services, and hoped that Federal grants could bring that up to 40 percent in one year’s time, to 60 percent later. These targets translated into dollar costs of $15 million for the first year, $20 million for the second and unspecified amounts thereafter.


Satisfied with this, Califano did not try to find the funds internally. Dollar trade-off offends doctors. He didn’t like it either. Instead, on February 16, he sent his people to the 0MB for a supplemental appropriation. The Administration had changed, but not the government: Zafra, still suspicious, was waiting to receive them. This time Zafra had available to him, alongside OMB in the Executive Office of the President, the Science Adviser's Office (formally the Office of Science and Technology Policy, OSTP), with an assistant director in health-related matters. The latter strengthened Zafra’s hand and sharpened budget questions, urging, among other things, that healthy people over 65 need not invariably be presumed high risks.


The OMB examiners thereupon recommended a still smaller program, and they wanted it absorbed without additional appropriations. The issue reached the Budget Director and Califano compromised (on paper). He got a program of his size but funded separately for only its first year; the second year costs were to be absorbed by PHS. This was agreed, Congress willing. OMB examiners assumed that Congress would be only too willing to undo the absorption scheme (trade-offs in public health were no more usual at the top of Capitol Hill than at the bottom). Thereupon the President included $15 million for the first year in a supplemental appropriation request. It went to Congress February 23.


At the same time, with 0MB clearance HEW asked Congress for a permanent authorization. This invoked the Kennedy and Rogers subcommittees. Their response turned out to be more problematical than the Administration had foreseen. The Rogers subcommittee was insistent on receiving first a version of the liability report for which it had been waiting since the previous September. The Kennedy subcommittee had some members scoffing at a program "… from the same folks who brought us swine flu." As we write, neither subcommittee has reported out a bill; appropriations are remote without one.


Still, two years after Sencer’s action-memorandum Califano has endorsed a long-term version of the “minimum response” Sencer rejected then. If Congress acts, influenza will have joined rubella, measles, polio, among continuing, accepted, Federal immunization initiatives. This offers a perspective on the swine flu story. At the least it indicates what CDC as learned.


It also shows what influenza specialists have gained. If Congress does not act the endorsement remains and flu is still a part of more agendas than before.



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