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The Swine Flu Affair: Decision-Making on a Slippery Disease
The day before, the President had pledged vaccine to everyone. A week later, Cooper, on the Hill, would state his goal as “95 percent of all Americans.” Hilleman’s discrepancy seems to have left Meyer untroubled.
On April 2, Sencer in Atlanta hosted a monster meeting to acquaint state health officials and representatives of private medicine with these targets (Congress willing) and with CDC’s conception of administrative follow-through based on state immunization plans. Prompt filing of these plans was sought by CDC. Funding and technical assistance were to follow. Vaccine distribution would begin as soon as field trials, tests and bottling allowed, and states should start at once to put it into people. Taking maximum advantage of the time at hand, the states now had a chance to immunize the country, or most of it, before the next flu season.
Here was a challenge for the Public Health officialdom from coast to coast, an opportunity to do in 1976 precisely what had not been done in 1968 or 1957—and at Federal expense with the President responsible. Energy and time and personnel might have to be withdrawn from other uses, to be sure, but not much money begged from any legislature except Congress, his trouble not theirs. Besides, there was the vision of the Kilbournes and the Coopers: Preventive medicine raised high in public consciousness. Who could be against that?
Actually, there seem to have been many persons present who, in some degree or other, feared the swine flu program either as a dubious diversion from less speculative ventures—measles, polio—or as a likely failure in the public mind, the opposite of Kilbourne's view, or worse as a presumptive danger to the public health because of unknown side effects, the Alexander worry. Jonathan Fielding, Massachusetts Commissioner of Public Health, told us that he remembers disagreeing:
I didn't favor a mass vaccination program because I thought the risk of an epidemic small and I didn't want to divert resources from other programs.
But Massachusetts had a long-standing feud with CDC and everybody knew it.
One Regional Director of the HEW who had come to the meeting with officials from “his” states wrote afterwards:
How certain are we that an epidemic or pandemic will occur? There is a recognition that this decision [to proceed] is based on probability. Yet the recommendation to go forward was not wholly persuasive.
How certain are we that this virus will be a “killer,” or possibly a “normal” virus resulting in relatively mild illness? The answer seems to be the latter …. This answer also relates to the relative lack of certainty that the epidemic-pandemic will occur, thus combining to weaken the threshold assertion to go forward with the program.
This might have been interesting before decision; coming after, it was taken as spectator sportsmanship.
Alexander, hearing of the meeting, wrote Sencer a tactful note: