in view. With that comes what the influenza specialists in public health have long desired, recognition for the flu alongside polio or measles among Federally-supported immunization initiatives.

While media attention focused on the troubles of the swine flu program—which were many—net effects on general public consciousness seem small. Possibly, indeed, they will turn out on balance to have been more positive than negative for public health. Swine flu may have a bad ring in public ears, but millions may have heard of flu shots for the first time. On this nobody has good information.

Yet to attentive publics in and near the Washington community, to doctors in the country’s schools of medicine and public health, to professionals in print and electronic journalism, to members of Congress and the Carter Administration, also to most members of the Ford Administration, the swine flu program was once widely seen and now is overwhelmingly recalled as a "fiasco," a "disaster," or a "tragedy."

More interesting still, it was and is a trauma to the government officials most involved and to their scientific advisers. A year and more later, cheeks flush, brows furrow, voices crack.

In February 1977, as the program waned, Secretary Califano asked us to review and reconstruct it in detail for his own education. His purpose was managerial. He sought lessons for the future useful to a man in his position. He had just authorized a limited resumption of the program through the rest of the flu season for the sake of high-risk groups. His position and its problems were vivid in his mind. Lessons were what he wanted, not a history; finger-pointing did not interest him in terms of last time; his concern was with next time.

Yet as he was aware, having read a comparable report by one of us done years ago for President Kennedy, we know no better way to draw most lessons than to tell the applicable portions of the story. We began with that bias. It was only reinforced when we discovered the persistence and pervasiveness of trauma. The lessons of this program, we believe, will be obscured for relative outsiders unless they understand why it had such profound effects, not on the country but rather on its own participants. That understanding is imparted best by a selective narrative.

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