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The Swine Flu Affair: Decision-Making on a Slippery Disease
oping Guillain-Barré syndrome seemed to be eleven times greater with vaccination than without. But the risk was still remote, about 1 in 105,000, and the risk of death but 1 in 2 million.
On January 14, the ACIP recommended limited resumption of the swine flu program so that the Victoria vaccine locked up in bivalent doses could be made available again to high risk groups. Sencer promptly sent this on to Cooper who responded with questions. These Sencer pursued in a telephone poll of the states. Almost all said they would make bivalent vaccine readily available for high risk groups, two-thirds said they also would make monovalent available; only a few were prepared to consider resuming an active public campaign. Short of a campaign the estimated cost of restarting the program was only $15-30,000, the cost of printing new consent forms.
On January 17 Sencer reported back. Cooper now expressed his personal agreement but refused to act. The new Administration was but three days off; leave it to them. There was no hurry. Swine flu epidemic nowhere in the world, Victoria nowhere in America.
Twelve days later, Victoria flu erupted in a nursing home in Miami, Florida. Califano now faced the decision Cooper had put off. There was no one else to face it. Improvising as he went, advised mainly by Fredrickson and Dr. David Hamburg, head of the Institute of Medicine, the Secretary settled on a straightforward procedure. First, Sencer's recommendation and the work behind it would be set before an ad hoc advisory group of broader character and less commitment than the ACIP, and with prestigious chairmen from outside the flu establishment. The deliberations of the group would be both covered by the press and open to the public (which in Washington means organizations) and there would be time for comment from the audience. Califano would appear himself and hear as much as he could. Then, the group would draw conclusions and present them to him for his own decision.
While Fredrickson and Hamburg put together the group’s membership, Califano wrote Carter, apprised him of the problem, and explained the procedure. Members of the old ACIP would be included.
But in light of the controversy surrounding the immunization program, I will ask other experts to join the special advisory group so that we will have as broad and objective a base as possible under the circumstances. The group will be led by two of our nation’s most distinguished scientists. Dr. John Knowles and Dr. Ivan Bennett.28
Knowles was President of the Rockefeller Foundation and Bennett the Dean of New York University Medical Center. Califano had recruited them himself.
Thus the White House was at once informed and kept away. This was not to be a presidential decision. The new President was evidently satisfied. As for the new staff, they and Califano had divergent views on many things, but not on this.
Califano’s special group met Monday, February 7, for an all-day session in the conference room on the 8th floor of HEW’s new headquarters, since named for Hubert