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The Swine Flu Affair: Decision-Making on a Slippery Disease
assembled again, discussed again, and adjourned, leaving the reports to work their way to agency or congressional action.
Cooper was ten weeks gone by the time of the April Conference, but Califano showed up full of expressed interest. This gained immediate approval followed by drawn-out disappointment. Califano’s staff work at the time had not sufficed to count the cost of his expressiveness. He had already announced his immunization initiatives for children, incidentally over-promising in Cooper’s wake. Now he went to this affair to demonstrate how much the general subject mattered to him and how differently he felt about such departmental doings than had Mathews, the phantom. But soon enough, staff found they disagreed with many portions of those working group reports. Califano was more than willing to hold still. At lower levels this appeared erratic.
Three of the six reports had featured a proposal eagerly accepted by most conferees, a National Immunization Commission or Policy Council. This was an adaptation of the Kennedy idea. Its authors meant to substitute for both the old ACIP and Califano-like ad hoc-ery a permanent body at the apex of decision-making:
The commission should have the responsibility for reviewing and advising the Secretary on all matters concerning immunization policies, priorities, and practices as they may affect the public health of the United States…. continuing awareness of the effectiveness, safety, need for the availability of existing … and additional vaccines…. stimulation and support of … research … training of personnel … public and professional education…. judgment of the need for public vaccination campaigns; review of the present system of vaccine administration, both public and private; and provision of long range support of programs to assure adequate immunization levels of the population ….33
Many persons had combined to produce this proposal. Among them was Salk, for reasons running back to his original agenda of a year before. His interest was well known to Kennedy through Dr. Lawrence Horowitz, a subcommittee staffer. And the work groups that proposed it represented other interests too, ranging from the professors, researchers, and consumers who might sit on it to the three agencies whose stabilized relationships had barely been defense enough against recent upheavals: CDC, BoB and NIAID. A National Commission could be counted on to spread stability one and two levels up, easing the way for them.
Two difficulties strike us but were not voiced at the Conference and perhaps struck no one there. One difficulty is that along with stability a body of this sort would also bring, in time, its members’ own agendas and their mutual accommodations, turning into but another agency among the many predisposed in given ways. Its predispositions almost surely would include a growing role for federal immunization. They also almost surely would reflect the preferences of staff, and staffers more than likely would be drawn from the three agencies below: CDC, BoB and NIAID. Even if the higher level body had a wholly separate staff, it could not help but seek to bargain with those three for positions they could advocate together.
To lose ad hoc-ery for that strikes us as a poor bargain.